[1]蒋薇,陈刚.海桐皮汤薰洗联合体外冲击波疗法治疗轻中度膝骨关节炎的疗效观察[J].中医正骨,2020,32(04):15-20.
　JIANG Wei,CHEN Gang.Observation on the curative effects of steaming and washing therapy with Haitongpi Tang(海桐皮汤)combined with extracorporeal shock wave therapy for treatment of mild-to-moderate knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(04):15-20.
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海桐皮汤薰洗联合体外冲击波疗法治疗轻中度膝骨关节炎的疗效观察()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年04期
页码:
15-20
栏目:
临床研究
出版日期:
2020-04-20

文章信息/Info

Title:
Observation on the curative effects of steaming and washing therapy with Haitongpi Tang(海桐皮汤)combined with extracorporeal shock wave therapy for treatment of mild-to-moderate knee osteoarthritis
作者:
蒋薇1; 陈刚2
(1.杭州市富阳区第一人民医院,浙江 杭州 311499; 2.杭州市富阳区中医院,浙江 杭州 311499)
Author(s):
JIANG Wei1; CHEN Gang2
1.The First People's Hospital of Fuyang,Hangzhou 311499,Zhejiang,China 2.Fuyang Hospital of Traditional Chinese Medicine,Hangzhou 311499,Zhejiang,China
关键词:
骨关节炎; 膝;  薰洗;  海桐皮汤;  体外冲击波疗法;  透明质酸;  白细胞介素1β;  肿瘤坏死因子α;  C反应蛋白质
Keywords:
osteoarthritis; knee;  steaming washing therapy;  Haitongpi Tang;  extracorporeal shock wave therapy;  hyaluronic acid;  interleukin-1β;  tumor necrosis factor-α;  C-reactive protein
摘要:
摘 要 目的:探讨海桐皮汤薰洗联合体外冲击波疗法治疗轻中度膝骨关节炎(knee osteoarthritis,KOA)的临床疗效。方法:共纳入KOA患者75例,男22例、女53例; 年龄50～77岁,中位数61岁; 病程3～59个月,中位数30个月; Kellgren-Lawrence影像学分级Ⅰ级13例、Ⅱ级41例、Ⅲ级21例。随机分为2组,中药联合冲击波组37例、玻璃酸钠组38例。中药联合冲击波组采用海桐皮汤薰洗联合体外冲击波治疗,中药薰洗每次30 min,每日1次,连续治疗5周; 体外冲击波治疗每周1次,共治疗5次。玻璃酸钠组采用玻璃酸钠关节腔注射治疗,每周1次,共注射5次。分别于治疗前及治疗结束后,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价患膝疼痛情况,采用西安大略和麦克马斯特大学(Western Ontario and McMasters Universities,WOMAC)骨关节炎指数从疼痛、僵硬及日常活动3个方面评价临床疗效,采用酶联免疫反应法测定患者血清白细胞介素1β(interleukin-1β,IL-1β)和肿瘤坏死因子α(tumor necrosis factor,TNF-α)的含量,采用免疫浊度法测定患者血清超敏C反应蛋白质(hypersensitive C-reactive protein,hs-CRP)的含量。结果:2组患者均顺利完成治疗。①患膝疼痛VAS评分。治疗前,2组患者患膝疼痛VAS评分的组间差异无统计学意义[(4.76±1.28)分,(4.55±1.46)分,t=0.642,P=0.523]; 治疗结束后,2组患者患膝疼痛VAS评分均低于治疗前[(4.76±1.28)分,(1.97±0.96)分,t=12.673,P=0.000;(4.55±1.46)分,(2.42±0.89)分,t=13.258,P=0.000],且中药联合冲击波组低于玻璃酸钠组(t=-2.101,P=0.039)。②患膝WOMAC骨关节炎指数。治疗前,2组患者患膝WOMAC骨关节炎指数中疼痛、僵硬、日常活动评分及总分的组间差异均无统计学意义[(10.08±2.98)分,(9.74±3.30)分,t=0.474,P=0.637;(4.19±1.02)分,(3.84±1.05)分,t=1.447,P=0.152;(34.70±4.10)分,(34.18±3.07)分,t=0.621,P=0.536;(48.97±5.89)分,(47.76±6.38)分,t=0.853,P=0.397]; 治疗结束后,2组患者WOMAC骨关节炎指数各项评分、总分均低于治疗前[中药联合冲击波组:(10.08±2.98)分,(4.16±1.42)分,t=15.979,P=0.000;(4.19±1.02)分,(1.81±0.88)分,t=20.072,P=0.000;(34.70±4.10)分,(12.95±3.55)分,t=25.644,P=0.000;(48.97±5.89)分,(18.92±3.24)分,t=30.284,P=0.000。玻璃酸钠组:(9.74±3.30)分,(4.92±1.62)分,t=13.861,P=0.000;(3.84±1.05)分,(2.34±0.97)分,t=18.248,P=0.000;(34.18±3.07)分,(14.87±4.04)分,t=25.572,P=0.000;(47.76±6.38)分,(22.11±4.83)分,t=31.744,P=0.000],且中药联合冲击波组均低于玻璃酸钠组(t=-2.154,P=0.035; t=-2.492,P=0.015; t=-2.186,P=0.032; t=-3.361,P=0.001)。③血清炎性因子含量。治疗前,2组患者血清IL-1β、TNF-α、hs-CRP含量的组间差异均无统计学意义[(72.83±10.49)pg·mL-1,(74.05±9.68)pg·mL-1,t=-0.524,P=0.602;(19.61±4.32)pg·mL-1,(18.59±4.70)pg·mL-1,t=0.980,P=0.330;(8.79±2.07)mg·L-1,(8.22±1.69)mg·L-1,t=1.297,P=0.198]; 治疗结束后,2组患者血清IL-1β、TNF-α、hs-CRP含量均低于治疗前[中药联合冲击波组:(72.83±10.49)pg·mL-1,(34.45±6.47)pg·mL-1,t=21.530,P=0.000;(19.61±4.32)pg·mL-1,(8.35±2.36)pg·mL-1,t=13.359,P=0.000;(8.79±2.07)mg·L-1,(3.61±0.91)mg·L-1,t=14.408,P=0.000。玻璃酸钠组:(74.05±9.68)pg·mL-1,(41.24±7.04)pg·mL-1,t=18.023,P=0.000;(18.59±4.70)pg·mL-1,(9.64±2.73)pg·mL-1,t=13.493,P=0.000;(8.22±1.69)mg·L-1,(4.53±0.96)mg·L-1,t=15.399,P=0.000],且中药联合冲击波组均低于玻璃酸钠组(t=-4.352,P=0.000; t=-2.176,P=0.033; t=-4.217,P=0.000)。结论:海桐皮汤薰洗联合体外冲击波疗法治疗轻中度KOA,能缓解患膝疼痛、改善患膝功能、降低血清炎性因子含量,且疗效优于玻璃酸钠关节腔注射。
Abstract:
Objective:To explore the clinical curative effects of steaming and washing therapy with Haitongpi Tang(海桐皮汤,HTPT)combined with extracorporeal shock wave therapy(ESWT)for treatment of mild-to-moderate knee osteoarthritis(KOA).Methods:Seventy-five patients with KOA were included in the study.The patients consisted of 22 males and 53 females,and ranged in age from 50 to 77 years(Median=61 yrs)and in disease course from 3 to 59 months(Median=30 months).The KOA belonged to gradeⅠ(13),Ⅱ(41)andⅢ(21)according to Kellgren-Lawrence imaging classification criteria.The patients were randomly divided into combination therapy group(37 cases)and sodium hyaluronate group(38 cases),and were treated with combination therapy of steaming and washing with HTPT and ESWT and monotherapy of intra-articular injection of sodium hyaluronate respectively.The steaming and washing therapy with HTPT was performed once a day,30 minutes at a time for consecutive 5 weeks.The ESWT and the intra-articular injection of sodium hyaluronate were performed once a week for totally 5 times.Before the treatment and after the end of the treatment,the knee pain was evaluated by using visual analogue scale(VAS)scores,the clinical curative effects were evaluated by using Western Ontario and McMaster Universities(WOMAC)osteoarthritis indexes including pain,stiffness and activity of daily living(ADL).The serum contents of interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)and the serum contents of hypersensitive C-reactive protein(hs-CRP)were measured by using enzyme-linked immunosorbent assay and immunoturbidimetry respectively.Results:The treatment was finished successfully in all patients.There was no statistical difference in knee pain VAS scores between the 2 groups before the treatment(4.76+/-1.28 vs 4.55+/-1.46 points,t=0.642,P=0.523).The knee pain VAS scores were lower after the end of the treatment compared to pre-treatment,and were lower in combination therapy group compared to sodium hyaluronate group(4.76+/-1.28 vs 1.97+/-0.96 points,t=12.673,P=0.000; 4.55+/-1.46 vs 2.42+/-0.89 points,t=13.258,P=0.000; t=-2.101,P=0.039).There was no statistical difference in the knee WOMAC osteoarthritis indexes including pain scores,stiffness scores,ADL scores and total scores between the 2 groups before the treatment(10.08+/-2.98 vs 9.74+/-3.30 points,t=0.474,P=0.637; 4.19+/-1.02 vs 3.84+/-1.05 points,t=1.447,P=0.152; 34.70+/-4.10 vs 34.18+/-3.07 points,t=0.621,P=0.536; 48.97+/-5.89 vs 47.76+/-6.38 points,t=0.853,P=0.397).The knee WOMAC osteoarthritis indexes including pain scores,stiffness scores,ADL scores and total scores were lower after the end of the treatment compared to pre-treatment,and were lower in combination therapy group compared to sodium hyaluronate group(combination therapy group:10.08+/-2.98 vs 4.16+/-1.42 points,t=15.979,P=0.000; 4.19+/-1.02 vs 1.81+/-0.88 points,t=20.072,P=0.000; 34.70+/-4.10 vs 12.95+/-3.55 points,t=25.644,P=0.000; 48.97+/-5.89 vs 18.92+/-3.24 points,t=30.284,P=0.000.sodium hyaluronate group:9.74+/-3.30 vs 4.92+/-1.62 points,t=13.861,P=0.000; 3.84+/-1.05 vs 2.34+/-0.97 points,t=18.248,P=0.000; 34.18+/-3.07 vs 14.87+/-4.04 points,t=25.572,P=0.000; 47.76+/-6.38 vs 22.11+/-4.83 points,t=31.744,P=0.000; t=-2.154,P=0.035; t=-2.492,P=0.015; t=-2.186,P=0.032; t=-3.361,P=0.001).There was no statistical difference in the serum contents of IL-1β,TNF-α and hs-CRP between the 2 groups before the treatment(72.83+/-10.49 vs 74.05+/-9.68 pg/mL,t=-0.524,P=0.602; 19.61+/-4.32 vs 18.59+/-4.70 pg/mL,t=0.980,P=0.330; 8.79+/-2.07 vs 8.22+/-1.69 mg/L,t=1.297,P=0.198).The serum contents of IL-1β,TNF-α and hs-CRP were lower after the end of the treatment compared to pre-treatment,and were lower in combination therapy group compared to sodium hyaluronate group(combination therapy group:72.83+/-10.49 vs 34.45+/-6.47 pg/mL,t=21.530,P=0.000; 19.61+/-4.32 vs 8.35+/-2.36 pg/mL,t=13.359,P=0.000; 8.79+/-2.07 vs 3.61+/-0.91 mg/L,t=14.408,P=0.000.sodium hyaluronate group:74.05+/-9.68 vs 41.24+/-7.04 pg/mL,t=18.023,P=0.000; 18.59+/-4.70 vs 9.64+/-2.73 pg/mL,t=13.493,P=0.000; 8.22+/-1.69 vs 4.53+/-0.96 mg/L,t=15.399,P=0.000; t=-4.352,P=0.000; t=-2.176,P=0.033; t=-4.217,P=0.000).Conclusion:Steaming and washing therapy with HTPT combined with ESWT can relieve the knee pain,improve the knee function and decrease the serum contents of inflammatory factors in treatment of mild-to-moderate KOA,and its curative effect is better than that of intra-articular injection of sodium hyaluronate.

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备注/Memo

备注/Memo:
(收稿日期:2019-10-15 本文编辑:杨雅)通讯作者:蒋薇 E-mail:jw7788999@126.com
更新日期/Last Update: 2020-07-31