杨元斐 赵敏

【摘 要】目的：观察补肾益气汤联合针刀对肝肾不足型骨关节炎患者临床疗效及炎症因子的影响。方法：将120例膝骨关节炎患者按照随机数字表法分为针刀组、中药组及针药组，每组40例。针刀组给予小针刀治疗，中药组口服补肾益气汤治疗，针药组给予补肾益气汤联合小针刀治疗。3组疗程均为4周。观察3组临床疗效，以及治疗前后白细胞介素（IL）-1β、IL-6、西安大略和麦克马斯特大学骨关节炎指数量表（WOMAC评分）、视觉模拟评分法（VAS）评分、膝关节活动度的变化，同时观察不良反应。结果：针药组总有效率为92.50%，高于针刀组的77.50%及中药组的82.50%，差异有统计学意义（P < 0.05）。治疗后，3组IL-1β水平、IL-6水平、WOMAC评分、VAS评分较治疗前均明显下降（P < 0.05），膝关节活动度较治疗前显著提高（P < 0.05），且针药组上述指标改善均明显优于针刀组和中药组（P < 0.05）。3组均未出现不良反应。结论：补肾益气汤联合针刀治疗肝肾不足型膝骨关节炎，能够有效缓解患者关节疼痛，临床疗效显著，安全性高，值得临床推广应用。

【关键词】 膝骨关节炎;补肾益气汤;针刀;炎症因子;临床疗效

Clinical Effect of Bushen Yiqi Tang（补肾益气汤）Combined with Acupotomy on Patients with Osteoarthritis

and the Influence on Inflammatory Factors

YANG Yuan-fei，ZHAO Min

【ABSTRACT】Objective：To observe the clinical effect of Bushen Yiqi Tang（补肾益气汤）combined with acupotomy on patients with osteoarthritis and the influence on inflammatory factors.Methods：One hundred and twenty patients with knee osteoarthritis were randomly divided into an acupotomy group，a Chinese medicine group and an acupuncture and medicine group，40 cases in each group.The acupotomy group was treated with small needle knife，the Chinese medicine group was treated with Bushen Yiqi Tang，and the acupuncture and medicine group was treated with Bushen Yiqi Tang combined with small needle knife.They were treated for 4 weeks.

The clinical efficacy，IL-1β，IL-6，WOMAC score，VAS，range of knee joint motion before and after treatment and the adverse reactions were observed.Results：The total effective rate of the acupuncture and medicine group was 92.50%，which was higher than 77.50% of the acupotomy group and 82.50% of the Chinese medicine group（P < 0.05）.After treatment，IL-1β level，and IL-6 level，WOMAC score，VAS score of the three groups were significantly decreased（P < 0.05），and the range of knee joint motion was significantly improved（P < 0.05）.The improvement of the above indexes in the acupuncture and medicine group was significantly better than that in the acupotomy group and the Chinese medicine group（P < 0.05）.There were no adverse reactions in the three groups.Conclusion：Bushen Yiqi Tang combined with acupotomy in the treatment of osteoarthritis with liver and kidney deficiency can effectively relieve joint pain，with significant clinical effect and high safety，which is worthy of clinical application.

【Keywords】 knee osteoarthritis;Bushen Yiqi Tang（補肾益气汤）;acupotomy;inflammatory factors;

clinical efficacy

膝骨关节炎（knee osteoarthritis，KOA）是一种以关节软骨退行性变和软骨下骨骨质增生为特征的慢性骨关节疾病，是基于炎性反应基础上的一种膝关节退行性病变，与生物力学平衡被打破，应力集中有关[1-2]。本病多发于中老年人，是引起老年人膝关节疼痛的主要原因之一，随着人口老龄化的加剧，其发病率也呈逐年上升趋势。中医学将其归属于“痹病”范畴，发病特点为本虚标实，本虚责之于肝脾肾，气血亏虚，标实则因筋脉痹阻，不通则痛。补肾益气汤为国家名老中医药专家胡荫奇治疗骨关节炎（osteoarthritis，OA）的经验方，临床疗效显著。针刀治疗OA疗效确切，通过机械刺激发挥活血化瘀、通络止痛及调整力学平衡的作用[3-4]。

本研究以补肾益气汤联合针刀治疗肝肾不足型KOA，观察其临床疗效及对炎性因子的影响。……