本文選題：膝骨性關(guān)節(jié)炎　切入點(diǎn)：關(guān)節(jié)鏡清理術(shù)　出處：《云南中醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:對(duì)比研究關(guān)節(jié)鏡清理術(shù)分別聯(lián)合常規(guī)療法與“洗按補(bǔ)”療法治療膝骨關(guān)節(jié)炎的臨床療效。方法:將2013年10月-2015年10月共收集47例納入本研究,運(yùn)用隨機(jī)數(shù)字表分組法。其中觀察組23例,對(duì)照組24例。觀察過程中因資料不全、醫(yī)囑性差、病例脫落等原因,最終觀察組20例,對(duì)照組20例。最終數(shù)據(jù)統(tǒng)計(jì)分析按40病例進(jìn)行研究,來評(píng)價(jià)關(guān)節(jié)鏡清理術(shù)聯(lián)合常規(guī)治療與“洗按補(bǔ)”療法治療膝關(guān)節(jié)骨關(guān)節(jié)炎的臨床療效。結(jié)果:1觀察組和對(duì)照組治療KOA的療效分析觀察組和對(duì)照組經(jīng)過治療后的總療效分析(表6)得知:HSS評(píng)分系統(tǒng)兩組總療效結(jié)果,觀察組有效率95%,對(duì)照組有效率90%;經(jīng)秩和檢驗(yàn)分析(Z=-2.031,P=0.0420.05),說明觀察組關(guān)節(jié)鏡清理術(shù)聯(lián)合“洗按補(bǔ)”療法與對(duì)照組關(guān)節(jié)鏡清理術(shù)聯(lián)合常規(guī)療法有差異性,且前者總療效率高于后者。2觀察組治療組前后主要癥狀對(duì)比分析觀察組經(jīng)過治療前后的主要癥狀分析(表7)得知:觀察組患者在HSS評(píng)分系統(tǒng)主要癥狀的治療前與治療后用配對(duì)t檢驗(yàn)表明:觀察組在改善患膝疼痛、功能、活動(dòng)度、肌力、屈曲攣縮上(P0.01)有極顯著差異性;在膝關(guān)節(jié)穩(wěn)定性上(P=0.3200.05)無統(tǒng)計(jì)學(xué)意義,無差異性。說明患者通過關(guān)節(jié)鏡清理術(shù)聯(lián)合“洗按補(bǔ)”療法治療KOA,在改善患膝疼痛、功能、活動(dòng)度、肌力、屈曲攣縮等臨床療效上有著極顯著的臨床改善。但對(duì)改善患者膝關(guān)節(jié)穩(wěn)定性上沒有明顯效果。3對(duì)照組治療組前后主要癥狀對(duì)比分析對(duì)照組經(jīng)過治療前后的主要癥狀分析(表8)得知:對(duì)照組患者在HSS評(píng)分系統(tǒng)主要癥狀的治療前與治療后用配對(duì)t檢驗(yàn)表明:對(duì)照組在改善患膝疼痛、功能、屈曲攣縮上(P0.01)有極顯著差異性;在活動(dòng)度、肌力上(P0.05)有統(tǒng)計(jì)學(xué)意義,有差異性;在膝關(guān)節(jié)穩(wěn)定性上(P0.05),無統(tǒng)計(jì)學(xué)意義,無差異性。說明關(guān)節(jié)鏡清理術(shù)聯(lián)合常規(guī)療法治療KOA,僅在患膝疼痛、功能、屈曲攣縮的臨床效果上有著極顯著的臨床改善,在活動(dòng)度和肌力的臨床效果上有著顯著的臨床改善,而在膝關(guān)節(jié)穩(wěn)定性上無明顯改善。4治療后觀察組與對(duì)照組主要癥狀對(duì)比分析治療后觀察組與對(duì)照組主要癥狀對(duì)比分析(表9)得知:治療后患者在HSS評(píng)分系統(tǒng)主要癥狀的觀察組與對(duì)照度用獨(dú)立樣本t檢驗(yàn)表明:觀察組和對(duì)照組治療后在改善患膝活動(dòng)度上(P0.01)有極顯著差異性;在疼痛、屈曲攣縮上(P0.05)有統(tǒng)計(jì)學(xué)意義,有差異性;在功能、穩(wěn)定性、肌力上(P0.05),無統(tǒng)計(jì)學(xué)意義,無差異性。結(jié)論:1 HSS系統(tǒng)評(píng)分?jǐn)?shù)據(jù)分析知觀察組有效率95%,對(duì)照組有效率90%;經(jīng)秩和驗(yàn)分析(Z=-2.031,P=0.0420.05),觀察組關(guān)節(jié)鏡清理術(shù)聯(lián)合“洗按補(bǔ)”療法對(duì)照組關(guān)節(jié)鏡清理術(shù)聯(lián)合常規(guī)療法二者具有差異性,且前者總療效高于后者。2兩組治療后療效數(shù)據(jù)對(duì)比分析知,HSS系統(tǒng)評(píng)分?jǐn)?shù)據(jù)分析中說明關(guān)節(jié)鏡清理術(shù)聯(lián)合“洗按補(bǔ)”療法治療KOA患者,在改善患者膝關(guān)節(jié)活動(dòng)度的臨床效果上極明顯優(yōu)于關(guān)節(jié)鏡清理術(shù)聯(lián)合常規(guī)療法(P0.01);在疼痛、屈曲攣縮的臨床效果明顯優(yōu)于關(guān)節(jié)鏡清理術(shù)聯(lián)合常規(guī)療法(P0.05);在功能、穩(wěn)定性、肌力的臨床效果上,二者治療效果無明顯差異(P0.05)。3綜上研究,關(guān)節(jié)鏡清理術(shù)聯(lián)合“洗按補(bǔ)”療法治療KOA在改善患者患膝疼痛、活動(dòng)度、屈曲攣縮、僵硬等主要臨床癥狀上有著很好的臨床效果,值得臨床運(yùn)用。
[Abstract]:Objective: To compare the effects of arthroscopic debridement combined with conventional therapy and wash separately according to the clinical curative effect of complement therapy in the treatment of knee osteoarthritis. Methods: the October 2013 -2015 year in October 47 cases were collected in this study, using a random number table grouping method. 23 cases in the observation group, 24 cases in the control group. The observation process for incomplete information, order difference, cause cases, the final 20 cases in the observation group, 20 cases in the control group. The final data were analyzed according to the study of 40 cases, to evaluate the arthroscopic debridement combined with routine treatment and wash according to the clinical curative effect of complement therapy in the treatment of knee osteoarthritis. Results: the observation group 1 and the control group curative effect in the treatment of KOA of the observation group and the control group after the total curative effect after the treatment analysis (Table 6) show that the HSS scoring system, the total effect of the two groups, the observation group the effective rate was 95%, the effective rate of control group 90%; the rank and inspection analysis (Z=-2.031, P =0.0420.05), the observation group of arthroscopic debridement combined with "wash to fill" therapy and the control group of arthroscopic debridement combined with conventional therapy has the difference, and the total treatment efficiency is higher than that of the latter analysis.2 observation group treatment group the main symptoms before and after comparison of the observation group after analysis the main symptoms before and after treatment (Table 7) that: observation and treatment the main symptoms of patients in the HSS score system before and after treatment by paired t test showed that the observation group in improving knee pain, function, activity, muscle strength, flexion contracture on (P0.01) had significant differences in knee stability; (P=0.3200.05) had no statistical significance, there was no difference in patients. Through arthroscopic debridement combined with "wash to fill" therapy in the treatment of KOA, in the improvement of knee pain, function, activity, muscle strength, flexion contracture of clinical curative effect has significant clinical improvement. But the improvement of patients with knee joint instability There is no obvious effect on the qualitative analysis group.3 control group before and after treatment of symptoms compared with the control group after the main symptoms before and after treatment and analysis (Table 8) that the control group in the HSS score system the main symptoms before and after treatment by paired t test showed that the control group in improving knee function, pain, flexion contracture on (P0.01) had significant differences; in activity, strength (P0.05) was statistically significant difference in knee stability; (P0.05), no statistical significance, no difference. Arthroscopic debridement combined with conventional therapy in the treatment of KOA, only in the function of knee pain, clinical. The effect of flexion contracture has significant clinical improvement, significant clinical improvements in clinical activity and muscle strength, and no significant improvement after.4 treatment, the observation group and the control group in the treatment of main symptoms of comparative analysis of the stability of the knee. After the observation group and the control group comparison analysis of main symptoms (Table 9) that: after treatment of patients with the main symptoms scoring system in HSS observation group and contrast with the independent sample t test showed that the observation group and the control group after treatment in improving knee motion (P0.01) has a significant difference in pain; flexion contracture (P0.05) on a statistically significant differences; in function, stability, strength (P0.05), no statistical significance, no difference. Conclusion: analysis of 1 known HSS system score data the effective rate of observation group was 95%, the effective rate of control group 90%; the rank and inspection analysis (Z=-2.031, P=0.0420.05) the observation group, arthroscopic debridement combined with "wash to fill" therapy in the control group of arthroscopic debridement combined with conventional treatment two has the difference, and the total effect of.2 was higher than that of the latter two groups after treatment efficacy data comparison analysis, analysis of HSS data shows that arthroscopic score system Combined with "wash according to supplement therapy in KOA patients, to improve clinical outcome in patients with knee joint activity was significantly better than the arthroscopic debridement combined with conventional therapy (P0.01); in pain, flexion contracture of the clinical effect is obviously better than that of arthroscopic debridement combined with conventional therapy (P0.05); in the function, stability and clinical effect of muscle strength no significant difference on the treatment effect of two (P0.05).3 in conclusion, arthroscopic debridement combined with" wash to fill "therapy in the treatment of KOA patients in improving knee pain, activity, flexion contracture, stiffness of the main clinical symptoms has a good clinical effect, worthy of clinical application.

【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687.4

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