消瘀接骨散外敷治疗早中期膝骨关节炎30例临床研究
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摘要
目的观察消瘀接骨散外敷治疗早中期膝骨关节炎的临床疗效。方法将60例膝骨关节炎患者随机分成观察组(外敷消瘀接骨散)和对照组(口服塞来昔布胶囊),每组30例。治疗2周后连续随访12周,比较两组临床疗效,观察治疗前后血沉(erythrocyte sedimentation rate,ESR)、碱性磷酸酶(alkaline phosphatase,ALP)、高敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、血小板(platelet,PLT)及疼痛视觉模拟评分(visual analogue scale,VAS)、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario McMaster University Osteoarthritis Index,WOMAC)、骨关节炎的严重程度指数(Lequesne MG)、膝关节活动度变化情况。结果观察组临床疗效优于对照组,但两组临床疗效的分布比较,差异无统计学意义(P>0.05)。观察组治疗后hs-CRP、ALP、PLT较治疗前显著降低,差异均有统计学意义(P<0.05);观察组PLT降低值显著大于对照组(P<0.05)。两组患者治疗后WOMAC、VAS、Lequesne MG评分均较治疗前显著降低(P<0.05),膝关节活动度较治疗前显著增加(P<0.05);与治疗2周末比较,两组患者随访时WOMAC、VAS、Lequesne MG评分均无明显变化(P>0.05),但膝关节活动度显著增加(P<0.05)。治疗2周末和随访时,观察组患者WOMAC、VAS、Lequesne MG评分显著低于对照组(P<0.05);治疗2周末,观察组患者膝关节活动度显著大于对照组(P<0.05);随访时,两组患者膝关节活动度比较,差异无统计学意义(P>0.05)。结论消瘀接骨散外敷治疗轻中度膝骨关节炎可显著改善临床症状和膝关节功能,提高患者生活质量。
Objective To investigate the clinical effect of external application of Xiaoyu Jiegu Powder in the treatment of early-to-mid knee osteoarthritis.Methods A total of 60 patients with knee osteoarthritis were randomly divided into observation group(treated with external application of Xiaoyu Jiegu Powder)and control group(treated with oral celecoxib capsules),with 30 patients in each group.The patients were followed up for 12 weeks after 2 weeks of treatment,and the two groups were compared in terms of clinical outcome and the changes in related indices after treatment,including erythrocyte sedimentation rate(ESR),alkaline phosphatase(ALP),hypersensitive C-reactive protein(hs-CRP),platelet count(PLT),Visual Analogue Scale(VAS)score,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),and Lequesne MG score for the severity of osteoarthritis.Results The observation group had a better clinical outcome than the control group,and there was no significant difference in the distribution of clinical outcomes between the two groups(P>0.05).The observation group had significant reductions in hs-CRP,ALP,and PLT after treatment(P<0.05),and the observation group had a significantly greater reduction in PLT than the control group(P<0.05).Both groups had significant reductions in WOMAC,VAS,and Lequesne MG scores and a significant increase in the range of motion of the knee joint after treatment(P<0.05).There were no significant changes in WOMAC,VAS,and Lequesne MG scores from the end of the 2-week treatment to follow-up(P>0.05),but there was a significant increase in the range of motion of the knee joint(P<0.05).At the end of the 2-week treatment and during follow-up,the observation group had significantly lower WOMAC,VAS,and Lequesne MG scores than the control group(P<0.05);at the end of the 2-week treatment,the observation group had a significantly higher range of motion of the knee joint than the control group(P<0.05);during follow-up,there was no significant difference in the range of motion of the knee joint between the two groups(P>0.05).Conclusion External application of Xiaoyu Jiegu Powder has a good clinical effect in the treatment of early-to-mid knee osteoarthritis and can significantly improve clinical symptoms,knee function,and patients'quality of life.
Objective To investigate the clinical effect of external application of Xiaoyu Jiegu Powder in the treatment of early-to-mid knee osteoarthritis.Methods A total of 60 patients with knee osteoarthritis were randomly divided into observation group(treated with external application of Xiaoyu Jiegu Powder)and control group(treated with oral celecoxib capsules),with 30 patients in each group.The patients were followed up for 12 weeks after 2 weeks of treatment,and the two groups were compared in terms of clinical outcome and the changes in related indices after treatment,including erythrocyte sedimentation rate(ESR),alkaline phosphatase(ALP),hypersensitive C-reactive protein(hs-CRP),platelet count(PLT),Visual Analogue Scale(VAS)score,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),and Lequesne MG score for the severity of osteoarthritis.Results The observation group had a better clinical outcome than the control group,and there was no significant difference in the distribution of clinical outcomes between the two groups(P>0.05).The observation group had significant reductions in hs-CRP,ALP,and PLT after treatment(P<0.05),and the observation group had a significantly greater reduction in PLT than the control group(P<0.05).Both groups had significant reductions in WOMAC,VAS,and Lequesne MG scores and a significant increase in the range of motion of the knee joint after treatment(P<0.05).There were no significant changes in WOMAC,VAS,and Lequesne MG scores from the end of the 2-week treatment to follow-up(P>0.05),but there was a significant increase in the range of motion of the knee joint(P<0.05).At the end of the 2-week treatment and during follow-up,the observation group had significantly lower WOMAC,VAS,and Lequesne MG scores than the control group(P<0.05);at the end of the 2-week treatment,the observation group had a significantly higher range of motion of the knee joint than the control group(P<0.05);during follow-up,there was no significant difference in the range of motion of the knee joint between the two groups(P>0.05).Conclusion External application of Xiaoyu Jiegu Powder has a good clinical effect in the treatment of early-to-mid knee osteoarthritis and can significantly improve clinical symptoms,knee function,and patients'quality of life.
引文
[1]中国中医药研究促进会骨科专业委员会,中国中西医结合学会骨伤科专业委员会关节工作委员会.膝骨关节炎中医诊疗专家共识(2015年版)[J].中医正骨,2015,27(7):4-5.
[2]BELLAMY N,BUCHANAN W W,Goldsmith C H,et al.Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee[J].J Rheumatol,1988,15(12):1833-1840.
[3]LEQUESNE M G,SAMSON M.Indices of severity in osteoarthritis for weight bearing joints[J].J Rheumatol Suppl,1991(27):16-18.
[4]陈园桃.中医病证诊疗常规[M].南京:东南大学出版社,2008.
[5]周正新,丁锷,李保泉,等.消瘀接骨散对骨折愈合相关血生化指标的影响[J].中国骨伤,1998,11(1):19-21.
[6]周正新,丁锷,李保泉,等.消瘀接骨散对骨折肢体血液循环的影响及其与骨折愈合的关系[J].中医正骨,1997,9(4):5-7.
[7]江树连,丁锷,李保泉,等.消瘀接骨散促进骨折愈合的实验研究[J].中国骨伤,2000,13(12):720-721.
[8]陈斌,丁锷,李保泉,等.手法整复治疗Colles骨折合并舟骨骨折9例[J].安徽中医学院学报,2001,20(2):23-24.
[9]万磊,刘健,黄传兵,等.消瘀接骨散对骨关节炎患者血瘀指标及NF-κB/RelA通路的影响[J].中国中西医结合杂志,2018,38(6):646-650.
[10]陈婷,宿树兰,段金廒,等.乳香-没药配伍前后化学成分溶出变化及其对LPS-诱导的巨噬细胞产生NO的影响[J].中国中药杂志,2013,38(2):179-185.
[11]刘英波,潘年松,莫应明.天南星的毒性认识及防治研究[J].井冈山大学学报(自然科学版),2015,36(3):99-103.
[12]张历元,李元文,林欢儿,等.中药冰片的商品种类与现代药理学研究进展[J].世界中医药,2018,13(4):1025-1030.
[13]章寅,许丁锐,王峰,等.消瘀接骨散对兔膝骨关节炎模型关节液中IL-1p、TNF-α、TGF-β1表达的影响[J].中医药临床杂志,2015,27(12):1726-1728.
[14]李本扬,王峰,梁文武.消瘀接骨散对兔膝骨关节炎模型关节液中MMP-1、MMP-3表达的影响[J].安徽中医药大学学报,2015,34(6):66-69.
[15]宋燕,朋汤义,冉姗,等.消瘀接骨散超高液相色谱指纹图谱研究[J].中国中医药信息杂志,2018,25(8):80-85.
[16]曹彭凯,王晓猛,白伟侠,等.2018年版《骨关节炎诊疗指南》解读[J].河北医科大学学报,2018,39(11):1241-1243.
[2]BELLAMY N,BUCHANAN W W,Goldsmith C H,et al.Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee[J].J Rheumatol,1988,15(12):1833-1840.
[3]LEQUESNE M G,SAMSON M.Indices of severity in osteoarthritis for weight bearing joints[J].J Rheumatol Suppl,1991(27):16-18.
[4]陈园桃.中医病证诊疗常规[M].南京:东南大学出版社,2008.
[5]周正新,丁锷,李保泉,等.消瘀接骨散对骨折愈合相关血生化指标的影响[J].中国骨伤,1998,11(1):19-21.
[6]周正新,丁锷,李保泉,等.消瘀接骨散对骨折肢体血液循环的影响及其与骨折愈合的关系[J].中医正骨,1997,9(4):5-7.
[7]江树连,丁锷,李保泉,等.消瘀接骨散促进骨折愈合的实验研究[J].中国骨伤,2000,13(12):720-721.
[8]陈斌,丁锷,李保泉,等.手法整复治疗Colles骨折合并舟骨骨折9例[J].安徽中医学院学报,2001,20(2):23-24.
[9]万磊,刘健,黄传兵,等.消瘀接骨散对骨关节炎患者血瘀指标及NF-κB/RelA通路的影响[J].中国中西医结合杂志,2018,38(6):646-650.
[10]陈婷,宿树兰,段金廒,等.乳香-没药配伍前后化学成分溶出变化及其对LPS-诱导的巨噬细胞产生NO的影响[J].中国中药杂志,2013,38(2):179-185.
[11]刘英波,潘年松,莫应明.天南星的毒性认识及防治研究[J].井冈山大学学报(自然科学版),2015,36(3):99-103.
[12]张历元,李元文,林欢儿,等.中药冰片的商品种类与现代药理学研究进展[J].世界中医药,2018,13(4):1025-1030.
[13]章寅,许丁锐,王峰,等.消瘀接骨散对兔膝骨关节炎模型关节液中IL-1p、TNF-α、TGF-β1表达的影响[J].中医药临床杂志,2015,27(12):1726-1728.
[14]李本扬,王峰,梁文武.消瘀接骨散对兔膝骨关节炎模型关节液中MMP-1、MMP-3表达的影响[J].安徽中医药大学学报,2015,34(6):66-69.
[15]宋燕,朋汤义,冉姗,等.消瘀接骨散超高液相色谱指纹图谱研究[J].中国中医药信息杂志,2018,25(8):80-85.
[16]曹彭凯,王晓猛,白伟侠,等.2018年版《骨关节炎诊疗指南》解读[J].河北医科大学学报,2018,39(11):1241-1243.