Objective: To compare the clinical efficacy and its effect on serum levels of tumor necrosis factor α(TNF-α), interleukin 1β(IL-1β), interleukin 6 (IL-6) and prostaglandin E2 (PGE2) between short needling (close-to-bone needling) and conventional acupuncture for knee osteoarthritis (KOA) with blood stasis obstruction.
Methods: A total of 68 KOA patients with blood stasis obstruction were randomized into a short needling group (34 cases, 3 cases dropped off) and a conventional acupuncture group (34 cases, 3 cases dropped off). The same acupoints (Dubi [ST 35], Neixiyan [EX-LE 4], Binzhong [Extra], Liangqiu [ST 34], etc. on the affected side) were selected in the two groups. In the short needling group, short needling technique was adopted, the needles were slowly inserted and the needle bodies were shaken, thus gradually penetrated to the bone. In the conventional acupuncture group, conventional acupuncture was adopted, the needles were penetrated to the muscle. After qi-arrival, Dubi (ST 35) and Neixiyan (EX-LE 4), Zusanli (ST 36) and Liangqiu (ST 34) were connected with CMNS6-1 electronic acupuncture instrument, with disperse-dense wave, 2 Hz/10 Hz in frequency, the current intensity was based on patients' feeling, the needles were retained for 30 min, at the same time, the knee joint was irradiated for 30 min with a special electromagnetic wave apparatus in the two groups. Once every other day, 3 times a week for 4 weeks. Before and after treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, knee joint pain visual analogue scale (VAS) score, inflammatory response related indexes (serum TNF-a, IL-1β, IL-6 and PGE2) and knee joint ultrasound were observed，and the clinical effect was evaluated in the two groups.
Results: After treatment，the pain, stiffness, function scores and total scores of WOMAC were decreased as compared with those before treatment in the two groups (P<0.05), except for the pain score, the changes of above scores in the short needling group were greater than the conventional acupuncture group (P<0.05). After treatment, the VAS scores, serum levels of TNF-a, IL-1β, IL-6, PGE2 and knee joint synovium thickness, intra-articular effusion were decreased as compared with those before treatment in the two groups (P<0.05), the levels of TNF-a, IL-1β, IL-6 in the short needling group were lower than the conventional acupuncture group (P<0.05). The total effective rate in the short needling group was 87.1% (27/31), which was superior to 83.9% (26/31) in the conventional acupuncture group (P<0.05).
Conclusion: Short needling could improve the knee joint function, relieve the pain and inflammatory response, improve the knee joint synovium inflammatory response, reduce the knee joint intra-articular effusion for KOA patients, its effect is better than conventional acupuncture.
目的：比较短刺与常规针刺治疗瘀血阻滞证膝关节骨关节炎（KOA）的疗效及对血清肿瘤坏死因子a（TNF-a）、白介素1β（IL-1β）、白介素6（IL-6）、前列腺素E2（PGE2）水平的影响。方法：将68例瘀血阻滞证KOA患者随机分为短刺组（34例，脱落3例）和常规针刺组（34例，脱落3例）。两组取穴（患侧犊鼻、内膝眼、髌中、梁丘等）相同，短刺组采用短刺手法，所有穴位缓慢进针，摇动针体逐步深入达骨膜；常规针刺组采用常规针刺，均针刺达肌肉层。两组针刺得气后，犊鼻和内膝眼、足三里和梁丘分别连接CMNS6-1型电子针灸治疗仪，予疏密波（2 Hz/10 Hz），强度以患者舒适为度，留针30 min，同时予特定电磁波治疗器照射膝关节30 min，均隔日1次，每周3次，治疗4周。于治疗前后观察两组西安大略和麦克马斯特大学骨关节炎指数（WOMAC）量表评分、膝关节疼痛视觉模拟量表（VAS）评分、炎性反应相关指标（血清TNF-a、IL-1β、IL-6、PGE2水平）和膝关节超声的变化，并评定两组疗效。结果：治疗后，两组患者WOMAC量表疼痛、僵硬、功能分项评分及总分均较治疗前降低（P<0.05）；除疼痛分项评分外，短刺组降低幅度均大于常规针刺组（P<0.05）。治疗后，两组患者VAS评分，血清TNF-a、IL-1β、IL-6、PGE2水平及患侧膝关节滑膜厚度、关节腔内积液厚度均较治疗前降低（P<0.05），短刺组TNF-a、IL-1β、IL-6水平低于常规针刺组（P<0.05）。短刺组总有效率为87.1%（27/31），高于常规针刺组的83.9%（26/31，P<0.05）。结论：短刺治疗可明显改善KOA患者膝关节功能，减轻膝关节疼痛及炎性反应，改善膝关节滑膜炎性病变，减少膝关节腔内积液，疗效优于常规针刺。.
Keywords: acupuncture; knee osteoarthritis; randomized controlled trial (RCT); short needling.