目的 探讨超声中频穴位导药联合玻璃酸钠注射对膝骨性关节炎患者IL-1β、TNF-α的影响及疗效。方法 选择属于膝骨关节炎X线Ⅰ~Ⅲ级(Kellgren-Lawrence分级)的患者60例,随机分成单一注射组及联合导药组,各30例,两组均进行关节腔注射玻璃酸钠,1次/周,共5次。联合导药组加用超声中频导药仪B贴片在阳陵泉、血海两个穴位导药治疗,每日1次,每次20 min,共治疗4周。治疗前、治疗结束后1周采用西安大略和麦克马斯特骨关节炎调查量表(WOMAC)评价两组患者症状、体征,用《中医病证诊断疗效标准》中骨痹的疗效标准评定治疗效果,并抽取关节液检测IL-1β、TNF-α含量。同时记录治疗过程中出现的不良反应。结果 治疗前,两组患者的WOMAC量表评分、关节液中IL-1β和TNF-α含量的差异均无统计学意义(P＞0.05);治疗后,两组患者的WOMAC量表评分、关节液中IL-1β和TNF-α含量与治疗前相比,均出现明显下降,差异有统计学意义(P<0.05),且联合导药组三项指标均较单一注射组低,差异有统计学意义(P<0.05)。联合导药组治疗总有效率为93.3%,单一注射组总有效率为70.0%,差异有统计学意义(P<0.05)。结论 玻璃酸钠关节腔注射联合超声中频穴位导药技术治疗膝骨性关节炎,与传统关节腔注射相比,可更好地抑制炎性因子IL-1β、TNF-α的释放,从而迅速减轻临床症状,改善关节功能,提高治疗效果。

Objective To explore the effect of ultrasound-mediated acupoint guidance combined with sodium hyaluronate injection on levels of IL-1β and TNF-α in patients with knee osteoarthritis.Methods Sixty patients with knee osteoarthritis of grade I-III using the Kellgren-Lawrence classification were selected and randomly divided into the single injection group and combined drug guidance group, with 30 patients in each. Each group received intra-articular injection of sodium hyaluronate, once a week, for a total of five times. The combined drug guidance group was treated with patch B at Yanglingquan and Xuehai points once a day, for 20 minutes, and for 4 weeks. Before treatment and one week after treatment, the symptoms and signs of the two groups were evaluated by Western Ontario and McMaster Osteoarthritis Questionnaire (WOMAC) scale, the therapeutic effect was evaluated by the criteria of diagnosis and treatment of TCM disease syndrome Gubi, and the contents of IL-1β and TNF-α in the synovial fluid were measured. Adverse reactions during treatment were simultaneously recorded.Results There was no significant difference in WOMAC scores or levels of IL-1β and TNF-αin synovial fluid between the two groups before treatment (P>0.05). After treatment, The WOMAC scores and levels of IL-1β and TNF-α in synovial fluid were significantly lower (P<0.05),and all the three indexes in the combined drug guidance group were significantly lower than those in the single injection group. The difference between the two groups was statistically significant (P<0.05).The total effective rate of the combined drug guidance group was 93.3%, compared to 70.0% in the single injection group. There was significant difference between the two groups (P<0.05).Conclusions Compared with conventional intra-articular injection, the treatment of knee osteoarthritis with sodium hyaluronate injection combined with the ultrasound-mediated acupoint guidance technique can better inhibit the release of such inflammatory factors as IL-1β and TNF-α,thus quickly alleviating clinical symptoms, improving joint function and enhancing the therapeutic effect.