中药熏洗联合富血小板血浆关节腔内注射治疗膝骨关节炎高位截骨术后患者的临床观察*

作者：秦 飞1，高 祥2，乔建玲3，张强泽1，亓 强1，任 燕1，聂紫嫣1，庄 贺4

单位：1.济南市人民医院，山东 济南 250102； 2.山东省文登整骨医院，山东 威海 264400； 3.济南市中西医结合医院，山东 济南 250001； 4.山东中医药大学康复医学院，山东 济南 250355

引用：引用：秦飞，高祥，乔建玲，张强泽，亓强，任燕，聂紫嫣，庄贺.中药熏洗联合富血小板血浆关节腔内注射治疗膝骨关节炎高位截骨术后患者的临床观察[J].中医药导报,2025,31(8):121-127.

DOI：10.13862/j.cn43-1446/r.2025.08.019

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摘要：

目的：观察中药熏洗联合富血小板血浆（PRP）关节腔内注射治疗膝骨关节炎高位截骨术（HTO）后的效果。方法：将112例行胫骨高位截骨术治疗的膝关节内翻性骨关节炎患者按照随机数字表法分为治疗组和对照组，每组56例。对照组患者术后采用常规康复治疗结合PRP关节腔内注射治疗，治疗组患者在对照组基础上予中药熏洗治疗，2组均连续治疗4周。比较两组患者膝关节功能[美国特种外科医院量表（HSS）]、疼痛[疼痛视觉模拟评分（VAS）]、内翻角度、截骨愈合时间、肢体肿胀、步态、患膝关节滑液细胞因子[肿瘤坏死因子-α（TNF-α）、基质金属蛋白酶-13（MMP-13）、白细胞介素-17（IL-17）]水平、简明健康调查问卷（SF-36）评分及并发症情况。结果：随着治疗的进行，两组患者HSS评分均较治疗前升高，VAS评分均较治疗前降低，膝关节内翻角度较治疗前减小，差异均有统计学意义（P＜0.05）；术后2周、术后4周，治疗组患者HSS评分均明显高于对照组，VAS评分均明显低于对照组，膝关节内翻角度均明显小于对照组，差异均有统计学意义（P<0.05）；治疗组患者截骨愈合时间短于对照组（P<0.05）；术后2周，治疗组患者肢体肿胀值低于对照组（P<0.05）。与术前比较，术后6个月两组患者步频、步速、步幅增加（P<0.05），且治疗组患者步频、步速、步幅大于对照组（P<0.05）；与术后1 d比较，两组患者术后4周膝关节滑液TNF-α、MMP-13、IL-17水平降低（P<0.05），且治疗组患者膝关节滑液TNF-α、MMP-13、IL-17水平低于对照组（P<0.05）。术后4周，两组患者SF-36评分均高于术前（P＜0.01），且治疗组患者SF-36评分高于对照组（P＜0.01）。治疗组患者并发症发生率[7.84%（4/51）]与对照组[16.00%（8/50）]比较，差异无统计学意义（P＞0.05）。结论：中药熏洗联合PRP关节腔内注射能促进膝骨关节炎HTO术后患者的康复进程，提高膝关节功能，减轻痛感，减小内翻角度，缩短截骨愈合时间，改善肢体肿胀、步态、生活质量，降低膝关节滑液中炎症因子水平。

关键词：膝骨关节炎；高位截骨术；中药熏洗；富血小板血浆；膝关节功能

Abstract：

Objective: To evaluate the efficacy of herbal fumigation-wash therapy combined with intra-articular platelet-rich plasma (PRP) injection in patients undergoing high tibial osteotomy (HTO) for varus knee osteoarthritis. Methods: 112 patients with varus knee osteoarthritis treated by HTO were randomly divided into treatment group (n=56) and control group (n=56). The control group received conventional rehabilitation plus intra-articular PRP injection postoperatively, while the treatment group received additional herbal fumigation-wash therapy. Both groups underwent 4 weeks of intervention. Outcome measures included: knee function (Hospital for Special Surgery Knee Score, HSS), pain intensity (Visual Analog Scale, VAS), varus angle, osteotomy healing time, limb swelling, gait parameters, synovial cytokine levels [tumor necrosis factor-α (TNF-α), matrix metalloproteinase-13 (MMP-13), interleukin-17 (IL-17)], 36-Item Short Form Health Survey (SF-36) scores, and complication rates. Results: Both groups showed statistically significant improvements over baseline in HSS scores (increased), VAS scores (decreased), and varus angle (reduced) during treatment (P<0.05). At 2 and 4 weeks postoperation, the treatment group demonstrated significantly higher HSS scores, lower VAS scores, and smaller varus angles versus controls (P<0.05). Osteotomy healing time was shorter in the treatment group (P<0.05). Limb swelling was significantly reduced in the treatment group at 2 weeks (P<0.05). At 6 months, both groups exhibited increased gait cadence, velocity, and stride length versus preoperative baselines (P<0.05), with superior improvements in the treatment group (P<0.05). Compared with postoperative day 1, the levels of TNF-α, MMP-13, and IL-17 in the synovial fluid of the knee joint decreased at 4 weeks postoperation in both groups (P<0.05). Moreover, the treatment group exhibited lower levels of these biomarkers than the control group (P<0.05). SF-36 scores significantly improved in both groups at 4 weeks (P<0.01), with greater improvement in the treatment group (P<0.01). Complication rates showed no significant difference between treatment group [7.84% (4/51)] and control group [16.00% (8/50)] (P>0.05). Conclusion: The combination of herbal fumigation-wash therapy and intra-articular PRP injection accelerates rehabilitation in post-HTO knee osteoarthritis patients, improving knee function, reducing pain, decreasing varus deformity, shortening osteotomy healing time, ameliorating limb swelling and gait parameters, enhancing quality of life, and reducing synovial inflammatory cytokines.

Key words：knee osteoarthritis; high tibial osteotomy; herbal fumigation-wash therapy; platelet-rich plasma; knee function

发布时间：2026-01-06

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