目的 探讨通络祛痛膏联合依托考昔治疗膝骨关节炎的临床疗效。方法 选取2019年8月—2022年7月东营市东营区人民医院收治的122例膝骨关节炎患者，按随机数字表法将所有患者分为对照组和治疗组，每组各61例。对照组口服依托考昔片，60 mg/次，1次/d。治疗组在对照组治疗基础上使用通络祛痛膏，根据患者痛处面积大小选用1～2贴外贴于患膝，1次/d，每次贴敷时间＜12 h。两组疗程均为8周。观察两组的临床疗效，比较治疗前后两组膝关节晨僵时间、疼痛视觉模拟量表（VAS）评分、肿胀评分和活动度，病情严重程度评分、膝骨性关节炎生存质量量表（QOL-KOA）总分、红细胞沉降率（ESR）及血清血小板反应蛋白-1（TSP-1）、Toll样受体4（TLR4）、C反应蛋白（CRP）、高迁移率族蛋白B1（HMGB1）水平。结果 治疗后，治疗组总有效率是95.08%，显著高于对照组的83.61%（P＜0.05）。治疗后，两组膝关节晨僵时间均显著缩短，疼痛VAS评分和肿胀评分均显著降低，主、被动活动度均显著增加（P＜0.05）；治疗后，这些指标均以治疗组改善更明显（P＜0.05）。治疗后，两组患者病情严重程度评分、QOL-KOA总分均显著降低（P＜0.05），且以治疗组下降更显著（P＜0.05）。治疗后，两组ESR和血清TSP-1、TLR4、CRP、HMGB1水平较治疗前均显著下降（P＜0.05）；且治疗后，治疗组ESR和血清TSP-1、TLR4、CRP、HMGB1水平均显著低于对照组（P＜0.05）。结论 通络祛痛膏联合依托考昔治疗膝骨关节炎有确切疗效，在改善患者膝关节症状、减轻病情及提高生活质量方面均可获得满意效果，并可进一步抑制机体炎症反应，且安全性较高。

Objective To investigate the clinical efficacy of Tongluo Qutong Ointment combined with etoricoxib in treatment of knee osteoarthritis. Methods A total of 122 patients with knee osteoarthritis admitted to Dongying District People’s Hospital of Dongying City from August 2019 to July 2022 were selected and divided into control group and treatment group according to random number table method, with 61 cases in each group. Patients in the control group were po administered with Etoricoxib Tablets, 60 mg/time, once daily. Patients in the treatment group were administered with Tongluo Qutong Ointment on the basis of the control group. According to the pain area of the patient, one to two external patches were applied to the affected knee, once daily, and the time of each patch was less than 12 h. The treatment course of both groups was 8 weeks. The clinical efficacy of the two groups were observed, and the time of morning stiffness of knee joint, VAS score, swelling score and range of motion, severity score, QOL-KOA score, erythrocyte settlement rate (ESR), TSP-1, TLR4, CRP, and HMGB1 were compared before and after treatment. Results After treatment, the total effective rate of the treatment group was 95.08%, which was significantly higher than that of the control group (83.61%, P < 0.05). After treatment, morning stiffness time of knee joint was significantly shortened, pain VAS score and swelling score were significantly decreased, and active and passive activity were significantly increased in both groups (P < 0.05). After treatment, these indexes were improved more significantly in the treatment group (P < 0.05). After treatment, the score of disease severity and the total score of QOL-KOA in 2 groups were significantly decreased (P < 0.05), and the decrease was more significant in the treatment group (P < 0.05). After treatment, the levels of ESR, serum TSP-1, TLR4, CRP and HMGB1 in 2 groups were significantly decreased compared with before treatment (P < 0.05). After treatment, the levels of ESR, serum TSP-1, TLR4, CRP and HMGB1 in treatment group were significantly lower than those in control group (P < 0.05). Conclusion Tongluo Qutong Ointment combined with etoricoxib has a definite curative effect in treatment of knee osteoarthritis. Satisfactory effects can be obtained in improving knee joint symptoms, relieving disease and improving quality of life, and can further inhibit the body’s inflammatory response, and it is safe higher.

R977

东营市卫生和计划生育委员会基金项目（2017HW252）