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小针刀、玻尿酸和高浓度血小板血浆三合一疗法治疗膝关节炎疗效观察
The Efficacy of Triple Therapy with Acupotomy, Hyaluronic Acid, and Platelet-Rich Plasma in
Combination with Subsequent Oral Hyaluronic Acid for Moderate Knee Osteoarthritis
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背景：玻尿酸、高浓度血小板血浆和小针刀三合一疗法对膝关节炎的疗效仍然未知。此篇研究目的在探讨三合一疗法对三种单独疗法的疗效比较。
方法：选取院内膝关节门诊60 位病患，共分四组，采用关节内玻尿酸注射15 位，小针刀疗法15 位，高浓度血小板血浆关节内注射15 位和上述三种合并疗法（三合一疗法）15 位。治疗後，四组开始服用玻尿酸共12 个月，观察治疗後一个月、三个月、六个月和十二个月疼痛视觉类比量表（VAS）和西安大略和麦马斯特大学骨性关节炎指数（WOMAC）临床评量。
结果：四组治疗後第一个月、第三个月、第六个月和第十二个月，VAS 缓解疼痛和WOMAC 功能恢复，都有明显疗效且具统计意义（p<0.05）。三合一疗法组个别与单纯治疗的玻尿酸注射组、高浓度血小板血浆组和小针刀组比较，於第一个月、第三个月、第六个月和第十二个月，在VAS 缓解疼痛和WOMAC 功能恢复方面都有明显疗效且具统计意义（p<0.05）。经一年的追踪发现，四组治疗後口服玻尿酸可维持疗效长达一年。
结论：三合一疗法後续口服玻尿酸治疗退化性膝关节炎比起单独疗法更有明显的疗效，惟更进一步严谨的双盲研究值得期待。
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Der-Shiang Tsai1,2*Tsung-Kuei Kao3
1School of Chinese Medicine for Post-Baccalaureate, I-ShouUniversity, Kaohsiung, Taiwan
2Department of Chinese medicine, Chinese WesterMedicne Integrated Clinic, Taipei, Taiwan
3Chung Hwa University of Medical Technology, Tainan, Taiwan
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Background: The exact outcome of combined use (triple therapy) with intraarticular hyaluronic acid (HA) injection,intra-articular platelet-rich plasma (PRP) injection and acupotomy (ACUP) in the treatment of moderate knee osteoarthritis remains unclear. The goal of the paper was to compare the efficacy of triple therapy with those of a cohort of patients treated with ACUP, HA and PRP only.
Methods: A total of 60 subjects with knee osteoarthritis, stage 3 were enrolled: 15 cases in HA group, 15 cases in PRPgroup, 15 cases in ACUP group and 15 cases in triple therapy group (HA+PRP+ACUP). After clinical evaluation, patients received a weekly HA injection of HA for 3 times in HA group, PRP for 1 time in HA group, a weekly acupotomy in ACUP group for 3 times, and combined use in triple therapy group. All 4 groups subsequently received self rehabilitation and healthy food nutrition (oral HA). Clinical outcomes were evaluated using Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire at baseline and after 1,3,6 and 12 months.
Results: The study showed that all 4 groups have significant improvement at 1,3, 6 and 12 month after therapy (p<0.05, respectively). In addition, triple therapy group had significant reduction in VAS score and WOMAC function activity score at 1, 3, 6, 12 month when compared to ACUP, HA, and PRP group respectively (p<0.05). Oral hyaluronic acid maintained the effect till one year in all four group was observed.
Conclusion: The findings of the study support the use of triple therapy as an effective treatment for moderate knee osteoarthritis when compared to other three group. Further rigorously designed and well-controlled RCTs with long-term follow-up are warranted.
【Keywords】Knee osteoarthritis, Acupotomy, Hyaluronic acid, Platelet-rich plasma, VAS, WOMAC
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232.2 小针刀、玻尿酸和高浓度血小板血浆三合一疗法治疗膝关节炎疗效观察
