柴胡桂枝汤对中期KOA患者痛点镇痛效果临床疗效观察
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摘要
目的:探究中期KOA患者痛点规律及在玻璃酸钠膝关节注射基础上对比柴胡桂枝汤与地塞米松磷酸钠合利多卡因对中期KOA患者痛点镇痛效果。方法:2012年3月—2015年3月就诊于云南省中医医院和昆明市中医医院骨科符合KOA诊断标准及纳入标准患者154例,随机分为对照组(77例、91膝)和研究组(77例、93膝)。2组患者均予玻璃酸钠注射液膝关节腔注射1次/周,连用4周;对照组加用地塞米松磷酸钠注射液合利多卡因注射液于第1周及第4周(必要时);研究组口服柴胡桂枝汤100 m L,tid,连用1周间隔1周后再用1周,共用2周。4周后对比2组治疗前后痛点VAS疼痛评分(9分法)及临床疗效。结果:研究组有效率(67.1%)高于对照组(58.3%),且研究组(27.1%)治疗期间止痛药应用情况低于对照组(41.6%);按照膝关节9分法分区,中期KOA痛点多集中于外侧,治疗前各区痛点VAS评分无差异(P>0.05),治疗后研究组外侧区及全膝痛点VAS评分低于对照组(P<0.05)。结论:KOA中期的基本病机可能在于"枢机不利、气血痹阻",同时可能与膝关节周围神经末梢退变相关,而应用柴胡桂枝汤合玻璃酸钠注射液治疗可以获得较为满意的痛点镇痛效果。
Objective:To investigate the pain regulations of media stage KOA and on the basis of injection of Sodium Hyaluronate compared the clinical effects of Chaihu Guzhi Decoction and Dexamethasone Sodium Phophate accompanying Lidocaine on pain points of KOA patients in media stage. Methods:From March 2012 to March 2015 selected the 154 patients in the traumatic and orthopedic department in Yunnan TCM hospital and Kunming municiple TCM hospital complying with the diagnosis and absorbing standards. Randomly divided into control group(77 cases,91 knees)and study group(77 cases,93 knees). 2 groups were treated with intraarticular injection of Sodium Hyaluronate Injection once per week continuously for 4 weeks. In addition the control group was treated with intra articular injection of Dexamethasone Sodium Phophate and Lidocaine in the first and last week(if essential)of 4 weeks. The study group was treated with Chaihu Guzhi Decoction 100 m L oral tid continuously for one week in the first and third week of the 4 weeks. After the treatment comparized the VAS score(9 scores method)and the clinical efficiency. Results:The efficient proportion of study(67.1%)was higher than that of control group(58.3%). During the treatment the happening rate of analgesic intake for study group(27.1%)was lower than control group(41.6%). According to the 9 dividing ways of knee joint the pain points of media stage KOA predisposed to the outside of knee,before the treatment the VAS scores of 2 groups had no difference(P>0.05),after the treatment the VAS score of study especially in the outside and the whole knee was lower than those of control group(P<0.05). Conclusion:the patholigical mechanism of media stage KOA may be Shuji disballance and choking of Qi and Blood and propabally associate with the degradation of nerve endings. Chaihu GuzhiDecoction accompanying Sodium Hyaluronate Injection may have better clinical treatment for killing pain of pain points of media stage KOA patients.
Objective:To investigate the pain regulations of media stage KOA and on the basis of injection of Sodium Hyaluronate compared the clinical effects of Chaihu Guzhi Decoction and Dexamethasone Sodium Phophate accompanying Lidocaine on pain points of KOA patients in media stage. Methods:From March 2012 to March 2015 selected the 154 patients in the traumatic and orthopedic department in Yunnan TCM hospital and Kunming municiple TCM hospital complying with the diagnosis and absorbing standards. Randomly divided into control group(77 cases,91 knees)and study group(77 cases,93 knees). 2 groups were treated with intraarticular injection of Sodium Hyaluronate Injection once per week continuously for 4 weeks. In addition the control group was treated with intra articular injection of Dexamethasone Sodium Phophate and Lidocaine in the first and last week(if essential)of 4 weeks. The study group was treated with Chaihu Guzhi Decoction 100 m L oral tid continuously for one week in the first and third week of the 4 weeks. After the treatment comparized the VAS score(9 scores method)and the clinical efficiency. Results:The efficient proportion of study(67.1%)was higher than that of control group(58.3%). During the treatment the happening rate of analgesic intake for study group(27.1%)was lower than control group(41.6%). According to the 9 dividing ways of knee joint the pain points of media stage KOA predisposed to the outside of knee,before the treatment the VAS scores of 2 groups had no difference(P>0.05),after the treatment the VAS score of study especially in the outside and the whole knee was lower than those of control group(P<0.05). Conclusion:the patholigical mechanism of media stage KOA may be Shuji disballance and choking of Qi and Blood and propabally associate with the degradation of nerve endings. Chaihu GuzhiDecoction accompanying Sodium Hyaluronate Injection may have better clinical treatment for killing pain of pain points of media stage KOA patients.
引文
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[22]吴思,邓书童,张红安.膝骨性关节炎红外热像表现及膝关节痛点分布规律分析[J].中国骨与关节损伤杂志,2017,25(1):5-11.
[23]Dor A,Kalichman L.A.myofascial component of pain in knee osteoarthritis[J].Bodyw Mov Ther,2017,21(3):642-647.
[24]Jeffrey L,Cummings MD.Toward a molecular neuropsychiatry of neurodegenerative diseases[J].Annals of Neurology,2003,54(2):147-154.
[25]彭裕文,刘树伟.局部解剖学[M].7版,北京:人民卫生出版社,2008:234-235.
[26]王玉梅.温经通络、益气养血法方剂治疗糖尿病足临床观察[J].新中医,2017,49(1):71-77.
[27]朱双龙,段会全,刘英富,等.柴胡皂苷a对大鼠急性脊髓损伤的神经保护作用与机制研究[J].中国修复重建外科杂志,2017,31(7):825-829.
[28]Doodnaught,Graeme M,Monteiro,et al.Pharmacokinetic and pharmacodynamic modelling after subcutaneous,intravenous and buccal administration of a high-concentration formulation of buprenorphine in conscious cats[J].Plos one,2017,12(5):1-16.
[2]Mantyselka P,Kumpusalo E,Ahonen R,et al.Pain as a reason to visit the doctor:a study in Finnish primary health care[J].Pain,2016,89(2):175-180.
[3]Wyke B.The neurology of joints:a reviewof general principles[J].Ann R Coll Surg Engl,1967,41(1):25-50.
[4]刘小立.骨关节炎神经病理性疼痛诊疗概述[J].中国新药杂志,2015,24(18):2073-2076.
[5]陈百成,王晓峰,张静,等.膝关节骨关节炎滑膜中神经生长因子和P物质水平测试与观察[J].中华骨科杂志,2003,23(3):156-160.
[6]Ferreira-Gomes J,Ad?es S,Sousa RM,et al.Dose-dependent expression of neuronal injury markers during experimental osteoarthritis induced by monoiodoacetate in the rat[J].Mol Pain,2012,50(8):844-850.
[7]Yang W,Kang X,Qin N,et al.Melatonin protects chondrocytes from impairment induced by glucocorticoids via NAD+-dependent SIRT1[J].Steroids,2017,126(6):24-29.
[8]Mankin HJ,Dorfman H,Lippiello L,et al.Biochemical and abnormalities in articular from osteo-arthritic human hips[J].Journal of Bone&Joint Surgery American Volume,1970,52(3):424.
[9]胥少汀,葛宝丰,徐印坎,等.实用骨科学[M].4版.北京:人民卫生出版社,2014:1678-1679.
[10]张伟强,李波,李帆冰.膝骨性关节炎分期与疼痛部位的相关性研究[J].云南中医学院学报,2016,39(5):78-83.
[11]Nattapol Tammachote MD,Supakit Kanitnate MD,Thanasak Yakumpor MD,et al.Intra-Articular,Single-Shot Hylan G-F20 Hyaluronic Acid Injection Compared with Corticosteroid in Knee Osteoarthritis[J].The Journal of Bone&Joint Surgery,2016,98(11):885-892.
[12]白清.黄芪桂枝五物汤对糖尿病周围神经病变的疗效及神经传导速度的影响[J].中成药,2015,37(5):962-967.
[13]曾广南,冯沃君,胡永祥,等.膝关节退行性骨关节炎常见压痛点的临床观察[J].中国中医骨伤科杂志,2007,15(11):18-23.
[14]J Westra,EL Ashbeck,A Guermazi,et al.Burden of MRI-detected pathological features and future trajectories of pain and function in participants with radiographic knee osteoarthritis[J].Osteoarthritis and Cartilage,2017,25(1):372-373.
[15]王强,陈元川,庞坚,等.膝骨关节炎证候分型与疼痛程度的相关性分析[J].中国中医骨伤科杂志,2016,24(5):9-14.
[16]杨顺刚,江川,顾鑫锋,等.糖皮质激素与透明质酸钠序贯性治疗膝关节骨性关节炎的疗效比较[J].中国骨与关节损伤杂志,2015,30(10):1052-1055.
[17]石印玉,徐荣喜,陈友红.养血软坚方治疗膝骨性关节炎的临床报告[J].中国中医骨伤科杂志,1994,2(4):33-36.
[18]黄旭东,王跃辉.运用肝脾相关理论治疗膝骨关节炎探讨[J].时珍国医国药,2010,21(8):2019-2022.
[19]王孟凯,周震.论枢机在人体中的生理特点[J].光明中医,2014,29(10):2158-2159.
[20]Cohen E,Lee YC.A Mechanism-Based Approach to the Management of Osteoarthritis Pain[J].Curr Osteoporos Rep,2015,13(6):399-406.
[21]RGC Riist,M Henriksen.The effects of intra-articular glucocorticoids and exercise on pain and synovitis assessed on static and dynamic magnetic resonance imaging in knee osteoarthritis:exploratory outcomes from a randomized controlled trial[J].Osteoarthritis and Cartilage,2017,25(4):481-489.
[22]吴思,邓书童,张红安.膝骨性关节炎红外热像表现及膝关节痛点分布规律分析[J].中国骨与关节损伤杂志,2017,25(1):5-11.
[23]Dor A,Kalichman L.A.myofascial component of pain in knee osteoarthritis[J].Bodyw Mov Ther,2017,21(3):642-647.
[24]Jeffrey L,Cummings MD.Toward a molecular neuropsychiatry of neurodegenerative diseases[J].Annals of Neurology,2003,54(2):147-154.
[25]彭裕文,刘树伟.局部解剖学[M].7版,北京:人民卫生出版社,2008:234-235.
[26]王玉梅.温经通络、益气养血法方剂治疗糖尿病足临床观察[J].新中医,2017,49(1):71-77.
[27]朱双龙,段会全,刘英富,等.柴胡皂苷a对大鼠急性脊髓损伤的神经保护作用与机制研究[J].中国修复重建外科杂志,2017,31(7):825-829.
[28]Doodnaught,Graeme M,Monteiro,et al.Pharmacokinetic and pharmacodynamic modelling after subcutaneous,intravenous and buccal administration of a high-concentration formulation of buprenorphine in conscious cats[J].Plos one,2017,12(5):1-16.