腓骨近端截骨联合中医药治疗膝关节内侧间室骨关节炎肝肾不足、气滞血瘀证
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摘要
目的比较腓骨近端截骨术联合中医药与单纯腓骨近端截骨术治疗膝关节内侧间室骨关节炎肝肾不足、气滞血瘀证的疗效。方法回顾性分析2014年10月至2017年5月收治的符合纳入及排除标准的膝关节骨关节炎肝肾不足、气滞血瘀证患者58例,其中单纯行腓骨近端截骨术28例(A组),行腓骨近端截骨术结合中药热敷、口服中药治疗30例(B组)。A组男性8例,女性20例,年龄51～64岁,平均年龄为(58.4±2.1)岁。B组男性7例,女性23例,年龄53～63岁,平均龄为(59.4±3.3)岁。分别术后1 w、1个月、3个月、6个月及12个月随访并比较两组患者的疼痛视觉模拟评分(VAS)、美国特种外科医院(HSS)膝关节评分、患者满意度、住院时间和医疗费用等。结果单纯腓骨近端截骨术(A组)26例患者得到随访,2例失访,腓骨近端截骨术结合中药热敷、口服中药(B组)26例得到随访,4例失访,随访时间10～26个月,平均(12.5±3.4)个月。术前A组与B组的VAS评分、HSS评分比较,差异均无统计学意义(P>0.05)。术后A组患者的VAS评分[(5.8±0.7)分]高于B组[(2.8±0.6)分],差异具有统计学意义(t=11.548,P<0.05),A组的HSS评分[(69.2±1.1)分]低于B组[(75.7±1.8)分],差异具有统计学意义(t=11.071,P<0.05),患者满意度(53.8%)低于B组(76.9%),差异具有统计学意义(t=7.721,P<0.05),两组住院时间、医疗费用比较,差异无统计学意义(P>0.05)。结论腓骨近端截骨联合中医药治疗膝关节内侧间室骨关节炎肝肾不足、气滞血瘀证的效果优于单纯腓骨近端截骨术,可明显减轻患者的疼痛,有利于患肢肿胀的消退,提高患者满意度,快速康复患肢的功能,值得临床推广。
Objective To compare the efficacy of Proximal Fibular Osteotomy(PFO)combined with traditional Chinese medicine and proximal fibular osteotomy alone in the treatment of medial compartment osteoarthritis of knee joint with liver and kidney insufficiency and qi stagnation and blood stasis syndrome.Methods A retrospective analysis was made on 58 patients with osteoarthritis of knee joint with liver and kidney insufficiency and qi stagnation and blood stasis syndrome from October 2014 to May 2017.Among them,28 patients were treated with PFO alone(group A),30 patients were treated with PFO combined with traditional Chinese medicine hot compress and oral Chinese medicine(group B).There were 8 males and 20 females in group A,aged 51-64 years,with an average age of(58.4+2.1)years.In group B,there were 7 males and 23 females,aged from 53 to 63 years,with an average age of(59.4+3.3)years.The patients were followed up for 1 w,1 month,3 months,6 months and 12 months after operation.VAS and HSS were compared between the two groups.And patient satisfaction,hospitalization time and medical expenses.Results 26 patients in group A were followed up,2 patients were lost,26 patients in group B were followed up,and 4 patients were lost.The follow-up period ranged from 10 months to 26 months,with an average of(12+3)months.There were no significant differences in VAS scores and HSS scores between group A and group B before surgery(P>0.05).The VAS score(5.8±0.7)of group A patients was higher than that of group B(2.8±0.6),the difference was statistically significant(t=11.548,P<0.05),HSS score(69.2±1.1)of group A was lower than group B(75.7±1.8),the difference was statistically significant(t=11.071,P<0.05),patient satisfaction(53.8%)of group A was lower than group B(76.9%),the difference was statistically significant(t=7.721,P<0.05).There was no significant difference in the length of hospital stay and medical expenses between the two groups(P>0.05).Conclusions The treatment of proximal humerus osteotomy combined with traditional Chinese medicine for the treatment of medial compartment osteoarthritis of the knee joint with liver and kidney deficiency and qi stagnation and blood stasis syndrome is better than the proximal humerus osteotomy.The postoperative pain can significantly reduce the patient's pain and benefit the patient.The decline of limb swelling,improve patient satisfaction,and quickly recover the function of the affected limb is worthy of clinical promotion.
Objective To compare the efficacy of Proximal Fibular Osteotomy(PFO)combined with traditional Chinese medicine and proximal fibular osteotomy alone in the treatment of medial compartment osteoarthritis of knee joint with liver and kidney insufficiency and qi stagnation and blood stasis syndrome.Methods A retrospective analysis was made on 58 patients with osteoarthritis of knee joint with liver and kidney insufficiency and qi stagnation and blood stasis syndrome from October 2014 to May 2017.Among them,28 patients were treated with PFO alone(group A),30 patients were treated with PFO combined with traditional Chinese medicine hot compress and oral Chinese medicine(group B).There were 8 males and 20 females in group A,aged 51-64 years,with an average age of(58.4+2.1)years.In group B,there were 7 males and 23 females,aged from 53 to 63 years,with an average age of(59.4+3.3)years.The patients were followed up for 1 w,1 month,3 months,6 months and 12 months after operation.VAS and HSS were compared between the two groups.And patient satisfaction,hospitalization time and medical expenses.Results 26 patients in group A were followed up,2 patients were lost,26 patients in group B were followed up,and 4 patients were lost.The follow-up period ranged from 10 months to 26 months,with an average of(12+3)months.There were no significant differences in VAS scores and HSS scores between group A and group B before surgery(P>0.05).The VAS score(5.8±0.7)of group A patients was higher than that of group B(2.8±0.6),the difference was statistically significant(t=11.548,P<0.05),HSS score(69.2±1.1)of group A was lower than group B(75.7±1.8),the difference was statistically significant(t=11.071,P<0.05),patient satisfaction(53.8%)of group A was lower than group B(76.9%),the difference was statistically significant(t=7.721,P<0.05).There was no significant difference in the length of hospital stay and medical expenses between the two groups(P>0.05).Conclusions The treatment of proximal humerus osteotomy combined with traditional Chinese medicine for the treatment of medial compartment osteoarthritis of the knee joint with liver and kidney deficiency and qi stagnation and blood stasis syndrome is better than the proximal humerus osteotomy.The postoperative pain can significantly reduce the patient's pain and benefit the patient.The decline of limb swelling,improve patient satisfaction,and quickly recover the function of the affected limb is worthy of clinical promotion.
引文
1 Zhang Y,Jordan JM.Epidemiology of osteoarthritis[J].Clin Geriatr Med,2010,26(3):355-369.
2中华医学会风湿病分会.骨关节炎诊治及治疗指南[J].中华风病杂志,2010,14(6):416-419.
3张英泽,李存祥,李冀东,等.不均匀沉降在膝关节退变及内翻过程中机制的研究[J].河北医科大学学报,2014,35(2):218-219.
4明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25-27.
5孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40-41.
6陈伟,张英泽,侯志勇,等.应用腓骨截骨术治疗膝关节骨关节炎[J].实用骨科杂志,2015(10):945-946.
7陈伟,陈百成,王飞,等.应用不同方法治疗膝关节骨性关节炎的对比研究[J].河北医科大学学报,2015(5):600-602.
8郭然,杨惠民,陈婧,等.中西医结合治疗膝关节骨性关节炎40例临床观察[J].世界中西医结合杂志,2016,11(9):1261-1264.
9郑筱萸.中药新药临床研究指导原则:试行[M].北京:中国医药科技出版社,2002:349-352.
10 Kohn MD,Sassoon AA,Fernando ND.Classifications inbrief:Kellgren-Lawrence Classification of osteoarthritis[J].Clin Orthop Relat R es,2016,474(8):1886-1893.
11蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:177-178.
12余建平,魏杰,苏云星,等.腓骨截骨术治疗膝骨关节炎的临床分析[J].中国药物与临床,2015,15(8):1161-1162.
13于浩达,王秀艳.中西医治疗膝关节骨性关节炎的研究进展[J].现代中西医结合杂志,2015,24(22):2506-2508.
14梅其杰,袁长深,段戡,等.壮药骨痹方汤熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(7):27-30.
15洪海平,卫晓恩,陈勇,等.膝骨关节炎患者股四头肌肌张力与膝关节功能的关系研究[J].中医正骨,2014,26(10):32-34.
16何景力,唐满海,张琰冰,等.人工全膝关节置换术结合中医外洗对晚期膝关节骨性关节炎的临床价值研究[J].临床医药文献电子杂志,2016,3(38):7557-7558.
17 Mc AT,Bonnum RR,Sulivan MC,et al.Oarsi guidelines for the nonsurgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388.
18郑召民,许振华.骨内高压与活血化瘀[J].中国中医骨伤,1994,2(3):43-47.
2中华医学会风湿病分会.骨关节炎诊治及治疗指南[J].中华风病杂志,2010,14(6):416-419.
3张英泽,李存祥,李冀东,等.不均匀沉降在膝关节退变及内翻过程中机制的研究[J].河北医科大学学报,2014,35(2):218-219.
4明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25-27.
5孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40-41.
6陈伟,张英泽,侯志勇,等.应用腓骨截骨术治疗膝关节骨关节炎[J].实用骨科杂志,2015(10):945-946.
7陈伟,陈百成,王飞,等.应用不同方法治疗膝关节骨性关节炎的对比研究[J].河北医科大学学报,2015(5):600-602.
8郭然,杨惠民,陈婧,等.中西医结合治疗膝关节骨性关节炎40例临床观察[J].世界中西医结合杂志,2016,11(9):1261-1264.
9郑筱萸.中药新药临床研究指导原则:试行[M].北京:中国医药科技出版社,2002:349-352.
10 Kohn MD,Sassoon AA,Fernando ND.Classifications inbrief:Kellgren-Lawrence Classification of osteoarthritis[J].Clin Orthop Relat R es,2016,474(8):1886-1893.
11蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:177-178.
12余建平,魏杰,苏云星,等.腓骨截骨术治疗膝骨关节炎的临床分析[J].中国药物与临床,2015,15(8):1161-1162.
13于浩达,王秀艳.中西医治疗膝关节骨性关节炎的研究进展[J].现代中西医结合杂志,2015,24(22):2506-2508.
14梅其杰,袁长深,段戡,等.壮药骨痹方汤熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(7):27-30.
15洪海平,卫晓恩,陈勇,等.膝骨关节炎患者股四头肌肌张力与膝关节功能的关系研究[J].中医正骨,2014,26(10):32-34.
16何景力,唐满海,张琰冰,等.人工全膝关节置换术结合中医外洗对晚期膝关节骨性关节炎的临床价值研究[J].临床医药文献电子杂志,2016,3(38):7557-7558.
17 Mc AT,Bonnum RR,Sulivan MC,et al.Oarsi guidelines for the nonsurgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388.
18郑召民,许振华.骨内高压与活血化瘀[J].中国中医骨伤,1994,2(3):43-47.