[1]倪力刚,胡劲涛.关节镜清理术联合中药薰蒸与单纯关节镜清理术治疗 早期膝骨关节炎的对比研究[J].中医正骨,2015,27(12):41-45.
　NI Ligang,HU Jintao.A retrospective trial of arthroscopic debridement integrated and nonintegrated with Chinese herbal steaming for treatment of early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):41-45.
点击复制

关节镜清理术联合中药薰蒸与单纯关节镜清理术治疗 早期膝骨关节炎的对比研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期数:
2015年12期
页码:
41-45
栏目:
临床研究
出版日期:
2015-12-30

文章信息/Info

Title:
A retrospective trial of arthroscopic debridement integrated and nonintegrated with Chinese herbal steaming for treatment of early knee osteoarthritis
作者:
倪力刚1; 胡劲涛2
1.浙江省杭州市余杭区第五人民医院,浙江 杭州 311100;
2.浙江省绍兴市柯桥区中医医院,浙江 绍兴 312030
Author(s):
NI Ligang1; HU Jintao2
1.The Fifth People's Hospital of Yuhang district in Hangzhou City,Hangzhou 311100,Zhejiang,China
2.Keqiao Hospital of Traditional Chinese Medicine in Shaoxing City,Shaoxing 312030,Zhejiang,China
关键词:
骨关节炎; 膝;  关节镜检查;  薰洗;  治疗; 临床研究性
Keywords:
osteoarthritis; knee;  arthroscopy;  steaming washing therapy;  therapies; investigational
摘要:
目的:比较关节镜清理术联合中药薰蒸与单纯关节镜清理术治疗早期膝骨关节炎的临床疗效。方法:回顾性分析64例早期膝骨关节炎患者的病例资料,其中采用单纯关节镜清理术治疗35例,采用关节镜清理术联合中药薰蒸治疗29例。男26例,女38例。年龄53～67岁,中位数59岁。按照骨关节炎Kellgren-Lawrence影像学分级,Ⅰ级22例、Ⅱ级42例。分别比较术前、术后6个月及术后12个月时2组患者的膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、健康调查简表(36-item short form health survey,SF-36)评分及Lysholm膝关节评分。结果:手术前后不同时间点膝关节疼痛VAS评分比较,差异有统计学意义,存在时间效应(F=1032.375,P=0.000); 2组患者膝关节疼痛VAS评分比较,组间差异有统计学意义,存在分组效应(F=6.772,P=0.012); 术前2组患者膝关节疼痛VAS评分比较,差异无统计学意义[(8.2±0.8)分,(8.3±0.7)分,t=0.354,P=0.554]; 术后6个月和术后12个月,关节镜清理术联合中药薰蒸组的膝关节疼痛VAS评分均低于单纯关节镜清理术组[(1.2±1.0)分,(1.9±1.0)分,t=7.512,P=0.008;(2.0±1.0)分,(2.6±1.0)分,t=4.326,P=0.042]; 时间因素和分组因素存在交互效应(F=3.567,P=0.031)。手术前后不同时间点SF-36评分比较,差异有统计学意义,存在时间效应(F=2501.188,P=0.000); 2组患者SF-36评分比较,组间差异有统计学意义,存在分组效应(F=40.308,P=0.000); 术前2组患者SF-36评分比较,差异无统计学意义[(55.5±3.6)分,(56.0±3.7)分,t=0.363,P=0.549]; 术后6个月和术后12个月,关节镜清理术联合中药薰蒸组的SF-36评分均高于单纯关节镜清理术组[(91.7±3.0)分,(87.9±2.9)分,t=25.938,P=0.000;(88.8±2.6)分,(83.7±3.2)分,t=55.254,P=0.000]; 时间因素和分组因素存在交互效应(F=9.868,P=0.000)。手术前后不同时间点Lysholm膝关节评分比较,差异有统计学意义,存在时间效应(F=1980.728,P=0.000); 2组患者Lysholm膝关节评分比较,组间差异有统计学意义,存在分组效应(F=39.257,P=0.000); 术前2组患者Lysholm膝关节评分比较,差异无统计学意义[(52.3±3.8)分,(52.3±3.7)分,t=0.004,P=0.950]; 术后6个月和术后12个月,关节镜清理术联合中药薰蒸组的Lysholm膝关节评分均高于单纯关节镜清理术组[(90.5±2.8)分,(87.0±3.2)分,t=20.987,P=0.000;(88.5±3.1)分,(82.8±4.3)分,t=35.725,P=0.000]; 时间因素和分组因素存在交互效应(F=9.744,P=0.000)。结论:关节镜清理术联合中药薰蒸治疗早期KOA,能够缓解或消除膝关节疼痛,改善膝关节功能,提高患者生活质量,其疗效优于单纯关节镜清理术,值得临床推广应用。
Abstract:
Objective:To compare the clinical curative effects of combination therapy of arthroscopic debridement and Chinese herbal steaming versus monotherapy of arthroscopic debridement in the treatment of early knee osteoarthritis(KOA).Methods:The medical records of 64 patients with early KOA were analyzed retrospectively.Thirty-five patients were treated with monotherapy of arthroscopic debridement(monotherapy group)while the others were treated with combination therapy of arthroscopic debridement and Chinese herbal steaming(combination therapy group).The patients consisted of 26 males and 38 females,and ranged in age from 53 to 67 years(Median=59 yrs).According to Kellgren-Lawrence imaging classification,the KOA belonged to typesⅠ(22)andⅡ(42).The visual analogue scale (VAS)scores,36-item short form health survey(SF-36)scores and Lysholm knee scores were compared between the 2 groups before the surgery and at 6 and 12 months after the surgery respectively.Results:There was statistical difference in the knee pain VAS scores between different time points,in other words,there was time effect(F=1032.375,P=0.000).There was statistical difference in the knee pain VAS scores between the two groups,in other words,there was group effect(F=6.772,P=0.012).There was no statistical difference in preoperative knee pain VAS scores between the 2 groups(8.2+/-0.8 vs 8.3+/-0.7 points,t=0.354,P=0.554).The knee pain VAS scores were lower in combination therapy group compared to monotherapy group at 6 and 12 months after the surgery(1.2+/-1.0 vs 1.9+/-1.0 points,t=7.512,P=0.008; 2.0+/-1.0 vs 2.6+/-1.0 points,t=4.326,P=0.042).There was interaction between time factor and group factor(F=3.567,P=0.031).There was statistical difference in the SF-36 scores between different time points,in other words,there was time effect(F=2501.188,P=0.000).There was statistical difference in the SF-36 scores between the two groups,in other words,there was group effect(F=40.308,P=0.000).There was no statistical difference in preoperative SF-36 scores between the 2 groups(55.5+/-3.6 vs 56.0+/-3.7 points,t=0.363,P=0.549).The SF-36 scores were higher in combination therapy group compared to monotherapy group at 6 and 12 months after the surgery(91.7+/-3.0 vs 87.9+/-2.9 points,t=25.938,P=0.000; 88.8±2.6 vs 83.7±3.2 points,t=55.254,P=0.000).There was interaction between time factor and group factor(F=9.868,P=0.000).There was statistical difference in the Lysholm knee scores between different time points,in other words,there was time effect(F=1980.728,P=0.000).There was statistical difference in the Lysholm knee scores between the two groups,in other words,there was group effect(F=39.257,P=0.000).There was no statistical difference in preoperative Lysholm knee scores between the 2 groups(52.3+/-3.8 vs 52.3+/-3.7 points,t=0.004,P=0.950).The Lysholm knee scores were higher in combination therapy group compared to monotherapy group at 6 and 12 months after the surgery(90.5+/-2.8 vs 87.0+/-3.2 points,t=20.987,P=0.000; 88.5+/-3.1 vs 82.8+/-4.3 points,t=35.725,P=0.000).There was interaction between time factor and group factor(F=9.744,P=0.000).Conclusion:The combination therapy of arthroscopic debridement and Chinese herbal steaming can relieve or eliminate the knee pain and improve the knee function and the quality of live of patients with early KOA,and it surpasses the monotherapy of arthroscopic debridement in curative effect,so it is worthy of popularizing in clinic.

参考文献/References:

[1] Ibarra CJ,Cabrales M,Crisótomo JF,et al.Resultados obtenidos obtenidos con la limpieza articular de rodilla en pacientes con osteoarthritis[J].Acta Ortop Mex,2009,23(2):85-89.
[2] Kellgren JH,Lawrence JS.Radiological assesment of osteoarthritis[J].Ann Rheum Dis,1957,16(4):494-502.
[3] 中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国矫形外科杂志,2014,27(3):287-288.
[4] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[5] Ware JE,Gandek B.Overview of the SF-36 health survey and the international quality of Life assessment(IQOLA)project[J].J Clin Epidemiol,1998,51(11):903-912.
[6] Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[7] Bohnsack M,LipkaW,Rǜhmann O,et al.The value of knee arthroscopy in patients with severe radiological osteoarthritis[J].Arch Orthop Trauma Surg,2002,122(8):451-453.
[8] Swank AM,Kachelman JB,Bibeau W,et al.Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis[J].J Strength Cond Res,2011,25(2):318-325.
[9] Pisters MF,Veenhof C,Schellevis FG,et al.Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee:a randomized controlled trial comparing two different physical therapy interventions[J].Osteoarthritis and Cartilage,2010,18(8):1019-1026.
[10] Bernard J,Lemon M,Patterson MH.Arthroscopic washout of the knee -a 5-year survival analysis[J].Knee,2004,11(3):233-235.
[11] Figueroa D,Calvo R,Villalon IE,et al.Clinical outcomes after arthroscopic treatment of knee osteoarthritis[J].Knee,2013,20(6):591-594.
[12] Dearing J,Nutton RW.Evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee[J].Knee,2008,15(3):159-163.
[13] 蒋尧传,蒋就喜,唐志宏,等.膝骨性关节炎的关节镜手术治疗[J].中国骨与关节损伤杂志,2010,25(3):259-260.
[14] 冯欢欢,王培民,范竞,等.膝骨关节炎X线表现与膝关节疼痛程度的相关性分析[J].中医正骨,2013,25(6):29-30.
[15] 谭福柱,张乐鑫,任树军.针刺配合口服骨力胶囊治疗膝关节骨性关节炎的临床研究[J].中医正骨,2015,27(1):20-22, 26.
[16] 佘明明.中药外洗结合功能锻炼治疗骨性关节炎80例[J].长春中医药大学学报,2009,25(1):102-103.
[17] 黄崇博.中药外洗外敷治疗膝骨性关节炎60例临床观察[J].中药材,2009,32(4):651-652.
[18] 蒙剑德,夏贤生,赵小泉,等.功能锻炼联合中药薰蒸在膝关节半月板损伤关节镜下成形术后康复治疗中的应用[J].中医正骨,2015,27(6):37-38.

相似文献/References:

[1]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[2]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[3]郑春松,叶蕻芝,李西海,等.透骨消痛胶囊中补肾柔肝药和活血祛风药治疗 骨关节炎作用方式的计算机模拟比较[J].中医正骨,2015,27(07):6.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Comparison of the mode of action of Bushen Rougan(补肾柔肝)drugs versus Huoxue Qufeng(活血祛风)drugs contained in Tougu Xiaotong Jiaonang(透骨消痛胶囊)for the treatment of osteoarthritis:A computer simulation study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):6.
[4]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[5]郑春松,叶蕻芝,李西海,等.独活寄生汤含药血清对白细胞介素1β诱导的 退变关节软骨细胞中基质金属蛋白酶 和环氧化酶2表达的影响[J].中医正骨,2015,27(12):1.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Impact of Duhuo Jisheng Tang(独活寄生汤)medicated serum on expression of matrix metalloproteinase and cyclooxygenase 2 in degenerative articular chondrocytes induced by interleukin-1 beta[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):1.
[6]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[7]冯荣,王平,李炳奇,等.铍针刺络拔罐结合中药口服治疗膝骨关节炎合并 原发性血小板增多症1例[J].中医正骨,2015,27(12):73.
[8]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[9]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[10]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[11]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[12]明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25.
[13]张杰,王人彦,张玉柱.膝骨关节炎的治疗进展[J].中医正骨,2015,27(10):68.
[14]梁朝,蔡静怡,闫立,等.针刀疗法改善膝骨关节炎早期疼痛症状的疗效评价[J].中医正骨,2015,27(09):9.
　LIANG Zhao,CAI Jingyi,YAN Li,et al.Evaluation of the curative effect of needle-knife therapy for relieving knee pain in patients with early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):9.
[15]王建武,党建军,李强,等.四联疗法治疗膝骨关节炎[J].中医正骨,2015,27(08):44.
[16]刘红娟,郭会利,郭树农.云克联合中药治疗膝骨关节炎的护理[J].中医正骨,2015,27(08):75.
[17]陈卫衡.探索建立系统的膝骨关节炎中医临床科研范式 和理论体系[J].中医正骨,2015,27(07):1.
[18]帅波,沈霖,杨艳萍,等.加味青娥丸治疗膝骨关节炎的作用机制研究[J].中医正骨,2015,27(07):15.
　SHUAI Bo,SHEN Lin,YANG Yanping,et al.Study on the mechanism of action of Jiawei Qing'e Wan(加味青娥丸)for the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):15.
[19]梅其杰,袁长深,段戡,等.壮药骨痹方烫熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):27.
　MEI Qijie,YUAN Changshen,DUAN Kan,et al.Clinical study of the curative effect of hot compressing and rubbing with packet of Gubi Fang(骨痹方)combined with exercise therapy in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):27.
[20]王丹辉,张燕,刘丽娟,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白 关节腔注射联合中药薰洗治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):31.
　WANG Danhui,ZHANG Yan,LIU Lijuan,et al.Clinical study on intra-articular injection of TypeⅡrecombinant human tumor necrosis factor receptor-Fc fusion protein combined with Chinese herbal steaming and washing therapy for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):31.

备注/Memo

备注/Memo:
2015-10-07收稿 2015-11-18修回
通讯作者:倪力刚 E-mail:nlg_sam@126.com
更新日期/Last Update: 2015-12-30