老年膝骨性关节炎的中西医结合临床综合干预方案制定和优化的临床研究

摘要 目的：制定并优化老年膝骨性关节炎（KOA）的中西医结合临床综合干预方案，为老年KOA提供更加规范化、可操作化的治疗方案。方法：选取2019年1月～2019年12月我院住院、符合纳入标准的KOA患者90例，按随机双盲法随机分为治疗1组、治疗2组及治疗3组各30例，治疗1组采用基础药物治疗+中医辨证论治中药口服+理疗方案治疗，外加日常医护人员的传统入院宣教。治疗2组在治疗1组的基础上增加三项中医特色疗法治疗。治疗3组在治疗2组的基础上再增加经过特定编排的系统宣教视频。记录视觉模拟量表（VAS）评分、膝关节评分表（KSS）评分，并考察肝肾功能等安全性指标及患者满意度。结果：治疗后三组VAS评分、KSS临床评分、KSS功能评分比较差异有统计学意义（P<0.05）。三组患者VAS评分、KSS临床评分、KSS功能评分治疗后均较治疗前有明显好转，差异均有统计学意义（均P<0.05）。与治疗1组治疗后比较，治疗2组、治疗3组VAS评分均较低，KSS临床评分和KSS功能评分均升高，差异均有统计学意义（均P<0.05）。三组间满意度比较差异无统计学意义（P>0.05），但与治疗1组治疗后比较，治疗3组满意度升高，差异有统计学意义（P<0.05）。全部患者均未见不良事件及并发症，治疗前后肝肾功能均无异常，安全性良好。结论：中西医结合保守治疗综合干预方案对于老年性KOA的治疗确实有效，中医特色疗法明显增加了疗效，统一规范、有可执行标准是其重点，系统的宣教有利于整个方案，疗效满意，且安全性良好，具有一定的临床推广价值。

Clinical Study on the Formulation and Optimization of Comprehensive Clinical Intervention Scheme of Integrated Traditional Chinese and Western Medicine in Elderly Knee Osteoarthritis

ABSTRACT Objective: Formulate and optimize the clinical comprehensive intervention scheme of integrated traditional chinese and western medicine for elderly knee osteoarthritis (KOA), so as to provide a more standardized and operable treatment scheme for elderly KOA. Methods: 90 patients with KOA who were hospitalized in our hospital from January 2019 to December 2019 and met the inclusion criteria were randomly divided into treatment group 1, treatment group 2 and treatment group 3, with 30 cases in each group.Treatment group 1 was treated with basic drug treatment + Oral administration of traditional Chinese medicine based on syndrome differentiation and treatment of traditional Chinese Medicine+physiotherapy, plus the traditional admission education of daily medical staff. Treatment group 2 added three traditional chinese medicine characteristic therapies on the basis of treatment group 1. On the basis of the treatment group 2, the treatment group 3 added the system propaganda video with specific arrangement. The scores of visual analogue scale (VAS) and knee joint scale (KSS) were recorded, and the safety indexes such as liver and kidney function and patient satisfaction were investigated. Results: There were significant differences in VAS score, KSS clinical score and KSS function score among the three groups after treatment (P<0.05). VAS score, KSS clinical score and KSS function score of the three groups were significantly improved after treatment compared with those before treatment (all P<0.05). Compared with treatment group 1 after treatment, the VAS score of treatment group 2 and treatment group 3 were lower, and the KSS clinical score and KSS function score were higher, the difference was statistically significant (all P<0.05). There was no significant difference in satisfaction among the three groups (P>0.05), but compared with the treatment group 1, the satisfaction of the treatment group 3 increased, and the difference was statistically significant (P<0.05). All patients had no adverse events and complications, and there was no abnormal liver and kidney function before and after treatment, and the safety was good. Conclusion: The comprehensive intervention scheme of conservative treatment of integrated traditional chinese and western medicine is indeed effective for the treatment of elderly KOA.The characteristic therapy of traditional chinese medicine has significantly increased the curative effect. The focus is to be unified, standardized and executable standards. The systematic publicity and education is conducive to the whole scheme, with satisfactory curative effect, good safety and certain clinical promotion value.