夏氏一指禅推法联合中药治疗肾虚寒凝型膝骨关节炎疗效观察

谭春林　刘峻承　郑德勇

摘要：目的 夏氏一指禪推法联合吴萸四逆合苓桂术甘汤治疗膝骨关节炎的疗效。方法 随机选取膝骨关节炎患者96例，治疗组与对照组各48例，治疗组采用夏氏一指禅推法联合中药内服治疗，对照组采用玻璃酸钠注射液关节腔内注射治疗。对2组患者的关节疼痛评分（VAS）、骨性关节炎指数（WOMAC）、膝关节功能评分（Lyshom）以及统计分析血清细胞因子IL-1、IL-6、TNF-α水平。结果 治疗组和对照组患者的VAS、WOMAC、Lyshom评分经治疗后，组内比较，治疗后均比治疗前显著性降低（P<0.01）;组间比较，治疗组评分较对照组降低（P<0.05）;2组细胞因子组内比较，患者血清IL-1、IL-6、TNF-α较治疗前明显降低;组间比较，治疗组细胞因子水平较对照组降低（P<0.05）;2组总有效率比较，治疗组的总有效率高于对照组（P<0.05）。结论 夏氏一指禅推法联合吴萸四逆合苓桂术甘汤能减轻KOA患者症状及体征，改善关节活动功能，并能下调炎症细胞因子IL-1、IL-6、TNF-α水平，其作用机制可能与控制炎症细胞因子水平有关，从而达到临床治疗目的。

关键词：夏氏一指禅推法;吴萸四逆合苓桂术甘汤;膝骨关节炎;细胞因子

中图分类号：R244.1   文献标志码：R   文章编号：1007-2349（2021）10-0060-05

【Abstract】Objective： To study the curative effect of Xia's one-finger pushing massage combined with Wuyusinihe Lingguishugan Decoction in the treatment of knee osteoarthritis （KOA）. Methods： 96 KOA patients were randomly selected and divided into a treatment group and a control group， 48 cases each group. The treatment group was treated with Xia's one-finger pushing massage combined with oral administration of traditional Chinese medicine， and the control group was treated with sodium hyaluronate injection in the articular cavity. The joint pain score （VAS）， osteoarthritis index （WOMAC）， knee joint function score （Lyshom） and statistical analysis of serum cytokine IL-1， IL-6， and TNF-α levels of the two groups were compared. Results： After treatment， the VAS， WOMAC， and Lyshom scores of the two group were significantly lower than those of the prior treatment （P<0.01）. Compared between the groups， the scores of the treatment group were lower than those of the control group （P<0.05）. Compared the cytokine groups between the two groups， the serum IL-1， IL-6， and TNF-α of the patients were significantly lower than those of the prior treatment. Compared between the groups， the cytokine level of the treatment group was lower than that of the control group （P<0.05）. Compared between the two groups， the total effective rate of the treatment group was higher than that of the control group （P<0.05）. Conclusion： Xia's one-finger pushing massage combined with Wuyusinhei Lingguizhugan Decoction can alleviate the symptoms and signs of KOA patients， improve their joint mobility， and down-regulate the levels of inflammatory cytokines IL-1， IL-6， and TNF-α. Its mechanism of action may be related to the control of inflammatory cytokine levels， so as to achieve the purpose of clinical treatment.

【Key words】Xia's One-finger Pushing Massage; Wuyusinihe Lingguishugan Decoction; Knee Osteoarthritis; Cytokines

膝骨关节炎（Knee joint osteoarthritis，KOA）是一种以膝关节软骨的退行性变伴或不伴骨质增生为特征的慢性关节疾病[1]。主要表现为膝关节疼痛，活动后加重，休息后缓解，在40岁人群患病率为10-17%，60岁以上为50%，75岁以上人群达到80%[2]。临床上治疗本病多采用非甾体类镇痛药、糖皮质激素、关节腔内注射类固醇类药物等治疗，但只能短时间维持，容易复发[3]。笔者有幸跟师夏惠明教授学习，经长期临床观察，夏氏一指禅推法联合中药内服治疗膝骨关节炎疗效明确，故选取本科96例患者进行对比研究，现报道如下。

1 资料与方法

1.1 一般资料 随机选取符合纳入标准的昭通市中医医院针推科2019年7月—2020年12月收治的96例膝骨性关节炎患者，分为治疗组和对照组各48例。治疗组中男女各24例;年龄在41～70岁之间，平均年龄为（55.49±7.05）岁;病程（0.5～10）a，平均病程为（3.70±2.47）a;对照组中男女……