改良海桐皮汤熏洗联合玻璃酸钠关节腔注射治疗早中期的膝关节骨性关节炎的临床研究

发布时间：2018-07-29 19:25

【摘要】：目的：探讨膝关节骨性关节炎的中西医研究进展,观察改良海桐皮汤熏洗配合玻璃酸钠关节腔注射治疗早中期膝关节骨性关节炎的临床疗效及安全性,探讨其作用机理,探索中西医治疗本病的新思路和新方法,同时为临床中医治疗膝关节骨性关节炎提供客观的科学依据。方法：选取60例符合标准的患者,将其随机分为治疗组与对照组,其中治疗组34例,对照组26例。治疗组采用改良海桐皮汤熏洗配合玻璃酸钠注射液关节腔注射,对照组仅使用玻璃酸钠注射液关节腔注射,1个月为一个疗程。通过中医症状评分评估两组患者中医症状的改善情况；采用VAS评分法评估两组患者膝关节的疼痛程度的改善情况；使用Lysholm膝关节功能评分量表评估两组患者膝关节功能活动的恢复情况。采用SPSS19.0软件对本次研究数据进行统计学分析。结果：(1)基线资料分析：治疗前两组患者的基线资料及基本病情差异均无统计学意义(P0.01),在此基础上进行临床试验,可信度较高。(2)疗效分析：①改善症状：从中医症状积分来分析,治疗结束后,治疗组的症状积分由56.32分降至17.56分,对照组由58.15分降至30.08分。两组组内比较,P0.01,差异有统计学意义。两组治疗后组间比较,P0.01,差异有统计学意义。说明两组均可改善症状,但治疗组改善临床症状的程度明显优于对照组；从中医症状疗效来分析,治疗结束后,治疗组的总有效率为94.12%,对照组的总有效率为76.92%。经χ2检验,P=0.025,P0.05,两组有效率差异有统计学意义,即治疗组的疗效优于对照组。②减轻疼痛：从膝关节疼痛评分的变化来分析,治疗结束后,治疗组的疼痛积分由6.45分降至2.17分,对照组由6.49分降至4.57分。两组组内比较,P0.01,差异有统计学意义。两组治疗后组间比较,P0.01,差异有统计学意义。说明两组均可减轻患者的疼痛,但是治疗组减轻疼痛的效果更优于对照组。③改善关节功能活动：从Lysholm膝关节功能评分的变化来分析,治疗结束后,治疗组的功能评分由58.24分升至80.32分,对照组由59.23分升至73.73分。两组组内比较,P0.01,差异具有统计学意义。两组治疗后组间比较,P0.01,差异具有统计学意义。说明两组均能改善膝关节的功能活动,但是治疗改善功能活动的效果优于对照组。(3)安全性分析：治疗期间观察患者治疗前后有无临床感染及其他不适,定期监测患者血常规、生化等检查,均未见不良反应及毒副作用。结论：导师以《医宗金鉴·正骨心法要旨》中的海桐皮汤为基础,结合多年临床经验,选取其中主要药物组成协定方,使用中药熏洗的方法,用以治疗肢体功能活动障碍。本次课题研究证明,使用改良海桐皮汤熏洗配合玻璃酸钠关节腔注射治疗早中期的膝关节骨性关节炎对改善膝关节的中医症状、缓解膝关节疼痛、消除膝关节肿胀以及恢复膝关节功能活动均有不错的疗效,安全性较好,具有一定临床应用的价值,值得深入研究。
[Abstract]:Objective: To investigate the progress of traditional Chinese and Western Medicine on osteoarthritis of knee joint, to observe the clinical efficacy and safety of modified hyaluronas fumigation and sodium hyaluronate injection in the treatment of knee osteoarthritis in the early and middle stages, explore its mechanism, explore new ideas and methods for the treatment of this disease by traditional Chinese medicine and traditional Chinese medicine, and treat the knee in clinical traditional Chinese medicine. Objective to provide an objective scientific basis for osteoarthritis of the joint. Methods: 60 patients were randomly divided into the treatment group and the control group, including 34 cases in the treatment group and 26 cases in the control group. The treatment group was treated with modified Haitong skin soup fumigation and Sodium Hyaluronate Injection joint injection, and the control group only used Sodium Hyaluronate Injection joint cavity. Injection, 1 months as a course of treatment. The improvement of TCM symptoms in two groups of patients was evaluated by TCM symptom score; the improvement of the pain degree of knee joint in two groups of patients was evaluated by VAS score; and the recovery of functional activity of knee joint in the two groups was evaluated using the Lysholm knee function score scale. The SPSS19.0 software was used. Statistical analysis of the data. Results: (1) baseline data analysis: the baseline data and basic condition difference of the two groups before treatment were not statistically significant (P0.01), and on the basis of the clinical trials, the reliability was higher. (2) the analysis of the curative effect: (1) the improvement of the symptoms: from the TCM symptom score, after the treatment ended, the treatment was treated. The symptom score of the group was reduced from 56.32 points to 17.56 points, and the control group was reduced from 58.15 to 30.08. The difference between the two groups was statistically significant. The difference was statistically significant between the two groups after treatment. The difference between the two groups was statistically significant. The two groups could improve the symptoms, but the improvement of the clinical symptoms in the treatment group was obviously superior to the control group; from the traditional Chinese medicine symptoms, the treatment group was significantly better than the control group. The symptoms of the treatment group were significantly better than the control group; from the traditional Chinese medicine symptoms, the symptoms were significantly better than the control group. After the treatment, the total effective rate of the treatment group was 94.12%, the total effective rate of the control group was 76.92%. by chi 2 test, P=0.025, P0.05, the two groups had significant difference in efficiency, that is, the curative effect of the treatment group was better than the control group. The integral from 6.45 points to 2.17 points, the control group from 6.49 to 4.57 points. The two group comparison, P0.01, the difference has statistical significance. Two groups after treatment group comparison, P0.01, the difference has statistical significance. The two groups can reduce the pain of the patients, but the treatment group to alleviate pain is better than the control group. Thirdly, improve joint functional activity: improve the effect of joint function: From the change of Lysholm knee function score, after the treatment, the function score of the treatment group was from 58.24 to 80.32, and the control group was from 59.23 to 73.73. The two group was compared, P0.01, the difference has statistical significance. The two groups after treatment group comparison, P0.01, difference has statistical significance. It shows that two groups can improve the knee joint. Functional activities were better than those of the control group. (3) safety analysis: during the treatment, there were no clinical infection and other discomfort before and after treatment, regular monitoring of patients' blood routine, biochemical examination, and no adverse reactions and side effects. On the basis of the Haitong skin soup, combined with many years of clinical experience, the main drug components are selected and used to treat the dysfunction of limb function. This study has proved that the modified hyaluronas and sodium hyaluronate are used for the treatment of knee osteoarthritis in the early and middle stages to improve the knee osteoarthritis. The TCM symptoms of joint have good curative effect on relieving knee pain, eliminating swelling of knee joint and restoring the function of knee joint. It has good safety and value of clinical application. It is worth studying in depth.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R684.3

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