1、消肿利节方治疗急性创伤性膝关节滑膜炎近期临床疗效观察【摘 要】目的:观察消肿利节方治疗急性创伤性膝关节滑膜炎的近期疗效。方法:将 79 例膝关节创伤性滑膜炎患者随机分为治疗组 41例和对照组 38 例,治疗组口服消肿利节方,对照组口服双氯芬酸钠。2组均以 5 d 为 1 个观察点,15 d 为 1 个疗程,进行疗效评定和观察指标分析。结果:治疗组治愈 22 例,好转 16 例,未愈 3 例,总有效率为 92.68%;对照组治愈 17例,好转 11 例,未愈 10 例,总有效率为 73.68%。2 组比较,差异有统计学意义(P 0.05) 。2 组观察指标比较,重复测量资料采用方差分析得出,疼痛
2、(F = 4.91,P = 0.03 0.05) ;肿胀(F = 12.92,P = 0.01 0.05) ;功能障碍(F = 4.03, P = 0.048 0.05) 。可认为治疗组与对照组在改善疼痛、肿胀、功能障碍方面有差异,且治疗组改善优于对照组(P 0.05) 。结论:消肿利节方在改善疼痛、肿胀、功能障碍方面优于双氯芬酸钠缓释片,近期疗效确切。 【关键词】 创伤性滑膜炎;急性;消肿利节方;膝关节;近期疗效 doi:10.3969/j.issn.2095-4174.2016.02.003 Clinical Observation on the Short-term Curative E
3、ffect of Xiaozhong Lijie Fang (消肿利节方) in the Treatment of Acute Traumatic Synovitis of Knee Joint LIU Bin,GUO Yan-xing,WEN Yong-bing 【ABSTRACT】 Objective:To observe the short-term curative effect of Xiaozhong Lijie Fang(消肿利节方,a prescription for promoting the circulation of blood and relaxing the joi
4、nts)in the treatment of acute traumatic synovitis of knee joint.Methods:79 cases with acute traumatic synovitis of knee joint were randomly divided into a treatment group (41 cases) and a control group (38 cases).The treatment group was treated with Xiaozhong Lijie Fang,while the control group was o
5、rally given diclofenac sodium.The 2 groups were treated for 15 days as a course,and they were observed every 5 days.The curative effect was evaluated and the observation index was analyzed in the two groups.Results:In the treatment group,22 cases were cured,condition of 16 cases was improved,3 cases
6、 were not cured,and the total efficiency of was 92.68%;while in the control group,17 cases were cured,condition of 11 cases was improved,10 cases were ineffective,and the total efficiency of was 73.68%.The difference between the 2 groups was statistically significant (P 0.05).Index comparison and an
7、alysis of variance to repeated measurement data in the two groups showed pain (F = 4.91,P = 0.03 0.05) ,swelling (F = 1.292,P = 0.01 0.05) and dysfunction (F = 4.03,P = 0.048 0.05).It can be considered that the treatment group is better than the control group in relieving pain,swelling and dysfuncti
8、on (P 0.05).Conclusion:Xiaozhong Lijie Fang is better than diclofenac sodium sustained release tablets in relieving pain,swelling and dysfunction and has a short-term curative effect. 【Keywords】traumatic synovitis;acute;Xiaozhong Lijie Fang (消肿利节方) ;knee joint;short-term curative effect 创伤性滑膜炎是外伤引起的
9、滑膜非感染性炎症反应,其病理主要表现为关节内压力升高,滑膜血管扩张、充血,血浆及血细胞外渗;临床表现多为膝关节疼痛、肿胀、活动受限等1。本研究采用消肿利节方治疗急性创伤性膝关节滑膜炎患者 本病属中医学“痹证”范畴, 杂病源流犀烛曰:“忽然闪挫,必为气之震,震则激,激则雍,气雍在何处,则血亦凝在何处。 ”刘斌等10-11认为,急性损伤,脉络破损,气血、水湿循行受阻,瘀血、水湿流注关节,又遇风寒湿乘虚侵袭,郁而化热,痹阻筋骨,出现疼痛、肿胀、功能障碍。其病机主要为气滞血瘀,水湿滞留,痹阻筋骨。郭艳幸12推崇“衡则康,不衡则痼” ,认为恢复平衡是伤科治疗的目的,结合急性创伤性膝关节滑膜炎特点,以气血
10、辨证为纲,调节平衡为法,创立消肿利节方。方中连翘清热解毒,散诸经血结气聚,疏散风寒;当归、茜草调血和血、凉血,祛瘀通经;防己、萆?Z 祛风除湿,利水消肿,祛痹通经;防风、柴胡祛风胜湿,和解表里,疏肝行气;牛膝活血祛瘀,补肝肾强筋骨;甘草缓急止痛,调和诸药。诸药合用,具有活血化瘀、消肿散结、祛风除湿、恢复平衡之效。通过本课题研究,进一步验证了消肿利节方在改善疼痛、肿胀、功能障碍方面优于双氯芬酸钠缓释片,近期疗效确切。其作用机制有待进一步研究探讨,以便临床运用和推广。 5 参考文献 1 胥少汀,葛宝丰,徐印坎.实用骨科学M.北京:人民军医出版社,2012:2267. 2 国家中医药管理局.中医病证
11、诊断疗效标准M.南京:南京大学出版社,1994:197. 3 严广斌.视觉模拟评分法J.中华关节外科杂志:电子版,2014,8(2):34. 4 蒋位庄,王和鸣.中医骨病学M.2 版.北京:人民卫生出版社,2011:167. 5 曹永飞,贾鹏,王长海.滑膜炎颗粒口服联合中药外敷治疗急性创伤性膝关节滑膜炎临床研究J.中国中医急症,2015,24(3):413-414,456. 6 魏立伟,秦娜.综合疗法治疗创伤性膝关节滑膜炎 27 例J.风湿病与关节炎,2013,2(10):41-42. 7 杨波,何承建.玻璃酸钠联合地塞米松膝关节腔内注射治疗创伤性滑膜炎的临床观察J.湖北中医学院学报,2009
12、,11(27):48-49. 8 Ros CD.Arthroscopy and psoriatic knee joint synovitisJ.J Rheamatol,2002,29(9):2017. 9 梁翼,李敏,高志.膝关节创伤性滑膜炎中西医诊疗进展J.华西医学,2010,25(6):1189-1192. 10 刘斌,郭艳幸,郭珈宜,等.平乐正骨平衡思想在痰瘀痹阻型膝痹病中的运用J.中国中医基础医学杂志,2015(6):761-762. 11 刘斌,郭艳幸,郭珈宜,等.通经活利汤联合展筋酊治疗慢性膝关节滑膜炎临床观察J.风湿病与关节炎,2015,4(9):17-19,54. 12 张锟,朱小磊,郭艳幸.郭艳幸教授平衡理论论治强直性脊柱炎经验J.风湿病与关节炎,2016,5(1):41-43. 收稿日期:2015-08-26;修回日期:2015-10-03