關節(jié)鏡清理聯(lián)合消瘀散外敷治療早中期KOA臨床療效分析
發(fā)布時間：2019-04-21 16:36
【摘要】：目的(1)對膝關節(jié)鏡清理聯(lián)合中藥(消瘀散)外敷治療早、中期KOA患者的臨床療效進行客觀評價,探討早、中期KOA患者膝關節(jié)液中IL-1、CTX-Ⅱ的含量與膝關節(jié)退行性病變的關聯(lián)性。(2)明確中藥(消瘀散)外敷治療早、中期KOA的臨床療效、作用特點和優(yōu)勢,探尋綜合治療早、中期KOA的臨床合理、安全和有效的治療方案。方法受試者均為安徽中醫(yī)藥大學第一附屬醫(yī)院骨一科住院治療病人,方法為臨床觀察,依照病例納入標準與排除標準,共選擇40例病例,隨機分組為試驗組和對照組均為20例。試驗組除接受關節(jié)鏡清理術外,術后聯(lián)合中藥外敷,每晚1次,連續(xù)外敷3周,對照組接受關節(jié)鏡清理術及相關治療。試驗組與對照組在抗生素應用前應按無菌操作原則抽取關節(jié)液,記錄VAS評分和評價膝關節(jié)Lequesne指數(shù),分別于術后1周、4周及3個月隨訪時留取關節(jié)液各監(jiān)測指標以及記錄VAS評分與評價膝關節(jié)Lequesne指數(shù)。采用SPSS17.0對數(shù)據(jù)進行研究統(tǒng)計分析。結果(1)VAS疼痛評分治療1周后,試驗組的VAS疼痛評分(3.30±0.45)較治療前明顯減少(P0.05);治療4周后與治療前比較,試驗組的VAS疼痛評分(2.84±0.84)顯著減少(P0.01),對照組VAS疼痛評分(4.82±0.43)有所減少(P0.05);試驗組治療1周的后VAS疼痛評分(3.30±0.45)與治療4周后(2.84±0.84)差異有統(tǒng)計學意義(P0.05);隨訪3個月后試驗組VAS疼痛評分(2.0±0.78)比治療前顯著減少(P0.01),對照組VAS疼痛評分(3.6±1.45)比治療前有所減少(P0.05)。說明膝關節(jié)鏡清理聯(lián)合消瘀散外敷治療能明顯減輕KOA患者的疼痛。(2)Lequesne指數(shù)治療1周后,試驗組的Lequesne指數(shù)(8.61±3.05)較治療前(11.48±0.49)有降低,差異有統(tǒng)計學意義(P0.01);試驗組治療4周后Lequesne指數(shù)(3.23±1.92)與治療前(11.48±0.49)比較明顯降低(P0.01);試驗組治療1周后的Lequesne指數(shù)(8.61±3.05)與治療4周后(3.23±1.92)比較,差異有統(tǒng)計學意義(P0.05);對照組治療1周后Lequesne指數(shù)(10.88±2.65)與4周后(8.68±2.17)比較,差異有統(tǒng)計學意義(P0.05);3個月后隨訪,試驗組的Lequesne指數(shù)(2.7±0.38)與對照組(5.6±0.36)與治療前比較,均有統(tǒng)計學意義(P0.01)。說明經膝關節(jié)鏡清理聯(lián)合消瘀散外敷治療可以提高KOA患者膝關節(jié)的活動度,提高患者的生活質量,且遠期療效顯著。(3)膝關節(jié)液中IL-1濃度治療1周后,試驗組的膝關節(jié)液中IL-1濃度(772.35±92.38)與對照組(824.87±72.87)均有顯著減少(P0.01)。與治療前比較,治療4周后試驗組的膝關節(jié)液中IL-1濃度(390.71±168.12)與對照組(432.42±156.72)均有顯著減少(P0.01);試驗治療1周后(772.35±92.38)與治療4周后膝關節(jié)液中IL-1濃度(390.71±168.12)比較,差異有統(tǒng)計學意義(P0.01);與治療前比較,隨訪3個月后試驗組膝關節(jié)液中IL-1濃度(290.72±220.02)差異有統(tǒng)計學意義(P0.01)。均能顯著降低膝關節(jié)液中IL-1濃度,試驗組較對照組更顯著。(4)膝關節(jié)液中CTX-Ⅱ濃度治療1周后,試驗組的膝關節(jié)液中CTX-Ⅱ濃度(287.15±21.32)較治療前(388.65±20.93)明顯減少(P0.05);治療4周后與治療前比較,試驗組的膝關節(jié)液中CTX-Ⅱ濃度(218.72±35.24)顯著減少(P0.01);試驗組治療1周的后膝關節(jié)液中CTX-Ⅱ濃度(287.15±21.32)與治療4周后(218.72±35.24)差異有統(tǒng)計學意義(P0.05);隨訪3個月后試驗組膝關節(jié)液中CTX-Ⅱ濃度(164.72±30.02)比治療前顯著減少(P0.01)。結論(1)膝關節(jié)鏡清理術對早、中期KOA療效確切;(2)膝關節(jié)鏡清理術聯(lián)合中藥(消瘀散)外敷治療早、中期KOA療效確切,并優(yōu)于單純膝關節(jié)鏡清理術;(3)早、中期KOA患者膝關節(jié)液中IL-1、CTX-Ⅱ的含量與膝關節(jié)退行性變有一定的關聯(lián)性。通過臨床對照研究,本課題觀察關節(jié)鏡清理術聯(lián)合中藥外敷對早、中期KOA的臨床療效,就臨床療效作用機制特點,對消瘀散的作用機制進行進一步深入研究,為為消瘀散申報新藥提供了前期新的理論基礎,同時為KOA的治療提供了合理有效的治療方案。
[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，
本文編號：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，
本文編號：2462370
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