关节镜清理联合术后针刺与鸡尾酒疗法治疗膝骨关节炎

目的探讨术后针刺联合鸡尾酒疗法辅助关节镜有限清理术治疗膝骨关节炎(KOA)的临床疗效。 方法筛选2012年01月至2014年06月在北京中医药大学东直门医院骨1科收治68例Kellgren &Lawrence( K-L) 1、2级的膝骨关节炎患者行膝关节镜下有限清理术。其中,A组采用"(200 mg罗哌卡因、5 mg肾上腺素,1 mg倍他米松由生理盐水稀释至100 ml)鸡尾酒"灌洗液辅助关节镜有限清理术结合术后针刺治疗;B组采用单纯关节镜有限清理术结合术后针刺治疗;C组采用鸡尾酒灌洗液辅助关节镜有限清理术治疗;D组采用单纯关节镜有限清理术治疗;每组17例。分别比较术前、术后1个月、术后3个月、术后6个月及术后12个月时4组患者的膝关节疼痛视觉模拟量表(VAS)评分、健康调查简表(SF-36)评分及Lysholm膝关节评分,比较4组术后症状缓解效果和关节功能改善状况。4组组间评分数值采用重复测量方差分析,组内两两比较采用LSD检验,定性资料采用卡方检验。 结果4组患者在手术前后VAS评分、SF-36评分和Lysholm膝关节功能评分差异均有统计学意义(均为P <0.05)。术后1、3、6、12个月的各组间评分比较差异也有统计学意义(均为P <0.05)。手术后1个月随访时,A组与B组比较,VAS评分(t＝3.728)、SF-36评分(t＝5.409)和Lysholm膝关节功能评分(t＝5.385)均明显改善,差异具有统计学意义(P <0.05);A组患者与C组比较,VAS评分(t＝2.812)、SF-36评分(t＝10.653)和Lysholm膝关节功能评(t＝12.160)分均明显改善,统计学分析具有显著性差异(P <0.05);A组患者与D组比较,VAS评分(t＝6.603)、SF-36评分(t＝17.04)和Lysholm膝关节功能评分(t＝23.835)均明显改善,统计学分析均具有显著性差异(P <0.05)。 结论术后针刺联合鸡尾酒疗法在关节镜下有限清理治疗KOA,能明显缓解临床症状、体征,改善关节活动功能,其疗效优于其他3组,有利于增加患者满意度,促进关节功能的早期康复,是值得推荐的一种中西医结合治疗KOA的疗法。

Postoperative acupuncture combining cocktail therapy assists arthroscopic debridement for treatment of knee osteoarthritis

ObjectiveTo investigate the clinical effects of acupuncture combined with cocktail therapy in the treatment of knee osteoarthritis (KOA) with limited arthroscopic debridement. MethodsFrom January 2012 to June 2014, 68 cases with KOA of Kellgren & Lawrence (K-L) stage one and two in department of orthopaedics of Dongzhimen Hospital, were treated with limited debridement under knee arthroscope. Among them, group A used "cocktail (200 mg ropivacaine, 5 mg epinephrine, 1 mg betamethasone diluted in 100 ml saline)" lavage fluid assisting arthroscopic limited debridement combining post-operative acupuncture treatment; group B used simple arthroscopic limited debridement combining postoperative acupuncture; group C was treated with a cocktail lavage solution and limited debridement with arthroscopy; and group D was treated with limited debridement arthroscopic treatment. Each group included 17 cases. The visual analogue scale (VAS) score, the short-form health survey (SF-36) score and the Lysholm knee score were compared between preoperative time point and at the postoperative one month, three months, six months and 12 months. The postoperative symptom relief and joint function improvement of the four groups were also compared. Repeated measurement of variance analysis and chi-square test were used for statistical analysis. ResultsThe VAS score, SF-36 score and Lysholm knee functional score were significantly different comparing the data before and after the operation in the four groups (P<0.05). At postoperative one month, three months, six months and 12 months, the evaluation scores among the four groups also showed significant differences (P<0.05). Compared with group B, VAS scores (t=3.728), SF-36 scores (t=5.409) and Lysholm knee functional scores (t=5.385) of group A were significantly improved (P<0.05). Compared with group C, VAS scores (t=2.812), SF-36 scores (t=10.653) and Lysholm scores (t=12.160) of group A were also significantly improved (P<0.05). Compared with group C, VAS scores (t=6.603), SF-36 scores (t=17.04) and Lysholm scores (t=23.835) were significantly improved in group A after the operation (P<0.05). ConclusionAcupuncture combined with cocktail therapy in arthroscopic limited debridement in the treatment of KOA, can significantly alleviate the clinical symptoms, improve joint activity function, showing better curative effect than simple debridement, also increase patient satisfaction, promote the early rehabilitation of joint function, which is worthy of recommendation for the therapy of KOA.