黄芪桂枝五物汤结合关节镜治疗膝骨性关节炎的疗效观察

发布时间：2018-05-28 11:28

本文选题：膝骨性关节炎 + 黄芪桂枝五物汤　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:1.客观的评价黄芪桂枝五物汤联同膝关节镜清理术治疗早中期KOA的临床疗效。2.探究黄芪桂枝五物汤结合膝关节镜清理术,对于KOA的特色优势与其作用特点,为膝关节镜清理术与黄芪桂枝五物汤在临床上结合使用提供循证医学依据。方法:选取2015年12月至2017年2月在云南中医学院第一附属医院骨一科及骨四科的采取膝关节镜治疗,中医辨证属于气血不足证的住院患者60例,按照随机数字表法分为两组,治疗组30例,对照组30例。两组患者在性别、年龄、病程、X线分级、VAS评分、WOMAC评分和膝关节温差方面无明显差异(p0.05),治疗前整体情况具有可比性。黄芪桂枝五物汤(黄芪30g、桂枝10g、芍药10g、生姜25g、大枣4枚,每剂汤药制成3袋合剂,每袋100ml,每天服用2次)结合膝关节镜方案作为治疗组,做完手术之后第二天服用中药;对照组则使用塞来昔布结合膝关节镜治疗。两组都定期评价患者治疗前后疗效。结果:1.VAS评分:试验组患者治疗1周后VAS评分与对照组相比不具有显著性差异(p0.05);试验组患者治疗2周、3周、4周后VAS评分,与对照组相比,具有显著性差异(p0.05);试验组与对照组治疗4周后的VAS评分与治疗前相比均具有显著性差异(p0.05)。2.WOMAC综合评分:试验组患者治疗1周后WOMAC综合评分与对照组相比不具有显著性差异(p0.05);试验组患者治疗2周、3周、4周后WOMAC综合评分,与对照组相比,具有显著性差异(p0.05);试验组与对照组治疗4周后的WOMAC综合评分与治疗前相比均具有显著性差异(p0.05)。3.膝关节皮温差:试验组患者治疗1天后、治疗10天后皮温差与对照组相比,无明显差异(p0.05);试验组治疗4天、7天后膝关节温差与对照组相比,具有显著性差异(p0.05)。4.疗效评定:治疗1周后WOMAC评分疗效评定与对照组相比无显著统计学差异(p0.05);试验组治疗2周、3周、4周后WOMAC评分疗效评定与对照组相比具有统计学差异(p0.05)。5.安全性评定:住院治疗及之后的随访中,未发现患者有明显的不良反应,两组各个患者治疗前后的安全性评价指标和实验室检验指标均未超出正常值范畴。结论:1.在缓解患者症状,改善膝关节功能方面,膝关节镜术后配合使用黄芪桂枝五物汤的效果较之塞来昔布的疗效更显著。2.进一步证实膝关节镜清理术对于早中期KOA的治疗具有显著的效果。3.住院治疗及患者出院后的随访中,黄芪桂枝五物汤和膝关节镜清理术都有明显的疗效,把二者结合一并用于治疗疗效更加确切。黄芪桂枝五物汤阻断产生疼痛的相关病理因子,膝关节镜清理了大部分的产生疼痛的累积因素。但值得注意的是,原始病例资料中个别患者评分甚至有所回升,功能评分有所下降,这种治疗方法并没有从根本上改变的膝关节的退变过程,随着时间迁移,患者的KOA有可能加重,但两者结合治疗的总体疗效显著。4.中药名方黄芪桂枝五物汤的安全性高,没有明显的不良反应。
[Abstract]:Purpose 1. Objective to evaluate the clinical efficacy of Huangqi Guizhi Wuwu decoction combined with knee arthroscopy in the treatment of KOA in early and middle period. To explore the characteristics of Huangqi Guizhi Wuwu decoction combined with arthroscopic debridement for KOA, and to provide evidence based medicine basis for the clinical application of Astragalus Guizhi Wuwu decoction and knee arthroscopic debridement combined with Huangqi Guizhi Wuwu decoction. Methods: from December 2015 to February 2017, 60 inpatients who were treated with knee arthroscopy in the first affiliated Hospital of Yunnan Institute of traditional Chinese Medicine were divided into two groups according to the method of random digital table. There were 30 cases in the treatment group and 30 cases in the control group. There was no significant difference between the two groups in sex, age, course of disease and VAS score, WOMAC score and knee joint temperature difference (P 0.05), and the overall situation was comparable before treatment. Huangqi Guizhi Wuwu decoction (Astragalus 30 g, Guizhi 10g, Paeoniflorin 10g, ginger 25g, jujube 4) was made into 3 bags of mixture, 100 ml per bag, 2 times a day) combined with knee arthroscopy as the treatment group, the second day after the operation took Chinese medicine; The control group was treated with celecoxib combined with knee arthroscopy. Both groups regularly evaluated the efficacy before and after treatment. Results 1. VAS score: there was no significant difference in VAS score between the experimental group and the control group after 1 week of treatment (p0.05), while the VAS score in the trial group was significantly different from that in the control group after 2 weeks and 3 weeks, and 4 weeks after treatment, compared with the control group. There were significant differences in VAS scores between the test group and the control group after 4 weeks of treatment. 2. WOMAC comprehensive score: there was no significant difference in the WOMAC score between the trial group and the control group after 1 week of treatment. The WOMAC scores of the patients in the trial group were evaluated after 2 weeks and 3 weeks of treatment and 4 weeks after treatment. Compared with the control group, there was a significant difference in the WOMAC scores between the experimental group and the control group after 4 weeks of treatment, and there was a significant difference between the experimental group and the control group after 4 weeks of treatment compared with before treatment. Knee joint skin temperature difference: after 1 day of treatment, 10 days after treatment, there was no significant difference in skin temperature difference between the test group and the control group, and there was significant difference in the knee joint temperature difference between the experimental group and the control group after 4 days and 7 days. Evaluation of curative effect: there was no significant difference in WOMAC score between the treatment group and the control group after 1 week of treatment (p 0.05), but there was significant difference in the evaluation of the effect of WOMAC score between the two groups after 2 weeks and 3 weeks and 4 weeks after treatment compared with the control group (P 0.05. 5). Safety assessment: no significant adverse reactions were found during hospitalization and follow-up. The safety evaluation indexes and laboratory test indexes of each group before and after treatment did not exceed the normal range. Conclusion 1. In relieving symptoms and improving knee function, the effect of Huangqi Guizhi Wuwu decoction combined with Huangqi Guizhi Wuwu decoction after knee arthroscopy was more significant than that of celecoxib. It is further confirmed that arthroscopic debridement has a significant effect on the treatment of KOA in early and middle stage. 3. 3. During hospitalization and follow-up, Huangqi Guizhi Wuwu decoction and knee arthroscopic debridement have obvious curative effect. Huangqi Guizhi Wuwu decoction blocked the related pathological factors of pain, and knee arthroscopy cleaned up most of the cumulative factors of pain. However, it is worth noting that the scores of individual patients in the original case data have even recovered, and the functional score has declined. This treatment method does not fundamentally change the process of degeneration of the knee joint, and it moves over time. Patients with KOA may be aggravated, but the combined treatment of the overall efficacy is significant. 4. 4. Huangqi Guizhi Wuwu decoction, a famous prescription of traditional Chinese medicine, has high safety and no obvious adverse reactions.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684.3

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