三伏贴联合医用臭氧膝关节腔注射治疗膝骨关节炎阳虚寒凝证

目的:探讨三伏贴联合医用臭氧膝关节腔注射治疗膝骨关节炎阳虚寒凝证的临床疗效。方法:纳入膝骨关节炎阳虚寒凝证患者40例,随机分为三伏贴联合医用臭氧组和塞来昔布联合盐酸氨基葡萄糖组,每组20例。三伏贴联合医用臭氧组,采用生白芥子、延胡索、甘遂、细辛、麝香、冰片、附子制成药饼贴敷内风市、膝髎、膝海等穴,在初伏、中伏、末伏日分别贴敷1次,每次4～6 h,共贴3次;并于初伏日前10 d至末伏日后10 d内,每周行医用臭氧膝关节腔注射2次,共注射10次。塞来昔布联合盐酸氨基葡萄糖组,采用塞来昔布片和盐酸氨基葡萄糖胶囊口服,每日2次,共服5周。治疗期间2组患者均行康复功能锻炼。分别于治疗前和治疗结束后,采用酶联免疫吸附法检测患膝关节液中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)含量,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价患膝疼痛情况,采用改良Lysholm膝关节评分标准评价患膝功能。结果:治疗前2组患者患膝关节液中TNF-α含量、患膝疼痛VAS评分、患膝功能Lysholm评分比较,组间差异均无统计学意义(89. 51±11. 76)μg·L^-1,(87. 48±10. 61)μg·L^-1,t=0. 573,P=0. 570;(7. 52±0. 56)分,(7. 48±0. 61)分,t=0. 216,P=0. 830;(74. 62±7. 38)分,(75. 04±7. 52)分,t=0. 178,P=0. 859];治疗结束后,三伏贴联合医用臭氧组患膝关节液中TNF-α含量和患膝疼痛VAS评分低于塞来昔布联合盐酸氨基葡萄糖组,患膝功能Lysholm评分高于塞来昔布联合盐酸氨基葡萄糖组(41. 83±7. 85)μg·L^-1,(64. 42±8. 32)μg·L^-1,t=8. 832,P=0. 000;(2. 10±0. 25)分,(4. 02±0. 32)分,t=21. 145,P=0. 000;(88. 64±8. 35)分,(82. 12±8. 28)分,t=2. 480,P=0. 018]。结论:对于膝骨关节炎阳虚寒凝证,采用三伏贴联合医用臭氧膝关节腔注射治疗和采用塞来昔布片联合盐酸氨基葡萄糖胶囊口服治疗,均能降低患膝关节液中TNF-α含量、缓解患膝疼痛、改善患膝功能,且前者疗效优于后者。

External application of dog-days strapping combined with knee intra-articular injection of medical ozone for treatment of knee osteoarthritis with yang-deficiency and cold-congelation syndrome

Objective:To explore the clinical curative effects of dog-days strapping combined with intra-articular injection of medical ozone for treatment of knee osteoarthritis(KOA)with yang-deficiency and cold-coagulation syndrome.Methods:Forty patients with yang-deficiency and cold-coagulation type KOA were enrolled in the study and were randomly divided into group A and group B,20 cases in each group.The patients in group A were treated with medical cakes made of raw white mustard seed,rhizoma corydalis,kansui root,asarum,musk,borneol and radix aconiti carmichaeli at the acupoints including Neifengshi(内风市),Xiliao(膝髎)and Xihai(膝海)on the1 st,2 nd and last dog-day in summer respectively for consecutive 3 times,4-6 hours at a time.Moreover,the knee intra-articular injections of medical ozone were performed on patients in group A from the 10 th day before the 1 st dog-day to the 10 th day after the last dog-day,twice a week for 10 times.The patients in group B were treated with oral applications of celecoxib tablets and glucosamine hydrochloride capsules,twice a day for consecutive 5 weeks.The functional rehabilitation exercises were performed on all patients in the 2 groups during the treatment period.The content of tumor necrosis factor-α(TNF-α)in knee synovial fluid was detected by using enzyme linked immunosorbent assay(ELISA),and the knee pain and knee function were evaluated by using visual analogue scale(VAS)and modified Lysholm knee scoring standards respectively before the treatment and after the end of the treatment.Results:There was no statistical difference in the content of TNF-αin knee synovial fluid,knee pain VAS scores and Lysholm knee function scores between the 2 groups before the treatment(89.51+/-11.76 vs 87.48+/-10.61μg/L,t=0.573,P=0.570;7.52+/-0.56 vs 7.48+/-0.61 points,t=0.216,P=0.830;74.62+/-7.38 vs 75.04+/-7.52 points,t=0.178,P=0.859).The content of TNF-αin knee synovial fluid and the knee pain VAS scores were lower,and the Lysholm knee function scores were higher in group A compared to group B after the end of the treatment(41.83+/-7.85 vs 64.42+/-8.32μg/L,t=8.832,P=0.000;2.10+/-0.25 vs 4.02+/-0.32 points,t=21.145,P=0.000;88.64+/-8.35 vs 82.12+/-8.28 points,t=2.480,P=0.018).Conclusion:For patients with yang-deficiency and cold-coagulation type KOA,both combination therapy of external application of dog-days strapping and knee intra-articular injection of medical ozone and combination therapy of oral applications of celecoxib tablets and glucosamine hydrochloride capsules can reduce the content of TNF-αin knee synovial fluid,relieve knee pain and improve knee function,moreover,the former surpasses the latter in clinical curative effects.