世界中医药

目的：观察小针刀综合治疗对膝关节炎患者疼痛及生存质量的影响，并从生物力学平衡和炎性反应因子两个方面探析小针刀的机制。方法：随机选取2014年1月至2015年10月，于我院针灸科、骨科门诊部和住院部就诊的膝关节炎患者60例，以就诊先后顺序编号，单盲随机数字表法分为针刀组和对照组，每组各30例。对照组采用西药玻璃酸钠注射液注入膝关节腔内治疗，针刀组基于对照组基础上，采用小针刀治疗。用疼痛视觉模拟评分（Visual Simulation Score，VAS）评价小针刀对膝关节炎患者疼痛的影响，以生存质量量表-36(Items Short Form Health Survey Scale-36，SF-36)评估患者治疗后的生存质量。通过测量股骨角、胫骨角、股胫角、LT/LP值(髌韧带的长度(LT)与髌骨最大对角线长度(LP)的比值)和LT/HI值(髌韧带的长度(LT)与胫骨切迹高度(HI)的比值)，分析小针刀治疗后对膝关节生物力学平衡的影响，同时结合检测膝关节腔积液中肿瘤坏死因子-α(Tumor Necrosis Factor-alpha，TNF-α)的表达情况，协同探讨小针刀治疗膝关节炎的机制。结果：针刀组治疗后VAS评分低于治疗前（t＝-9.063，P=0.001<0.05）；与对照组相比，针刀组评分较低（t＝-7.811，P=0.003<0.05）。治疗后，针刀组SF-36量表中8个维度评分均明显提高，与治疗前和对照组治疗后比较，差异均有统计学意义（P<0.01）。2组治疗前后股骨角、胫骨角和股胫角测量结果比较，差异无统计学意义（P>0.05）。针刀组治疗后LT/LP值和LT/HI值均较治疗前有所改善，差异有统计学意义（P<0.05）；对照组治疗前后均未见明显改变（P>0.05）。与对照组（52.42±4.37）pg/mL相比，治疗后针刀组TNF-α表达（34.25±3.83）pg/mL较低（t＝-2.54，P=0.01<0.05）。治疗后针刀组TNF-α表达（34.25±3.83）pg/mL较治疗前（101.35±6.44）pg/mL低（t＝3.14，P=0.000<0.05）。结论：小针刀综合治疗膝关节炎，松解粘连和消除挛缩，恢复膝关节生物力学平衡和降低炎性反应，减轻膝关节炎患者的疼痛程度，提高生存质量。

English Summary:

To observe the effect of Acupotomy therapy on pain and quality of life in patients with osteoarthritis,and the biomechanical balance and inflammatory factors of Acupotomy mechanism.Methods:During January 2014 to October 2015,total 60 knee osteoarthritis cases in department of acupuncture,orthopaedics and in-patient of our hospital were divided into into Acupotomy group and control group according to visiting sequence numbers and single blind randomized digital table method,each group with 30 cases.Patients in control group received sodium hyaluronate injection into the knee joint cavity,Acupotomy group treated by Acupotomy therapy based on the control group’s treatment.Pain visual simulation score (VAS) was used to evaluate of Acupotomy therapy’s effect on pain,and the quality of life table (36 items short form health survey scale,the SF 36) was used to assess the life quality of the patients after treatment.Through the measurement of femoral angle,tibial angle,femoral and tibial angle,LT/LP value (value of patella and patellar ligament length (LT) maximum diagonal length (LP) ratio) and LT/HI (the ratio of patellar ligament length (LT) and tibial notch height (HI)),Acupotomy treatment of knee joint biomechanics balance effect was observed.Combined with the detection of articular cavity effusion tumor necrosis factor alpha (TNF-alpha),the synergy of the mechanism of Acupotomy treatment for osteoarthritis of the knee was observed.Results:The VAS score in acupotomy group became significantly lower after the treatment (t＝-9.063 P=0.001<0.05).Compared with the control group,the VAS score of Acupotomy group was significantly lower (t＝-7.811 P=0.003<005).After treatment,the SF-36 scale scores in 8 dimensions of acupotomy group significantly improved,compared with the score before treatment of acupotomy group and the score of control group after treatment,the differences were significant (P<0.01).There were no significant differences on femoral angle,tibial angle and femoral tibial angle measurement between the two groups before and after the treatment (P>0.05).The LT/LP value and LT/HI values in Acuptomy group improved significantly after the treatment (P<0.05); while the control group showed no significant changes (P>0.05).Compared with the TNF-alpha expression of control group (5.242±4.37) pg/mL,the TNF-alpha expression of Acupotomy group (34.25±3.83) pg/mL was lower after treatment (t＝-2.54,P=0.01<0.05).The TNF-alpha expression of acupotomy group after treatment (34.25±3.83) pg/mL was lower than those before treatment (101.35±6.44) pg /mL,(t＝3.14,P=0.000<0.05).Conclusion:Acupotomy treatment for knee osteoarthritis can help loose adhesions,eliminate contracture,recovery the biomechanical balance of knee and reduce inflammation,relieve pain and improve the quality of life.

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