Abstract:

Objective　To explore the effect of catgut implantation at acupoint in the treatment of knee osteoarthritis based on the concept of "regulating bone with tendons". Methods　This study was a randomized controlled trial. A total of 150 patients with knee osteoarthritis admitted to the Department of Rehabilitation Medicine of Xi'an Jiaotong University First Affiliated Hospital Yulin Hospital from March 2021 to March 2024 were selected as the research subjects and were divided into a control group and an observation group, with 75 cases in each group, by the random number table method. In the control group, there were 42 males and 33 females, aged (63.35±8.42) years, the disease duration was (20.36±5.17) months, and there were 26 cases on the left knee, 32 cases on the right knee, and 17 cases on both knees. In the observation group, there were 40 males and 35 females, aged (62.08±9.13) years, the disease course was (21.52±4.86) months, and there were 28 cases on the left knee, 31 cases on the right knee, and 16 cases on both knees. The control group received conventional western medicine treatment: oral celecoxib capsules, 0.2 g each time, once a day, for 4 consecutive weeks; the observation group received catgut implantation at acupoint on the basis of the control group: catgut implantation was done once on the 1st, 7th, 14th, 21st, and 28th days of the treatment, for a total of 5 times. The pain, knee joint function, severity of knee osteoarthritis, and levels of serum inflammatory factors and pain mediators were compared between the two groups before and after treatment, as well as the clinical efficacy and safety. Statistical analysis was performed using t-test and χ² test. Results　After treatment, the Visual Analogue Scale (VAS) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were decreased in both groups (all P<0.05), and those in the observation group were lower than those in the control group [(1.48±0.19) points vs. (2.97±0.41) points, (20.52±4.03) points vs. (30.65±5.29) points] (t=28.555 and 13.192; both P<0.05). After treatment, the Lysholm knee joint score was increased in both groups (both P<0.05), and the score of the observation group was higher than that of the control group [(79.95±8.13) points vs. (64.83±8.26) points] (t=11.298, P<0.05). After treatment, the levels of serum interleukin-1 (IL-1), IL-6, tumor necrosis factor-α (TNF-α), matrix metalloproteinase-3 (MMP-3), substance P (SP), dopamine (DA), and prostaglandin E₂ (PGE₂) were all decreased in both groups (all P<0.05), and those in the observation group were lower than those in the control group [(101.59±10.17) ng/L vs. (132.88±11.64) ng/L, (113.68±16.71) ng/L vs. (147.95±18.56) ng/L, (4.36±0.92) ng/L vs. (6.41±1.55) ng/L, (90.36±14.76) μg/L vs. (125.42±18.61) μg/L, (139.53±20.32) μg/L vs. (176.41±25.84) μg/L, (7.85±1.16) μg/L vs. (11.92±1.59) μg/L, (121.86±21.95) μg/L vs. (179.63±28.77) μg/L (t=17.531, 11.884, 9.850, 12.783, 9.716, 17.909, and 13.825, all P<0.05). The total clinical effective rate of the observation group was higher than that of the control group [96.00% (72/75) vs. 84.00% (63/75)] (χ²=6.000, P=0.014). Both groups did not experience any serious adverse reactions. Conclusion　Based on the concept of "regulating bone with tendons", catgut implantation at acupoint for patients with knee osteoarthritis can effectively reduce the pain and severity of the condition, improve the knee joint function, reduce the levels of inflammatory factors and pain mediators, and has good clinical efficacy and safety.

Key words: Knee osteoarthritis,  , Regulating bone with tendons,  , Catgut implantation at acupoint,  , Pain,  , Knee joint function

摘要：

目的　基于“以筋调骨”理念探讨穴位埋线在膝骨关节炎中的效果。方法　本研究为随机对照试验，选取2021年3月至2024年3月西安交通大学第一附属医院榆林医院康复医学科收治的150例膝骨关节炎患者为研究对象，通过随机数字表法分为对照组和观察组各75例。对照组男42例，女33例；年龄（63.35±8.42）岁；病程（20.36±5.17）个月；病变部位：左膝26例，右膝32例，双膝17例。观察组男40例，女35例；年龄（62.08±9.13）岁；病程（21.52±4.86）个月；病变部位：左膝28例，右膝31例，双膝16例。对照组采用常规西医治疗：口服塞来昔布胶囊，每次0.2 g，每天1次，连续服用4周；观察组在对照组基础上联合穴位埋线治疗：于治疗第1天、第7天、第14天、第21天、第28天各埋线一次，共5次。对比治疗前后两组患者疼痛、膝关节功能、膝骨关节炎严重程度以及血清炎症因子、疼痛介质水平，并比较临床疗效和安全性。采用t检验和χ2检验进行统计学分析。结果　治疗后，两组视觉模拟评分法（Visual Analogue Scale，VAS）评分、西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC）均降低（均P<0.05），且观察组低于对照组［（1.48±0.19）分比（2.97±0.41）分、（20.52±4.03）分比（30.65±5.29）分］（t=28.555、13.192，均P<0.05）；两组Lysholm膝关节评分均升高（P<0.05），且观察组高于对照组［（79.95±8.13）分比（64.83±8.26）分］（t=11.298，P<0.05）；两组血清白介素-1（interleukin-1，IL-1）、IL-6、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、基质金属蛋白酶3（matrix metalloproteinase-3，MMP-3）、P物质（substance P，SP）、多巴胺（dopamine，DA）、前列腺素E2（prostaglandin E2，PGE2）水平均降低（均P<0.05），且观察组低于对照组［（101.59±10.17）ng/L比（132.88±11.64）ng/L、（113.68±16.71）ng/L比（147.95±18.56）ng/L、（4.36±0.92）ng/L比（6.41±1.55）ng/L、（90.36±14.76）μg/L比（125.42±18.61）μg/L、（139.53±20.32）μg/L比（176.41±25.84）μg/L、（7.85±1.16）μg/L比（11.92±1.59）μg/L、（121.86±21.95）μg/L比（179.63±28.77）μg/L］（t=17.531、11.884、9.850、12.783、9.716、17.909、13.825，均P<0.05）。观察组临床总有效率高于对照组［96.00%（72/75）比84.00%（63/75）］（χ2=6.000，P=0.014）。两组均未出现严重不良反应。结论　基于“以筋调骨”理念对膝骨关节炎患者实施穴位埋线治疗，可有效减轻患者疼痛与病情严重程度，改善膝关节功能，降低炎症因子和疼痛介质水平，临床效果与安全性佳。

关键词: 膝骨关节炎, 以筋调骨, 穴位埋线, 疼痛, 膝关节功能