补肾生骨汤治疗中老年膝骨关节炎合并骨髓水肿临床观察
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摘要
目的:观察补肾生骨汤治疗中老年膝关节骨性关节炎(knee osteo arthritis,KOA)合并骨髓水肿(bone marrow edema,BME)的临床疗效。方法:选取2017年1月至2018年1月在本院骨伤科门诊接受诊治的KOA合并BME的中老年患者70例,给予补肾生骨汤口服并中药封包热敷治疗,4周为1个疗程,连续治疗3个疗程,分别观察患者治疗后4周、治疗后8周、治疗后12周的VAS评分、WOMAC评分及WORMS评分变化。结果:患者治疗4周后、8周后和12周后VAS评分、WOMAC评分较治疗前明显降低(P <0. 05);治疗12周后WORMS评分较治疗前明显降低(P <0. 05)。结论:补肾生骨汤可有效缓解中老年KOA合并BME患者的膝关节疼痛,明显减小骨髓水肿范围,改善膝关节功能。
Objective: To observe the clinical curative effect of Kidney-Nourishing Bone-Generating Decoction on knee osteo arthritis( KOA) with bone marrow edema( BME) in middle-aged and elderly patients. Methods: Seventy middle-aged and elderly patients with KOA and BME who were treated in our hospital's Outpatient Department of Orthopedics and Traumatology from January 2017 to January 2018 were treated with Kidney-Nourishing Bone-Generating Decoction for oral administration,and applied by hot compress with TCM. Four weeks were regarded as one course,and the treatment lasted for3 consecutive courses. Then the changes of VAS,WOMAC and WORMS scores of the patients were observed after 4 weeks',8 weeks' and 12 weeks' treatment respectively. Results: The VAS and WOMAC scores of patients after 4 weeks,8 weeks and 12 weeks of treatment were significantly lower than those before the treatment( P < 0. 05). After 12 weeks of treatment,WORMS score was significantly lower than that before treatment( P < 0. 05). Conclusion: Kidney-Nourishing Bone-Generating Decoction can effectively alleviate knee pain in middle-aged and elderly patients with KOA and BME,significantly reduce the range of bone marrow edema and improve knee joint function.
Objective: To observe the clinical curative effect of Kidney-Nourishing Bone-Generating Decoction on knee osteo arthritis( KOA) with bone marrow edema( BME) in middle-aged and elderly patients. Methods: Seventy middle-aged and elderly patients with KOA and BME who were treated in our hospital's Outpatient Department of Orthopedics and Traumatology from January 2017 to January 2018 were treated with Kidney-Nourishing Bone-Generating Decoction for oral administration,and applied by hot compress with TCM. Four weeks were regarded as one course,and the treatment lasted for3 consecutive courses. Then the changes of VAS,WOMAC and WORMS scores of the patients were observed after 4 weeks',8 weeks' and 12 weeks' treatment respectively. Results: The VAS and WOMAC scores of patients after 4 weeks,8 weeks and 12 weeks of treatment were significantly lower than those before the treatment( P < 0. 05). After 12 weeks of treatment,WORMS score was significantly lower than that before treatment( P < 0. 05). Conclusion: Kidney-Nourishing Bone-Generating Decoction can effectively alleviate knee pain in middle-aged and elderly patients with KOA and BME,significantly reduce the range of bone marrow edema and improve knee joint function.
引文
[1]薛庆云,王坤正,裴福兴,等.中国40岁以上人群原发性骨关节炎患病状况调查[J].中华骨科杂志,2015,35(12):1206-1212.
[2]帖小佳,郑如庚,赵梦,等.中国中老年人膝关节骨关节炎患病率的Meta分析[J].中国组织工程研究,2018,22(4):650-656.
[3]王斌,邢丹,董胜杰,等.中国膝骨关节炎流行病学和疾病负担的系统评价[J].中国循证医学杂志,2018,22(4):650-656.
[4]顾明士,张申岳,王萍,等.中老年人膝骨关节炎患病趋势十年前后对照分析[J].上海医药,2013,35(4):57-59.
[5]刘强,王德国,赵亮.全膝关节置换术的研究进展[J].中国矫形外科杂志,2013,17(16):1625-1628.
[6]李冬生,李剑锋,张建,等.人工全膝关节置换术治疗老年重度膝关节骨性关节炎临床观察[J].山东医药,2017,57(20):74-76.
[7]陈曦,卢东霞,张凤翔.膝关节骨髓水肿综合征的MRI表现[J].医学影像学杂志,2017,27(11):2205-2207.
[8]周嵘,钱齐荣.软骨下骨在骨关节炎发病中作用的研究进展[J].中国矫形外科杂志,2014,18(21):1971-1973.
[9]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.
[10]顾力军,董福慧.疼痛客观化指标在膝骨关节炎患者膝关节功能和疼痛评价中的应用[J].中医正骨,2013,25(9):22-24.
[11] AITKEN RCB. Measurement of feeling using visual analogue scales[J]. Proceedings of the Royal Society of Medicine,1969,59(4):415-422.
[12] BELLAMY N,BUCHANAN WW,GOLDSMITH CH,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.
[13]辛雷,苏佳灿.膝关节功能评分:现状与展望[J].中国组织工程研究与临床康复,2010,4(39):7367-7370.
[14] PETERFY CG,GUERMAZI A,ZAMI S,et al. Whole-Organ,MagneticResonance,Imaging,Score(WORMS)of the knee in osteoarthritis[J]. Osteoarthr Cartilage,2004,12(3):177-190.
[15]王琳,沈鸿鹄,刘鹏飞.膝关节骨性关节炎的MRI诊断进展[J].中华临床医师杂志(电子版),2013,7(23):10883-10886.
[16]刘源,王敬威,孙乾坤,等.骨髓水肿综合征研究进展[J].亚太传统医药,2016,12(13):51-53.
[17]郑昱新,李志强,顾新丰,等.膝关节骨髓水肿综合征[J].中华关节外科杂志(电子版),2010,4(3):412-414.
[18] WILSON AL,MURPHY WA,HARDY DC,et al. Transient osteoarthritis:transient bone marrowedema[J]. Radiology,1988,167(7):757-760.
[19]徐勤光,顾新丰,郑昱新,等.骨髓水肿与骨关节炎的临床研究进展[J].中华关节外科杂志(电子版),2014,8(2):256-259.
[20]冯媛媛,罗静,师静,等.膝骨关节炎患者关节疼痛与软骨下骨髓水肿的相关性研究[J].现代生物医学进展,2018,18(6):1155-1158.
[21]朱明双,许林,吕智勇,等. MRI软骨下骨髓水肿与早期膝骨关节炎临床表现的相关性研究[J].成都医学院学报,2016,11(2):146-149.
[22]刘永强,史庆轩,郭书英.盐酸氨基葡萄糖治疗骨关节炎的临床观察[J].中国矫形外科杂志,2018,22(34):1820-1821.
[23]董蓓蓓,宫月明,杨久山.中西医结合治疗膝骨关节炎骨髓水肿疗效观察[J].世界最新医学信息文摘,2018,18(51):175-176.
[24]张同华,肖尚领.关节镜下减压治疗膝关节骨髓水肿60例探讨[J].中外医疗,2012,31(1):62-62.
[25]李文雄.中医药治疗膝骨关节炎研究进展[J].河南中医,2014,34(12):2440-2441.
[26]郑维蓬,魏合伟,黄梓基,等.从瘀论治膝骨关节炎的研究现状及展望[J].新中医,2013,45(11):122-124.
[27]邢秋娟,吴佶,戴薇薇,等.益气化瘀补肾方治疗早中期原发性膝骨关节炎临床研究[J].河南中医,2018,38(3):396-403.
[28]郝胜坤,纪斌,石继祥,等.补肾活血中药治疗膝骨关节炎的作用机制[J].中医正骨,2017,29(4):31-33.
[2]帖小佳,郑如庚,赵梦,等.中国中老年人膝关节骨关节炎患病率的Meta分析[J].中国组织工程研究,2018,22(4):650-656.
[3]王斌,邢丹,董胜杰,等.中国膝骨关节炎流行病学和疾病负担的系统评价[J].中国循证医学杂志,2018,22(4):650-656.
[4]顾明士,张申岳,王萍,等.中老年人膝骨关节炎患病趋势十年前后对照分析[J].上海医药,2013,35(4):57-59.
[5]刘强,王德国,赵亮.全膝关节置换术的研究进展[J].中国矫形外科杂志,2013,17(16):1625-1628.
[6]李冬生,李剑锋,张建,等.人工全膝关节置换术治疗老年重度膝关节骨性关节炎临床观察[J].山东医药,2017,57(20):74-76.
[7]陈曦,卢东霞,张凤翔.膝关节骨髓水肿综合征的MRI表现[J].医学影像学杂志,2017,27(11):2205-2207.
[8]周嵘,钱齐荣.软骨下骨在骨关节炎发病中作用的研究进展[J].中国矫形外科杂志,2014,18(21):1971-1973.
[9]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.
[10]顾力军,董福慧.疼痛客观化指标在膝骨关节炎患者膝关节功能和疼痛评价中的应用[J].中医正骨,2013,25(9):22-24.
[11] AITKEN RCB. Measurement of feeling using visual analogue scales[J]. Proceedings of the Royal Society of Medicine,1969,59(4):415-422.
[12] BELLAMY N,BUCHANAN WW,GOLDSMITH CH,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.
[13]辛雷,苏佳灿.膝关节功能评分:现状与展望[J].中国组织工程研究与临床康复,2010,4(39):7367-7370.
[14] PETERFY CG,GUERMAZI A,ZAMI S,et al. Whole-Organ,MagneticResonance,Imaging,Score(WORMS)of the knee in osteoarthritis[J]. Osteoarthr Cartilage,2004,12(3):177-190.
[15]王琳,沈鸿鹄,刘鹏飞.膝关节骨性关节炎的MRI诊断进展[J].中华临床医师杂志(电子版),2013,7(23):10883-10886.
[16]刘源,王敬威,孙乾坤,等.骨髓水肿综合征研究进展[J].亚太传统医药,2016,12(13):51-53.
[17]郑昱新,李志强,顾新丰,等.膝关节骨髓水肿综合征[J].中华关节外科杂志(电子版),2010,4(3):412-414.
[18] WILSON AL,MURPHY WA,HARDY DC,et al. Transient osteoarthritis:transient bone marrowedema[J]. Radiology,1988,167(7):757-760.
[19]徐勤光,顾新丰,郑昱新,等.骨髓水肿与骨关节炎的临床研究进展[J].中华关节外科杂志(电子版),2014,8(2):256-259.
[20]冯媛媛,罗静,师静,等.膝骨关节炎患者关节疼痛与软骨下骨髓水肿的相关性研究[J].现代生物医学进展,2018,18(6):1155-1158.
[21]朱明双,许林,吕智勇,等. MRI软骨下骨髓水肿与早期膝骨关节炎临床表现的相关性研究[J].成都医学院学报,2016,11(2):146-149.
[22]刘永强,史庆轩,郭书英.盐酸氨基葡萄糖治疗骨关节炎的临床观察[J].中国矫形外科杂志,2018,22(34):1820-1821.
[23]董蓓蓓,宫月明,杨久山.中西医结合治疗膝骨关节炎骨髓水肿疗效观察[J].世界最新医学信息文摘,2018,18(51):175-176.
[24]张同华,肖尚领.关节镜下减压治疗膝关节骨髓水肿60例探讨[J].中外医疗,2012,31(1):62-62.
[25]李文雄.中医药治疗膝骨关节炎研究进展[J].河南中医,2014,34(12):2440-2441.
[26]郑维蓬,魏合伟,黄梓基,等.从瘀论治膝骨关节炎的研究现状及展望[J].新中医,2013,45(11):122-124.
[27]邢秋娟,吴佶,戴薇薇,等.益气化瘀补肾方治疗早中期原发性膝骨关节炎临床研究[J].河南中医,2018,38(3):396-403.
[28]郝胜坤,纪斌,石继祥,等.补肾活血中药治疗膝骨关节炎的作用机制[J].中医正骨,2017,29(4):31-33.