孙乾坤 郭珈宜 李峰 范仪铭 郭艳幸

【摘 要】目的：观察七珠展筋散联合中药汤剂加运动疗法治疗膝骨关节炎的临床疗效。方法：将98例膝骨关节炎患者按入院先后顺序随机分为治疗组和对照组，每组49例。对照组口服盐酸氨基葡萄糖，并运用低周波理疗，指导患者运动锻炼；治疗组采用七珠展筋散联合中药汤剂，同样指导患者运动锻炼。观察2组临床疗效，治疗前及治疗后4，8，12周采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分和视觉模拟评分法（VAS）评分评估2组膝关节功能、疼痛的改善情况，治疗前及治疗后4周检测实验室指标红细胞沉降率、C-反应蛋白改善情况。结果：治疗组临床痊愈14例，显效16例，有效9例，无效8例，总有效率为82.98%；对照组临床痊愈13例，显效12例，有效8例，无效12例，总有效率为73.33%。2组比较，差异有统计学意义（P < 0.05）。治疗后4，8，12周，2组WOMAC评分及VAS评分较治疗前均有改善（P < 0.05），且治疗组优于对照组（P < 0.05）；治疗后4周，2组红细胞沉降率、C-反应蛋白较治疗前均有改善（P < 0.05），治疗组红细胞沉降率优于对照组（P < 0.05）。结论：七珠展筋散联合中药汤剂加运动疗法治疗膝骨关节炎能明显改善患者临床症状和实验室指标，值得临床推广应用。

【关键词】 骨关节炎，膝；七珠展筋散；中药汤剂；运动疗法；临床疗效

【ABSTRACT】Objective：To observe the clinical effect of Qizhu Zhanjin San（七珠展筋散）combined with TCM decoction and exercise on knee osteoarthritis.Methods：Ninety-eight patients with knee osteoarthritis were randomly divided into a treatment group and a control group according to the order of admission，49 cases in each group.The control group orally took glucosamine hydrochloride and was guided to exercise with low wave physiotherapy；while the treatment group was treated with Qizhu Zhanjin San and other drugs combining exercise.The clinical efficacy of both groups was observed.Before and 4，8，12 weeks after treatment，WOMAC and VAS methods were used to evaluate the improvement of knee joint function，pain relief，erythrocyte sedimentation rate and C-reactive protein in both groups.Results：In the treatment group，14 cases were clinically controlled，16 cases were markedly effective，8 cases were effective and 8 cases were ineffective，with a total effective rate of 82.98%；while in the control group，13 cases were clinically controlled，12 cases were markedly effective，8 cases were effective，12 cases were ineffective，and the total effective rate was 73.33%.The difference between the two groups was statistically significant（P < 0.05）.4，8，12 weeks after treatment，the scores of WOMAC and VAS were improved in the two groups（P < 0.05），and the treatment group was better than the control group（P < 0.05）.After 4 weeks treatment，the erythrocyte sedimentation rate and C- reactive protein in the two groups were improved（P < 0.05），and the treatment group was superior to the treatment group（P < 0.05）.Conclusion：Qizhu Zhanjin San combined with TCM decoction and exercise can improve the clinical symptoms of knee osteoarthritis，which is worthy of clinical application.

【Keywords】 osteoarthritis，knee；Qizhu Zhanjin San（七珠展筋散）；TCM decoction；exercise therapy；clinical efficacy

膝骨關节炎（knee osteoarthritis，KOA）是常见的肌肉骨骼疾病，容易导致残疾，随着人口老龄化，KOA的患病率也在增加。研究显示，45～55岁人群中，8%患有KOA，而70岁人群患病比例增至30%[1]。KOA临床表现可概括为痛、拘、肿、畸。KOA以软骨破坏和软骨下骨囊性变为特征，并伴有全身的炎症反应[2]。目前，其病因和发病机制尚未完全明确。西医以非甾体抗炎药为主要治疗手段，而缺乏整体治疗。中医药采用传统的整体辨证论治而具有独特优势，针灸、手法、熏洗等均有其特色。本研究采用七珠展筋散联合中药汤剂加运动疗法治疗KOA，现总结报告如下。……