痛点针刀松解对膝关节骨性关节炎患者部分运动步态和血清TNF-α及IL-1的影响
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作者Author单位AddressE-Mail
王超 WANG Chao 安徽中医药大学第二附属医院, 安徽 合肥 230061  
朱俊琛 ZHU Jun-chen 安徽中医药大学第二附属医院, 安徽 合肥 230061 2006zhujc@163.com 
郑智文 ZHENG Zhi-wen 安徽中医药大学第二附属医院, 安徽 合肥 230061  
熊应宗 XIONG Ying-zong 安徽中医药大学第二附属医院, 安徽 合肥 230061  
马幸福 MA Xing-fu 安徽中医药大学第二附属医院, 安徽 合肥 230061  
龚悦诚 GONG Yue-cheng 安徽中医药大学, 安徽 合肥 230061 The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230061, Anhui, China  
贺业霖 HE Ye-lin 安徽中医药大学, 安徽 合肥 230061 The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230061, Anhui, China  
期刊信息:《中国骨伤》2022年,第35卷,第9期,第848-852页
DOI:10.12200/j.issn.1003-0034.2022.09.009
基金项目:安徽省科技攻关项目(编号:1704a0802168);安徽省"十三五"临床重点专科-中医骨伤科[编号:卫科教秘(2017)529号]
中文摘要:

目的:探讨痛点针刀松解对于膝关节骨性关节炎(knee osteoarthritis,KOA)患者疼痛,功能,步态以及血清炎性因子的影响。

方法:自2017年12月至2019年6月收集110例KOA患者,采用随机数字表法分为针刀组(56例)和西药组(54例)。针刀组男16例,女40例;年龄46~74(62.98±6.68)岁;病程24.50(15.25,33.00)个月;于膝关节周围各痛点行针刀松解治疗,每周1次,共3周。西药组男18例,女36例;年龄47~73(64.19±5.98)岁;病程25.00(13.75,33.00)个月;口服塞来昔布胶囊,每日1次,每次200 mg,共3周。分别于治疗前、治疗后3周和3个月时行英国牛津膝关节评分(Oxford Knee Score,OKS),治疗前和治疗后3周时行步态运动学分析和血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-1β(interleukin-1β,IL-1β)水平检测。

结果:所有患者获得随访,时间6~24(15.03±4.55)个月。两组患者治疗后3周和3个月时各项OKS较治疗前均显著下降(P<0.001);治疗后3个月与治疗3周比较,针刀组功能评分和总体评分显著下降(P<0.001);而且治疗后3周和3个月时针刀组各项OKS均显著低于西药组(P<0.05)。两组患者治疗后3周时步速、步频、步长与治疗前比较差异有统计学意义(P<0.001);治疗后3周时针刀组步频较西药组改善明显(P<0.05)。两组患者治疗后3周时TNF-α、IL-1β与治疗前比较,均显著降低(P<0.05);西药组IL-1β水平较针刀组更低(P<0.05),而TNF-α水平组间比较,差异无统计学意义(P>0.05)。

结论:痛点针刀松解可以显著改善早中期KOA患者的疼痛、功能、步态以及降低血清炎性因子,尤其在膝关节功能恢复和步频改善方面优于非甾体抗炎药。
【关键词】骨关节炎,膝  针刀疗法  步态分析  肿瘤坏死因子α  白细胞介素-1β
 
Effects of acupotomy on partial movement gait and serum tumor necrosis factor-α,interleukin-1β in patients with knee osteoarthritis
ABSTRACT  

Objective: To explore effects of acupotomy on pain,function,gait and serum inflammatory factors in patients with knee osteoarthritis (KOA).

Methods: From December 2017 to June 2019,110 patients with KOA were collected and divided into acupotomy group (56 cases) and western medicine group (54 cases) by using random number table method.In acupotomy group,there were 16 males and 40 females,aged from 46 to 74 years old with an average of (62.98±6.68) years old,the course of disease ranged from 1 to 240 months with an average of 24.5(15.25,33.00) months;were treated with acupotomy on the pain points around knee joint once a week for 3 weeks.In western medicine group,there were 18 males and 36 females,aged from 47 to 73 years old with an average of (64.19±5.98) years old;the course of disease ranged from 1 to 220 months with an average of 25.00(13.75,33.00) months;were took celecoxib capsule orally,200 mg once a day for 3 weeks.Oxford Knee Score (OKS) was performed before treatment,3 weeks and 3 months after treatment.Gait kinematics analysis and serum levels of tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) were measured before and after treatment for 3 weeks.

Results: All patients were followed up from 6 to 24 months with an average of (15.03±4.55) months.OKS between two groups decreased significantly at 3 weeks and 3 months after treatment (P<0.001).Functional scores and overall scores in acupotomology group were significantly decreased at 3 months compared with 3 weeks after treatment (P<0.001).OKS of acupotomy group were significantly lower than those of western medicine group at 3 weeks and 3 months after treatment (P<0.05).Gait speed,frequency and length between two groups were significantly improved at 3 weeks after treatment (P<0.05).At 3 weeks after treatment,gait freguency of acupotomy group was significantly improved compared with western medicine group (P<0.05).TNF-α and IL-1β were significantly lower in both groups at 3 weeks after treatment than before treatment (P<0.05).At 3 weeks after treatment,level of IL-1β was lower in western medicine group than in acupotomy group (P<0.05),and difference in TNF-α level was not statistically significant (P>0.05).

Conclusion: Acupotomology of pain points could significantly improve pain,function,gait,and decreased serum inflammatory factors at early to mid stage of KOA patients,in particular,it is superior to non-steroidal anti-inflammatory drugs in terms of knee function recovery and cadence improvement.
KEY WORDS  Osteoarthritis,knee  Acupotomy therapy  Gait analysis  Tumor necrosis factor-α  Interleukin-1β
 
引用本文,请按以下格式著录参考文献:
中文格式:王超,朱俊琛,郑智文,熊应宗,马幸福,龚悦诚,贺业霖.痛点针刀松解对膝关节骨性关节炎患者部分运动步态和血清TNF-α及IL-1的影响[J].中国骨伤,2022,35(9):848~852
英文格式:WANG Chao,ZHU Jun-chen,ZHENG Zhi-wen,XIONG Ying-zong,MA Xing-fu,GONG Yue-cheng,HE Ye-lin.Effects of acupotomy on partial movement gait and serum tumor necrosis factor-α,interleukin-1β in patients with knee osteoarthritis[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(9):848~852
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