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踝关节骨性关节炎属于关节退行性疾病,一般多在50岁左右中年或者老年人群体中发生,特征表现为关节软骨退变、畸形以及关节周骨质增生[1]。研究[2]显示,关节炎发病踝关节是膝关节的1/12~1/10。该病病人主要表现为关节疼痛及功能障碍,踝关节无法正常行使负重功能。目前,保守治疗和手术治疗是踝关节骨性关节炎最常用的治疗手段,其中保守治疗包括理疗、减轻负重、抗炎药物及透明质酸钠等方法[3],多用于疾病早期病人中,但无法彻底根治疾病。而中晚期病人多采用手术进行治疗,传统手术包括游离体去除、骨赘清理、关节置换或融合等,其创伤较大[4],存在较高并发症风险,影响术后预后质量。近年来微创外科不断获得进步,各种类型腔镜手术在临床中得到大范围推广和应用。自1981年关节镜用于探查踝关节的首次报道以来,踝关节镜病灶清理术得到显著进展,已逐步取代传统切开术,成了踝关节骨性关节炎治疗之第一选择[5]。中医治疗踝关节骨性关节炎有着悠久历史,中药配合踝关节镜术能够提升这一病症整体治疗效果。本文就选用补肾坚骨汤对中老年踝关节骨性关节炎治疗效果进行研究证实,旨在为临床提供指导。现作报道。
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观察组与对照组治疗总有效率分别为97.91%和83.33%,差异有统计学意义(P < 0.01)(见表 1)。
分组 n 显效 有效 无效 总有效率/% uc P 对照组 48 17 23 8 83.33 观察组 48 31 16 1 97.91 3.17 < 0.01 合计 96 48 39 9 90.63 表 1 2组病人治疗效果比较
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2组病人治疗前踝关节疼痛、肿胀及活动度评分比较差异均无统计学意义(P>0.05);治疗后,2组治疗后关节疼痛、肿胀及活动度评分均显著高于治疗前(P < 0.01),且观察组病人的踝关节疼痛、肿胀及活动度评分均明显高于对照组(P < 0.01)(见表 2)。
分组 n 疼痛 肿胀 活动度 治疗前 对照组 48 0.87±0.16 1.30±0.68 1.07±0.61 观察组 48 0.89±0.17 1.34±0.71 1.05±0.58 t — 0.59 0.28 0.16 P — >0.05 >0.05 >0.05 治疗后 对照组 48 1.47±0.58** 1.72±0.65** 2.13±0.75** 观察组 48 2.43±0.71** 2.16±0.54** 2.51±0.66** t — 7.25 3.61 2.64 P — < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 2 2组病人治疗前后的踝关节疼痛、肿胀及活动度评分比较
($ \overline{x}\pm s$;分) -
2组病人治疗前改良McGuire、Mazur及AOFAS评分差异均无统计学意义(P>0.05);随访1年后,2组病人的改良McGuire、Mazur及AOFAS评分均显著高于治疗前(P < 0.01),且观察组病人的改良McGuire、Mazur及AOFAS评分均显著高于对照组(P < 0.01)(见表 3)。
分组 n 改良McGuire Mazur AOFAS 治疗前 对照组 48 52.16±12.35 56.34±10.75 52.53±11.80 观察组 48 51.87±11.96 56.73±11.02 53.12±12.35 t — 0.12 0.18 0.24 P — >0.05 >0.05 >0.05 治疗一年后 对照组 48 73.18±9.58** 72.95±9.48** 72.15±8.81** 观察组 48 84.26±8.74** 85.10±8.67** 83.46±8.34** t — 5.92 6.55 6.46 P — < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 3 2组病人治疗前后改良McGuire、Mazur及AOFAS评分对比
($ \overline{x}\pm s$;分)
关节镜配合补肾坚骨汤对中老年踝关节骨性关节炎治疗的影响
Effect of the arthroscope combined with Bushenjiangu decoction in the treatment of osteoarthritis of ankle joint in middle and old age
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摘要:
目的研究关节镜术联合补肾坚骨汤对中老年踝关节骨性关节炎病人疼痛、肿胀及活动度的影响。 方法选择中老年踝关节骨性关节炎病人96例,采用随机数字法分为对照组和观察组,各48例。对照组病人行关节镜术治疗,观察组病人以此为基础,结合口服补肾坚骨汤进行治疗。比较2组病人疗效,同时对比治疗前和治疗后踝关节疼痛、肿胀及活动度评分;术后随访1年,对比改良McGuire、Mazur及美国矫形外科足踝协会(AOFAS)评分。 结果观察组与对照组治疗总有效率分别为97.91%和83.33%,差异有统计学意义(P < 0.01);治疗后,2组治疗后关节疼痛、肿胀及活动度评分均显著高于治疗前(P < 0.01),观察组病人的踝关节疼痛、肿胀及活动度评分均明显高于对照组(P < 0.01);随访1年后,2组改良McGuire、Mazur及AOFAS评分均显著高于治疗前(P < 0.01),观察组病人改良McGuire、Mazur及AOFAS评分均显著高于对照组(P < 0.01)。 结论关节镜术联合补肾坚骨汤对于中老年踝关节骨性关节炎疗效显著,可明显改善踝关节疼痛、肿胀等症状,增快踝关节功能恢复,而且治疗安全性较高,适合在临床实践中进行推广。 Abstract:ObjectiveTo study the effects of arthroscopic surgery combined with Bushenjiangu decoction on the ankle joint pain, swelling and activity in middle and old age patients with osteoarthritis. MethodsNinety-six elderly patients with osteoarthritis of the ankle joint were randomly divided into the control group and observation group(48 cases in each group).The control group was treated with arthroscopic surgery, and the observation group was treated with Bushenjiangu decoction on the basis of control group.The curative effect was compared between two groups, and the scores of ankle joint pain, swelling and activity in two groups were compared between before and after treatment.All cases were followed-up for 1 year.The improved McGuire, Mazur and AOFAS scores were compared. ResultsThe total effective rates of treatment in observation group and control group were 97.91% and 83.33%, respectively, and the difference of which was statistically significant(P < 0.01).The joint pain, swelling and activity scores in two groups after treatment were significantly higher than those before treatment(P < 0.01), and the joint pain, swelling and activity scores in observation group after treatment were significantly higher than those in control groups(P < 0.01).After 1 year of following-up, the improved McGuire, Mazur and AOFAS scores in two groups were significantly higher than before treatment(P < 0.01), and the improved McGuire, Mazur and AOFAS scores in observation group were significantly higher than those in control group(P < 0.01). ConclusionsThe curative effect of arthroscopic surgery combined with Bushenjiangu decoction on senile osteoarthritis of the ankle joint is significant, which can significantly improve the ankle pain, swelling and other symptoms, promote the recovery of ankle function, and is highly secure and worthy of promotion in clinic. -
表 1 2组病人治疗效果比较
分组 n 显效 有效 无效 总有效率/% uc P 对照组 48 17 23 8 83.33 观察组 48 31 16 1 97.91 3.17 < 0.01 合计 96 48 39 9 90.63 表 2 2组病人治疗前后的踝关节疼痛、肿胀及活动度评分比较
( ;分)$ \overline{x}\pm s$ 分组 n 疼痛 肿胀 活动度 治疗前 对照组 48 0.87±0.16 1.30±0.68 1.07±0.61 观察组 48 0.89±0.17 1.34±0.71 1.05±0.58 t — 0.59 0.28 0.16 P — >0.05 >0.05 >0.05 治疗后 对照组 48 1.47±0.58** 1.72±0.65** 2.13±0.75** 观察组 48 2.43±0.71** 2.16±0.54** 2.51±0.66** t — 7.25 3.61 2.64 P — < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 3 2组病人治疗前后改良McGuire、Mazur及AOFAS评分对比
( ;分)$ \overline{x}\pm s$ 分组 n 改良McGuire Mazur AOFAS 治疗前 对照组 48 52.16±12.35 56.34±10.75 52.53±11.80 观察组 48 51.87±11.96 56.73±11.02 53.12±12.35 t — 0.12 0.18 0.24 P — >0.05 >0.05 >0.05 治疗一年后 对照组 48 73.18±9.58** 72.95±9.48** 72.15±8.81** 观察组 48 84.26±8.74** 85.10±8.67** 83.46±8.34** t — 5.92 6.55 6.46 P — < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 -
[1] NAKAJIMA A, NAKAGAWA K, AOKI Y, et al.Changes in synovial fluid biochemical markers following arthroscopic surgery in patients with knee osteoarthritis[J].Rheumatol Int, 2013, 33(1):209. doi: 10.1007/s00296-012-2374-8 [2] 任珩, 杨益民, 袁学峰, 等.关节镜结合补肾坚骨汤治疗中老年踝关节骨性关节炎35例临床观察[J].中医药导报, 2014, 19(14):74. [3] AKALAN N E, APTI A, KUCHIMOV S, et al.Does clinically measured ankle plantar flexor muscle strength or weakness correlate with gait velocity, ankle kinematics and kinetics during walking for healthy individuals?[J].Gait Post, 2015, 42(13):25. [4] 杨益民, 任珩, 袁学峰, 等.关节镜结合中药治疗老年人髌股关节炎的临床研究[J].华南国防医学杂志, 2014, 28(10):976. [5] 任珩, 袁学峰, 杨益民.踝关节镜在中老年骨性关节炎中的临床应用[J].西部医学, 2014, 26(8):1051. doi: 10.3969/j.issn.1672-3511.2014.08.032 [6] DELCO ML, KENNEDY JG, BONASSAR LJ, et al.Post-traumatic osteoarthritis of the ankle:a distinct clinical entity requiring new research approaches.[J].J Orthop Res, 2016, 24(17):829. [7] 蒋逸秋, 桂鉴超.老年性踝关节骨性关节炎的外科干预[J].实用老年医学, 2015, 20(9):715. [8] WIKSTROM EA, ANDERSON RB.Alterations in gait initiation are present in those with posttraumatic ankle osteoarthritis:a pilot study.[J].J Appl Biomech, 2013, 29(3):245. doi: 10.1123/jab.29.3.245 [9] 任珩, 袁学峰, 刘雅静, 等.关节镜下手术治疗踝关节骨性关节炎的临床疗效观察[J].安徽医药, 2014, 18(3):517. doi: 10.3969/j.issn.1009-6469.2014.03.038 [10] FIGUEROA D, CALVO R, VILLALÓN IE, et al.Clinical outcomes after arthroscopic treatment of knee osteoarthritis[J].Knee, 2013, 20(6):591. doi: 10.1016/j.knee.2012.09.014 [11] PIHL K, ENGLUND M, LOHMANDER LS, et al.Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear[J].Acta Orthopaedica, 2017, 16(25):1. [12] 段小军, 杨柳.踝关节重度骨关节炎行关节镜下踝关节融合术的临床研究[J].第三军医大学学报, 2015, 37(3):220. [13] 袁奇亮, 王明君, 李振威, 等.关节镜下综合治疗踝关节骨关节炎28例临床分析[J].中华实用诊断与治疗杂志, 2013, 17(4):403. [14] NVESCH C, HUBER C, PAUL J, et al.Mid-to-Long-term clinical outcome and gait biomechanics after realignment surgery in asymmetric ankle osteoarthritis.[J].Foot Ankle Int, 2015, 36(8):908. doi: 10.1177/1071100715577371 [15] 夏卿, 王凌椿.关节镜清理术联合活血消肿汤辨证治疗膝关节骨性关节炎的疗效分析[J].四川中医, 2013, 31(10):79.