关节镜清理联合消瘀散外敷治疗早中期KOA临床疗效分析
发布时间：2019-04-21 16:36
【摘要】：目的(1)对膝关节镜清理联合中药(消瘀散)外敷治疗早、中期KOA患者的临床疗效进行客观评价,探讨早、中期KOA患者膝关节液中IL-1、CTX-Ⅱ的含量与膝关节退行性病变的关联性。(2)明确中药(消瘀散)外敷治疗早、中期KOA的临床疗效、作用特点和优势,探寻综合治疗早、中期KOA的临床合理、安全和有效的治疗方案。方法受试者均为安徽中医药大学第一附属医院骨一科住院治疗病人,方法为临床观察,依照病例纳入标准与排除标准,共选择40例病例,随机分组为试验组和对照组均为20例。试验组除接受关节镜清理术外,术后联合中药外敷,每晚1次,连续外敷3周,对照组接受关节镜清理术及相关治疗。试验组与对照组在抗生素应用前应按无菌操作原则抽取关节液,记录VAS评分和评价膝关节Lequesne指数,分别于术后1周、4周及3个月随访时留取关节液各监测指标以及记录VAS评分与评价膝关节Lequesne指数。采用SPSS17.0对数据进行研究统计分析。结果(1)VAS疼痛评分治疗1周后,试验组的VAS疼痛评分(3.30±0.45)较治疗前明显减少(P0.05);治疗4周后与治疗前比较,试验组的VAS疼痛评分(2.84±0.84)显著减少(P0.01),对照组VAS疼痛评分(4.82±0.43)有所减少(P0.05);试验组治疗1周的后VAS疼痛评分(3.30±0.45)与治疗4周后(2.84±0.84)差异有统计学意义(P0.05);随访3个月后试验组VAS疼痛评分(2.0±0.78)比治疗前显著减少(P0.01),对照组VAS疼痛评分(3.6±1.45)比治疗前有所减少(P0.05)。说明膝关节镜清理联合消瘀散外敷治疗能明显减轻KOA患者的疼痛。(2)Lequesne指数治疗1周后,试验组的Lequesne指数(8.61±3.05)较治疗前(11.48±0.49)有降低,差异有统计学意义(P0.01);试验组治疗4周后Lequesne指数(3.23±1.92)与治疗前(11.48±0.49)比较明显降低(P0.01);试验组治疗1周后的Lequesne指数(8.61±3.05)与治疗4周后(3.23±1.92)比较,差异有统计学意义(P0.05);对照组治疗1周后Lequesne指数(10.88±2.65)与4周后(8.68±2.17)比较,差异有统计学意义(P0.05);3个月后随访,试验组的Lequesne指数(2.7±0.38)与对照组(5.6±0.36)与治疗前比较,均有统计学意义(P0.01)。说明经膝关节镜清理联合消瘀散外敷治疗可以提高KOA患者膝关节的活动度,提高患者的生活质量,且远期疗效显著。(3)膝关节液中IL-1浓度治疗1周后,试验组的膝关节液中IL-1浓度(772.35±92.38)与对照组(824.87±72.87)均有显著减少(P0.01)。与治疗前比较,治疗4周后试验组的膝关节液中IL-1浓度(390.71±168.12)与对照组(432.42±156.72)均有显著减少(P0.01);试验治疗1周后(772.35±92.38)与治疗4周后膝关节液中IL-1浓度(390.71±168.12)比较,差异有统计学意义(P0.01);与治疗前比较,随访3个月后试验组膝关节液中IL-1浓度(290.72±220.02)差异有统计学意义(P0.01)。均能显著降低膝关节液中IL-1浓度,试验组较对照组更显著。(4)膝关节液中CTX-Ⅱ浓度治疗1周后,试验组的膝关节液中CTX-Ⅱ浓度(287.15±21.32)较治疗前(388.65±20.93)明显减少(P0.05);治疗4周后与治疗前比较,试验组的膝关节液中CTX-Ⅱ浓度(218.72±35.24)显著减少(P0.01);试验组治疗1周的后膝关节液中CTX-Ⅱ浓度(287.15±21.32)与治疗4周后(218.72±35.24)差异有统计学意义(P0.05);随访3个月后试验组膝关节液中CTX-Ⅱ浓度(164.72±30.02)比治疗前显著减少(P0.01)。结论(1)膝关节镜清理术对早、中期KOA疗效确切;(2)膝关节镜清理术联合中药(消瘀散)外敷治疗早、中期KOA疗效确切,并优于单纯膝关节镜清理术;(3)早、中期KOA患者膝关节液中IL-1、CTX-Ⅱ的含量与膝关节退行性变有一定的关联性。通过临床对照研究,本课题观察关节镜清理术联合中药外敷对早、中期KOA的临床疗效,就临床疗效作用机制特点,对消瘀散的作用机制进行进一步深入研究,为为消瘀散申报新药提供了前期新的理论基础,同时为KOA的治疗提供了合理有效的治疗方案。
[Abstract]:Objective (1) To evaluate the clinical efficacy of knee arthroscopy combined with traditional Chinese medicine (Xiaoyu San) for early and mid-term KOA, and to study the relationship between the content of IL-1 and CTX-II in the knee fluid of the early and medium-term KOA patients and the degenerative changes of the knee joint. (2) Clear the clinical curative effect, function characteristics and advantages of the traditional Chinese medicine (Xiaoyu San) on the early and mid-term KOA, and explore the clinical, reasonable, safe and effective treatment plan of the early and medium-term KOA. Methods A total of 40 cases were randomly divided into the test group and the control group, according to the criteria and the exclusion criteria, and 40 cases were selected according to the criteria and the exclusion criteria. In the test group, in addition to the arthroscopic debridement, the combined external application of the traditional Chinese medicine was performed once per night for 3 weeks, and the control group received arthroscopy and related treatment. The joint fluid was extracted from the test group and the control group according to the principle of the aseptic operation before the application of the antibiotics. The VAS scores and the evaluation of the Lequesne index of the knee joint were recorded, and the monitoring indexes of the joint fluid and the scores of the VAS and the Lequesne index of the knee joint were recorded at the follow-up of 1 week,4 and 3 months after the operation. The data were analyzed and analyzed by SPSS17.0. Results (1) The VAS pain score (3.30-0.45) in the test group was significantly decreased after 1 week of treatment (P0.05). The VAS pain score (2.84-0.84) in the test group was significantly decreased after 4 weeks of treatment (P 0.01). The VAS pain score (4.82-0.43) in the control group decreased (P0.05). The post-treatment VAS pain score (3.30-0.45) and the treatment for 4 weeks (2.84-0.84) in the test group were statistically significant (P0.05). The VAS pain score (2.0-0.78) in the test group was significantly decreased after 3 months of follow-up (P 0.01), and the VAS pain score (3.6% 1.45) in the control group was lower than that before treatment (P0.05). It is indicated that the treatment of knee arthroscopy combined with the external application of Xiaoyu Powder can reduce the pain of the patients with KOA. (2) The Lequesne index (8.61-3.05) in the test group was lower than that in the pre-treatment group (11.48-0.49) after treatment for 1 week, and the difference was significant (P0.01). The Lequesne index (3.23-1.92) after 4 weeks of treatment and the pre-treatment (11.48-0.49) in the test group was significantly lower (P0.01). The Lequesne index (8.61-3.05) after 1 week of treatment and 4-week treatment (3.23-1.92) in the test group was statistically significant (P0.05); in the control group, the Lequesne index (10.88-2.65) and 4-week follow-up (8.68-2.17) were statistically significant (P0.05); and follow-up after 3 months. The Lequesne index (2.7-0.38) in the test group and the control group (5.6-0.36) were statistically significant (P0.01). The method can improve the activity of the knee joint of the KOA patients, improve the quality of life of the patients, and has obvious long-term curative effect. (3) The IL-1 concentration (772.35-92.38) in the knee fluid of the test group and the control group (824.87-72.87) were significantly reduced after 1 week of IL-1 concentration in the knee fluid (P0.01). Compared with the control group, the IL-1 concentration (390.71-156.72) in the test group and the control group (432.42-156.72) were significantly reduced after 4 weeks of treatment (P0.01), and the IL-1 concentration in the knee joint solution after 1 week (772.35-92.38) was compared with the IL-1 concentration (390.71-156.72) in the knee solution after 4 weeks of treatment. The difference was statistically significant (P0.01), and the IL-1 concentration (290.72-220.02) in the knee fluid of the test group was statistically significant after 3 months of follow-up (P0.01). And the concentration of IL-1 in the knee joint solution can be obviously reduced, and the test group is more remarkable than the control group. (4) The CTX-鈪，
本文编号：2462370
[Abstract]:Objective (1) To evaluate the clinical efficacy of knee arthroscopy combined with traditional Chinese medicine (Xiaoyu San) for early and mid-term KOA, and to study the relationship between the content of IL-1 and CTX-II in the knee fluid of the early and medium-term KOA patients and the degenerative changes of the knee joint. (2) Clear the clinical curative effect, function characteristics and advantages of the traditional Chinese medicine (Xiaoyu San) on the early and mid-term KOA, and explore the clinical, reasonable, safe and effective treatment plan of the early and medium-term KOA. Methods A total of 40 cases were randomly divided into the test group and the control group, according to the criteria and the exclusion criteria, and 40 cases were selected according to the criteria and the exclusion criteria. In the test group, in addition to the arthroscopic debridement, the combined external application of the traditional Chinese medicine was performed once per night for 3 weeks, and the control group received arthroscopy and related treatment. The joint fluid was extracted from the test group and the control group according to the principle of the aseptic operation before the application of the antibiotics. The VAS scores and the evaluation of the Lequesne index of the knee joint were recorded, and the monitoring indexes of the joint fluid and the scores of the VAS and the Lequesne index of the knee joint were recorded at the follow-up of 1 week,4 and 3 months after the operation. The data were analyzed and analyzed by SPSS17.0. Results (1) The VAS pain score (3.30-0.45) in the test group was significantly decreased after 1 week of treatment (P0.05). The VAS pain score (2.84-0.84) in the test group was significantly decreased after 4 weeks of treatment (P 0.01). The VAS pain score (4.82-0.43) in the control group decreased (P0.05). The post-treatment VAS pain score (3.30-0.45) and the treatment for 4 weeks (2.84-0.84) in the test group were statistically significant (P0.05). The VAS pain score (2.0-0.78) in the test group was significantly decreased after 3 months of follow-up (P 0.01), and the VAS pain score (3.6% 1.45) in the control group was lower than that before treatment (P0.05). It is indicated that the treatment of knee arthroscopy combined with the external application of Xiaoyu Powder can reduce the pain of the patients with KOA. (2) The Lequesne index (8.61-3.05) in the test group was lower than that in the pre-treatment group (11.48-0.49) after treatment for 1 week, and the difference was significant (P0.01). The Lequesne index (3.23-1.92) after 4 weeks of treatment and the pre-treatment (11.48-0.49) in the test group was significantly lower (P0.01). The Lequesne index (8.61-3.05) after 1 week of treatment and 4-week treatment (3.23-1.92) in the test group was statistically significant (P0.05); in the control group, the Lequesne index (10.88-2.65) and 4-week follow-up (8.68-2.17) were statistically significant (P0.05); and follow-up after 3 months. The Lequesne index (2.7-0.38) in the test group and the control group (5.6-0.36) were statistically significant (P0.01). The method can improve the activity of the knee joint of the KOA patients, improve the quality of life of the patients, and has obvious long-term curative effect. (3) The IL-1 concentration (772.35-92.38) in the knee fluid of the test group and the control group (824.87-72.87) were significantly reduced after 1 week of IL-1 concentration in the knee fluid (P0.01). Compared with the control group, the IL-1 concentration (390.71-156.72) in the test group and the control group (432.42-156.72) were significantly reduced after 4 weeks of treatment (P0.01), and the IL-1 concentration in the knee joint solution after 1 week (772.35-92.38) was compared with the IL-1 concentration (390.71-156.72) in the knee solution after 4 weeks of treatment. The difference was statistically significant (P0.01), and the IL-1 concentration (290.72-220.02) in the knee fluid of the test group was statistically significant after 3 months of follow-up (P0.01). And the concentration of IL-1 in the knee joint solution can be obviously reduced, and the test group is more remarkable than the control group. (4) The CTX-鈪，
本文编号：2462370
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