中药封包治疗膝关节骨性关节炎的疗效观察
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摘要
目的：观察中药封包配合持续被动活动(Continuous Passive Motion, CPM)功能锻炼对膝关节骨性关节炎的治疗效果。为临床治疗膝关节骨性关节炎提供中西医结合治疗的新思路。
方法：根据筛选的标准,选择来自深圳市宝安区中医院门诊及住院部的膝关节骨性关节炎患者共60例,根据就诊及住院的时间先后顺序编号,随机分为两组,即治疗组(CPM功能锻炼+中药封包外敷)及对照组(CPM功能锻炼+玻璃酸钠关节腔内注射)。治疗组使用CPM机器进行患膝关节持续性被动功能锻炼,保持活动在无痛范围内,从小角度(0°~30°)开始,逐步增加活动度(每日增加5°~30°),直至病人的最大耐受程度,每日1次,每次30min；同时外敷我院自拟中药封包外敷患膝关节疼痛部位,每次约30分钟,每天使用2次。对照组同样使用CPM行患膝关节功能锻炼,但行玻璃酸钠关节腔内注射,2ml/次·周,四周后停药。治疗前后计分均参照JOA膝关节功能评分标准拟订评价标准,并通过症状体征的评分对比来评价疗效。
结果：
1、治疗组及对照组患者治疗前均有不同程度的膝部疼痛,经治疗后,两组患者膝部疼痛有显著差异性(P<0.01),两组治疗后膝关节疼痛有显著性差异(P<0.01)。
2、治疗组和对照组患者治疗前有不同程度的膝部肿胀,经治疗后,治疗组和对照组在治疗前后的膝部肿胀有显著改善(P<0.01),但两组治疗后膝部肿胀程度无显著性差异(P>0.05)。
3、治疗组和对照组患者治疗前均有不同程度的活动受限。经治疗后,治疗组和对照组在治疗前后的膝关节活动度都有显著改善(P<0.01),两组治疗后膝关节活动度有显著性差异(P<0.01)。
结论：中药封包配合CPM被动功能锻炼对膝关节骨性关节炎的症状及体征有明显的改善作用,且优于玻璃酸钠对膝关节骨性关节炎的治疗作用。
Objective:
To observe the therapeutic effect of medicine packet and continuous passive motion (CPM) on knee osteoarthritis (KOA). It supplies new methods for treating KOA with combination of TCM with Western medicine.
Methods:
According to the selection criteria,60 patients with knee osteoarthritis from Baoan hospital of TCM were randomly divided into two groups:1, Treatment group, in which patients received CPM applications and medicine packet treatment;2, Control group, in which patients received CPM applications and sodium hyaluronate injection of articular cavity. Compare and analyse the two groups of patients'sings and symptoms according to JOA scoring system before and after treatment.
Results:
1. The knee joint ache of two groups were significant relieved after treatment(P<0.01), and there were significant difference between the treatment group and the control group (P<0.01).
2. The knee swell of two groups were significant relieved after treatment, but there were no difference between the treatment group and the control group(P>0.05).
3. The knee active range of joint motion of two groups were significant relieved after treatment, and there were significant difference between the treatment group and the control group(P<0.01).
Conclusion:
The medicine packet treatment and CPM application can significantly improve the signs and symptoms of knee osteoarthritis.
方法：根据筛选的标准,选择来自深圳市宝安区中医院门诊及住院部的膝关节骨性关节炎患者共60例,根据就诊及住院的时间先后顺序编号,随机分为两组,即治疗组(CPM功能锻炼+中药封包外敷)及对照组(CPM功能锻炼+玻璃酸钠关节腔内注射)。治疗组使用CPM机器进行患膝关节持续性被动功能锻炼,保持活动在无痛范围内,从小角度(0°~30°)开始,逐步增加活动度(每日增加5°~30°),直至病人的最大耐受程度,每日1次,每次30min；同时外敷我院自拟中药封包外敷患膝关节疼痛部位,每次约30分钟,每天使用2次。对照组同样使用CPM行患膝关节功能锻炼,但行玻璃酸钠关节腔内注射,2ml/次·周,四周后停药。治疗前后计分均参照JOA膝关节功能评分标准拟订评价标准,并通过症状体征的评分对比来评价疗效。
结果：
1、治疗组及对照组患者治疗前均有不同程度的膝部疼痛,经治疗后,两组患者膝部疼痛有显著差异性(P<0.01),两组治疗后膝关节疼痛有显著性差异(P<0.01)。
2、治疗组和对照组患者治疗前有不同程度的膝部肿胀,经治疗后,治疗组和对照组在治疗前后的膝部肿胀有显著改善(P<0.01),但两组治疗后膝部肿胀程度无显著性差异(P>0.05)。
3、治疗组和对照组患者治疗前均有不同程度的活动受限。经治疗后,治疗组和对照组在治疗前后的膝关节活动度都有显著改善(P<0.01),两组治疗后膝关节活动度有显著性差异(P<0.01)。
结论：中药封包配合CPM被动功能锻炼对膝关节骨性关节炎的症状及体征有明显的改善作用,且优于玻璃酸钠对膝关节骨性关节炎的治疗作用。
Objective:
To observe the therapeutic effect of medicine packet and continuous passive motion (CPM) on knee osteoarthritis (KOA). It supplies new methods for treating KOA with combination of TCM with Western medicine.
Methods:
According to the selection criteria,60 patients with knee osteoarthritis from Baoan hospital of TCM were randomly divided into two groups:1, Treatment group, in which patients received CPM applications and medicine packet treatment;2, Control group, in which patients received CPM applications and sodium hyaluronate injection of articular cavity. Compare and analyse the two groups of patients'sings and symptoms according to JOA scoring system before and after treatment.
Results:
1. The knee joint ache of two groups were significant relieved after treatment(P<0.01), and there were significant difference between the treatment group and the control group (P<0.01).
2. The knee swell of two groups were significant relieved after treatment, but there were no difference between the treatment group and the control group(P>0.05).
3. The knee active range of joint motion of two groups were significant relieved after treatment, and there were significant difference between the treatment group and the control group(P<0.01).
Conclusion:
The medicine packet treatment and CPM application can significantly improve the signs and symptoms of knee osteoarthritis.
引文
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[2]高翔.益气化瘀利水方干预兔膝关节炎软骨中胰岛素样生长因子I的变化[J].中国临床康复,2006,10(39)：95-97
[3]王丽萍.自由基对骨关节炎的影响[J].中华风湿病学杂志,2006,10(2)：116-117
[4]杜宁,任峰,杨琦.膝关节骨关节病体征与功能的相互关系的研究[J].中国中医骨伤科杂志,1996,4(1)：8-11
[5]林华,陈新,张咏梅,等.绝经后妇女骨质疏松与骨关节炎的相关性研究[J].中国骨质疏松杂志,2006,12(5)：488-489
[6]张毓洲,许露玫.正常与骨内高压下骨髓微循环冷冻割断扫描电镜观察[J].中华骨科杂志,1999：19(5)：303-306
[7]高文香,刘元禄,李永生,等.补肾法防治兔膝关节骨性关节炎的病理形态学观察[J].中医正骨,1999,11(11)：13
[8]赵钟文.从补肾入手缓解膝关节骨性关节炎疼痛60例疗效观察[J].云南中医中药杂志,2005,26(6)：10.
[9]贺宪,陈孝银,尚平,等.益气补肾活血法防治家兔膝骨性关节炎的实验研究[J].辽宁中医杂志,2008,35(1)：140
[10]董军梅,魏琴.补肾壮骨汤治疗膝骨性关节炎疗效观察[J].长春中医药大学学报,2008,24(4)：414-415
[11]严培军,孙玉明,周福贻.从痰瘀水论治膝关节骨性关节炎176例[J].南京中医药大学报,2000,16(4)：249
[12]尹相峰,刘德玉.自拟活络汤治疗膝关节骨性关节炎43例[J].吉林中医药,2008,28(10)：745-746
[13]林亮.伤科消炎膏外敷治疗寒湿瘀阻型膝关节骨性关节炎的临床观察[J].现代医药卫生,2006;22(18)：2786
[14]陈成军.中药外敷治疗膝关节骨性关节炎150例疗效观察[J].云南中医中药杂志,2007,28(9)：15
[15]宋振飞,李鹏.中药熏洗治疗膝关节骨性关节炎临床体会[J].中国中医急症,2009,18(9)：1525
[16]李昭扬,李玲,粱力,等.中药熏蒸、外敷综合治疗膝关节骨性关节炎疗效比较[J].中国康复医学杂志,2007,22(11)：1042-1043
[17]张必萌,吴耀持,沈健.长针透刺治疗膝骨关节炎的临床研究[J].中国针 灸,2004,24(9)：613.
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