温肾宣痹汤治疗膝关节骨性关节炎的临床疗效观察

刘金柱 夏天卫 沈计荣

[摘要] 目的 觀察口服温肾宣痹汤治疗膝关节骨性关节炎的临床疗效。 方法 选取2018年9月～2019年12月江苏省中医院骨伤科门诊80例膝关节骨性关节炎患者作为研究对象，随机分成两组，治疗组40例，口服温肾宣痹汤加减治疗，对照组40例，口服痹祺胶囊治疗。两组经治疗2个疗程后，评估临床疗效，观察治疗后总有效率、视觉模拟疼痛评分（VAS）及WOMAC（包括疼痛、僵硬、活动度、有效性）评分方面的情况变化。 结果 ①中医诊疗标准方面，治疗组总有效率92.50%，对照组75.00%，差异有统计学意义（P<0.05）;②两组患者VAS评分均降低，较治疗前差异有统计学意义（P<0.05）;治疗组VAS评分明显低于对照组，差异有统计学意义（P<0.05）;③与治疗前比较，两组患者在疼痛、僵硬、日常活动度、WOMAC总分方面均有改善，差异有统计学意义（P<0.05），其中治疗组改善明显;尤其在疼痛评分方面，治疗组明显优于对照组，差异有统计学意义（P<0.05），其他指标组间比较差异均无统计学意义（P>0.05）。④两组在WOMAC评分改善方面比较差异无统计学意义（P>0.05），但治疗组总有效率87.50%，明显高于对照组72.50%。 结论 温肾宣痹汤治疗寒湿痹阻型膝关节骨性关节炎疗效确切，可显著缓解疼痛，改善膝关节活动度，总有效率优于痹祺胶囊，值得临床推广应用。

[关键词] 温肾宣痹汤;膝关节骨性关节炎;寒湿痹阻型;痹祺胶囊

[中图分类号] R684.3          [文献标识码] B          [文章编号] 1673-9701（2020）18-0139-04

An observation of clinical efficacy of Wenshen Xuanbi decoction in treating knee osteoarthritis

LIU Jinzhu   XIA Tianwei   SHEN Jirong

Department of TCM Orthopedics & Traumatology， the Affiliated Hospital of Nanjing University of Chinese Medicine， Jiangsu Province Hospital of Chinese Medicine， Nanjing   210029， China

[Abstract] Objective To observe clinical efficacy of Wenshen Xuanbi decoction taken orally in treating knee osteoarthritis（KOA）. Methods 80 patients with KOA receiving outpatient service in the Department of TCM Orthopedics and Traumatology of Jiangsu Province Hospital of Chinese Medicine from September 2018 to December 2019 were selected as the subjects of research and randomly divided into two groups， with 40 patients in the treatment group treated with modified Wenshen Xuanbi decoction， and 40 patients the control group treated with Biqi capsule. After two courses of treatment， the clinical efficacy in the two groups was evaluated and the changes after treatment in the total effective rate， visual analogue pain scale（VAS） scores and WOMAC scores（including pain， stiffness， mobility， and effectiveness） were observed. Results（1）In terms of TCM diagnosis and treatment standards， the total effective rate of the treatment group was 92.50%， while that of the control group was 75.00%， and the difference was statistically significant（P<0.05）.（2）The VAS scores of the two groups of patients were decreased， and the differences were both statistically significant（P<0.05）. The VAS scores of the treatment group were significantly lower than those of the control group， with statistically significant difference（P<0.05）. （3）Compared with those before treatment， the pain， stiffness， daily mobility and total WOMAC scores of the two groups of patients were ameliorated with statistically significant differences（P<0.05）， of which those of the treatment group were more obvious. Especially in terms of pain scores， the treatment group was obviously superior to the control group， and the difference was statistically significant（P<0.05）， and there was no statistically significant difference between the two groups in other indexes（P>0.05）. （4）There was no statistically significant difference in the improvement of WOMAC scores between the two groups（P>0.05）， but the total effective rate of the treatment group was 87.50%， which was significantly higher than the 72.50% the control group. Conclusion Wenshen Xuanbi decoction has definite efficacy against cold-dampness arthralgia KOA. It can significantly relieve pain and improve the mobility of knee joint. Its total effective rate is higher than that of Biqi capsule. It is worthy of clinical promotion and application.

[Key words] Wenshen Xuanbi decoction; Knee osteoarthritis; Cold-dampness arthralgia; Biqi capsule

骨性关节炎（Osteoarthritis）是成人中最常见的慢性退行性骨关节疾病，久治难愈，且易复发，临床调查显示，在65岁以上老人中，有手关节退变的约占60%，而33%的患者有不同程度的膝关节骨性关节炎症状[1-2]。膝关节骨性关节炎（Knee osteoarthritis，KOA）主要表现为疼痛、肿胀、畸形、功能障碍，与风湿性、类风湿性关节炎、强直性脊柱炎等炎症性风湿病相反，目前西医几乎没有任何有效治疗方法可以阻止KOA的病程，其高发病率与高致残率不仅给患者带来巨大经济压力，也严重影响患者的生活质量[3]，晚期只能通过人工单髁置换、全膝关节置换等外科手术来矫正畸形、缓解疼痛、改善功能，但同时不得不面临术后感染、松动、假体周围骨折、翻修等带来的问题[4]。