针刀联合臭氧关节腔内注射治疗膝骨性关节炎的临床疗效研究

发布时间：2018-12-17 11:59

【摘要】：骨性关节炎最早是由Garrod在1890年提出的[1]。膝关节骨性关节炎(Knee Osteoarthritis)是累及关节软骨、滑膜及关节周围组织的一种慢性无菌性炎症,又称增生性膝关节炎、老年性膝关节炎、退行性膝关节炎、肥大性膝关节炎。按美国风湿病协会[2]分类,KOA可分为原发性和继发性两大类;前者确切病因尚不明确,可能与性别、年龄、职业、种族、遗传和劳损等因素相关;后者可继发于膝关节损伤、半月板损伤、关节内或关节周围骨折、关节韧带损伤、先天畸形或关节感染等。临床根据病情的程度主要表现为膝关节疼痛,负重尤甚,关节僵硬,活动受限,关节内有骨摩擦音,日久肌肉痿废不用,关节畸形等症状,严重者导致下肢残疾。有调查显示,60岁以上的人群中OA的患病率可达50%,75岁的人群达80%,其中20%~30%有临床症状,致残率高达53%[3]。有统计显示在全球范围的致残疾病中膝关节骨性关节炎排名第十一位[4]。膝关节骨性关节炎给患者的身心带来的摧残不言而喻,因此针对该病的有效治疗显得尤为关键。目前膝关节骨性关节炎的治疗方法主要包括:物理治疗、药物治疗、手术治疗、小针刀微创疗法、关节腔注射疗法、中医中药治疗、软骨或软骨细胞治疗、基因治疗等。长期口服药物治疗存在药物毒副作用及耐药性的问题,手术治疗主要针对病情严重者,但手术治疗存在费用高、风险大、康复时间相对较长的弊端,中医中药治疗相比而言是一种绿色、安全、有效的疗法,并广泛应用于膝骨性关节炎的治疗中,但也存在一些诸如治疗周期长、疗效不持久等问题。临床上常依据患者病情选择一种或多种治疗方法联合治疗。目前,针刀联合臭氧、玻璃酸钠等治疗膝关节炎已较为广泛地应用于临床,通过治疗方案的改进,也取得了不错的疗效。本课题正是在现有研究的基础上,进一步探讨针刀联合臭氧关节腔内注射治疗膝骨性关节炎的临床疗效。研究目的观察针刀联合臭氧关节腔内注射治疗膝骨性关节炎的临床疗效。研究方法从十堰市太和医院康复治疗中心门诊部选取60例符合本试验诊断标准和纳入标准的单膝骨性关节炎患者,按随机数字表均分为两组,采用单盲法(盲病人)每组各30例。治疗前两组患者的年龄、性别、病程等一般资料比较,经统计学分析,差异均无统计学意义(p0.05),两组受试者具有可比性。签署知情同意书。治疗组采用针刀联合臭氧关节腔内注射治疗:先行针刀治疗,针刀术后即行臭氧关节腔内注射,间隔7天行下一次治疗,2次为1疗程。对照组采用针刀松解术治疗,治疗2个疗程。利用膝关节疼痛评分VAS量表及膝关节功能障碍评分Lysholm量表对患者膝关节疼痛及功能障碍进行评分,评估两组患者疗程结束后病情状况。研究结果治疗组和对照组治疗膝骨性关节炎均有较好的疗效。治疗组总有效率为93.33%,对照组总有效率为76.67%,可见治疗组疗效较对照组更优(p0.05)。两组治疗前后VAS评分均降低(p0.05),Lysholm评分均升高(p0.05),治疗组VAS评分降低较对照组更明显(p0.01),治疗组Lysholm评分升高较治疗组更显著(p0.01),说明针刀联合臭氧关节腔内注射治疗KOA较单纯针刀治疗KOA在改善患者疼痛及功活动方面效果更佳。结论治疗组及对照组均能改善膝骨性关节炎的疼痛等症状,提高其日常活动能力,但针刀联合臭氧关节腔内注射治疗膝骨性关节炎的疗效优于对照组针刀术治疗,值得临床推广运用。
[Abstract]:Osteoarthritis was first proposed by Garros in 1890[1]. Knee Osteoarthritis (Knee Osteoarthritis) is a kind of chronic aseptic inflammation involving the articular cartilage, the synovium and the surrounding tissues of the joint, also known as proliferative and knee-arthritis, senile knee arthritis, degenerative knee arthritis, and hypertrophic knee arthritis. According to the classification of the American Institute of Rheumatology[2], KOA can be divided into primary and secondary categories; the exact cause of the former is not clear and may be related to factors such as sex, age, occupation, race, heredity and strain; the latter can be secondary to knee injury, meniscal injury, In-articular or periarticular fracture, joint ligament injury, congenital malformation, or joint infection, etc. The clinical condition is mainly characterized by the pain of the knee joint, the weight of the bearing, the rigidity of the joint, the limitation of the activity, the bone friction sound in the joint, no use of the long-time muscle, no use of the joint, and the like, and the severe person has the disability of the lower limb. According to the survey, the prevalence of OA in the population over 60 years of age can reach 50%, the 75-year-old population is 80%, of which 20% to 30% have clinical symptoms, and the disability rate is 53%[3]. There is a statistical display of the eleventh[4] of the knee osteoarthritic arthritis in the global range of disabling diseases. The physical and psychological damage of the knee-bone arthritis to the patient is self-evident, and therefore the effective treatment of the disease is particularly critical. At present, the treatment method of the knee joint bone arthritis mainly comprises the physical treatment, the medicine treatment, the operation treatment, the small needle knife minimally invasive therapy, the joint cavity injection therapy, the traditional Chinese medicine treatment, the cartilage or the chondrocyte treatment, the gene therapy and the like. the traditional Chinese medicine is a green, safe and effective therapy compared with the traditional Chinese medicine treatment, It is widely used in the treatment of knee-bone arthritis, but there are some problems such as long treatment period, long curative effect and the like. A combination of one or more treatment methods is often selected based on the patient's condition. At present, the treatment of knee arthritis with the combination of the needle knife with ozone and sodium hyaluronate has been widely used in the clinic, and has achieved good curative effect through the improvement of the treatment plan. On the basis of the existing research, this paper further discusses the clinical curative effect of needle-knife combined with ozone joint in the treatment of knee-bone arthritis. Objective To observe the clinical effect of needle-knife combined with ozone joint in the treatment of knee-bone arthritis. In the study, 60 patients with single-knee osteoarthria were selected from the outpatient department of the Taihe Hospital of the Shiyan city and the hospital, and each group was divided into two groups according to the random digital form, and 30 cases of each group were used in single blind method (blind patient). There was no significant difference in the age, sex and course of the two groups in the first two groups (p0.05), and the two groups were comparable. Sign the informed consent form. The treatment group was treated with a needle-knife combined with an ozone-joint cavity for treatment: the first-hand knife treatment, the operation of the needle-knife, the internal injection of the ozone joint cavity, the next treatment at the interval of 7 days, and the second time being a course of treatment. In the control group, the needle knife was used for the treatment of 2 treatment courses. The patient's knee pain and dysfunction were assessed by using the knee pain score VAS scale and the Lysholm scale of the knee joint dysfunction score, and the condition of the two groups of patients was assessed. The results showed that the treatment group and the control group had good curative effect on the treatment of knee-bone arthritis. The total effective rate of the treatment group was 93.3%, the total effective rate of the control group was 70.67%, and the curative effect of the treatment group was better than that of the control group (p0.05). The VAS scores of the two groups decreased (p0.05) and the Lysholm scores increased (p0.05), and the VAS score of the treatment group was lower than that of the control group (p0.01), and the increase of the Lysholm score in the treatment group was higher than that of the treatment group (p0.01). It is indicated that the treatment of KOA with the combination of needle-knife and ozone joint in the treatment of KOA is more effective in improving the pain and work activity of the patient. Conclusion The treatment group and the control group can improve the pain and other symptoms of the knee-bone arthritis, and improve the daily activity, but the curative effect of the needle-knife combined with the ozone joint cavity for treating the knee-bone arthritis is superior to that of the control group, which is worthy of clinical popularization and application.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

【参考文献】