本文選題：水針刀療法 + 針刀療法　； 參考：《中國(guó)中醫(yī)科學(xué)院》2015年碩士論文

【摘要】：目的：膝骨關(guān)節(jié)炎(KOA Knee Osteoarthritis)是發(fā)生于膝關(guān)節(jié)的一種慢性、退行性骨關(guān)節(jié)疾病,是骨科臨床的常見(jiàn)病。KOA的主要臨床表現(xiàn)為疼痛、腫脹,并多伴雖有關(guān)節(jié)僵硬、變形及活動(dòng)受限等表現(xiàn),嚴(yán)重者導(dǎo)致關(guān)節(jié)功能障礙甚至殘疾,嚴(yán)重影響患者的生存質(zhì)量。對(duì)KOA的治療目標(biāo)主要集中在1、緩解疼痛2、改善功能3、延緩軟骨退化避免或減少畸形。水針刀治療KOA在臨床上已得到一定應(yīng)用,據(jù)文獻(xiàn)報(bào)道取得了較好的臨床療效,可有效緩解疼痛并改善關(guān)節(jié)功能。水針刀療法集針刺、注射和針刀療法之優(yōu)勢(shì),將藥物與針刀結(jié)合在一起。既可起到活血疏筋,又有松解粘連改善應(yīng)力不勻,并還可通過(guò)藥物達(dá)到消炎等作用。中醫(yī)治療雖短期療效較好,但由于缺乏臨床統(tǒng)一的療效評(píng)判標(biāo)準(zhǔn),且臨床報(bào)道缺少?lài)?yán)謹(jǐn)?shù)目蒲性O(shè)計(jì)與統(tǒng)計(jì)學(xué)處理從而缺乏說(shuō)服力。本研究通過(guò)使用水針刀治療KOA,并觀察VAS評(píng)分、Lequesne膝骨關(guān)節(jié)炎嚴(yán)重程度指數(shù)(ISOA index of severity for osteoarthritis of hip and knee)等相關(guān)指標(biāo),以探討評(píng)價(jià)水針刀治療膝骨關(guān)節(jié)炎的臨床療效研究方法：本試驗(yàn)為臨床多中心試驗(yàn),三所臨床醫(yī)院分別收錄符合納入標(biāo)準(zhǔn)患者30例,本試驗(yàn)共收錄患者90例。各組患者皆由了解標(biāo)準(zhǔn)操作規(guī)程的主治及以上醫(yī)師按統(tǒng)一方法進(jìn)行治療,每周兩次,共治療兩周。分別于治療開(kāi)始第一天及治療結(jié)束兩天內(nèi)記錄VAS評(píng)分、ISOA指數(shù)(ISOA index of severity for osteoarthritis of hip and knee)兩項(xiàng)觀察指標(biāo)。并根據(jù)患者的各項(xiàng)觀測(cè)指標(biāo)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,評(píng)價(jià)水針刀治療膝骨關(guān)節(jié)炎的臨床療效。采用excel 2003表錄入數(shù)據(jù),spss20.0軟件對(duì)數(shù)據(jù)處理分析。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差進(jìn)行統(tǒng)計(jì)描述,前后對(duì)比采用t檢驗(yàn)進(jìn)行比較,P值≤0.05被認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果：治療前后相關(guān)指標(biāo)比較：各組治療后VAS疼痛評(píng)分及ISOA指數(shù)均顯著下降,與治療前相比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),表明患者于各臨床試驗(yàn)中心經(jīng)水針刀治療后療效顯著。將三所臨床試驗(yàn)中心數(shù)據(jù)統(tǒng)一分析后顯示,本次試驗(yàn)治療后VAS疼痛評(píng)分及ISOA指數(shù)均顯著下降,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。表明本試驗(yàn)中患者經(jīng)水針刀治療后療效顯著。將ISOA指數(shù)拆分為日常生活疼痛、步行距離(步行能力)、日常活動(dòng)能力三部分評(píng)分。見(jiàn)各組治療后數(shù)據(jù)及本試驗(yàn)治療后數(shù)據(jù),三部分評(píng)分均顯著下降。與治療前相比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。表明水針刀治療在步行能力、日常活動(dòng)能力、日常生活疼痛這三方面都有顯著治療作用。依據(jù)ISOA嚴(yán)重程度分級(jí)標(biāo)準(zhǔn),將本試驗(yàn)患者分為中、重、很重、極重四組。見(jiàn)各嚴(yán)重程度分組治療后評(píng)分均顯著下降。與治療前相比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。根據(jù)療效評(píng)價(jià)標(biāo)準(zhǔn),包頭組總有效率100%,廣州組總有效率100%,溫州組總有效率93%,本試驗(yàn)總有效率97%。本試驗(yàn)各臨床試驗(yàn)中心患者均未見(jiàn)不良事件。結(jié)論：本研究結(jié)果表明,運(yùn)用水針刀治療KOA能顯著緩解患者膝關(guān)節(jié)疼痛癥狀,一定程度上改善膝關(guān)節(jié)功能,其中包括步行能力的改善及日�；顒�(dòng)功能的改善。是臨床改善膝骨關(guān)節(jié)炎疼痛癥狀及功能的安全有效的方法。
[Abstract]:Objective: KOA Knee Osteoarthritis is a chronic and degenerative osteoarthrosis of the knee joint. The main clinical manifestation of the common clinical.KOA in the Department of orthopedics is pain, swelling, and many associated with joint stiffness, deformation and limited activity, serious joint dysfunction or even disability, serious impact on the joint. The quality of life of the patients. The target of KOA is mainly focused on 1, alleviating pain 2, improving the function 3, postponing the degeneration of cartilage or reducing malformation. The treatment of KOA with water needle knife has been applied in clinical practice. According to the literature, it has achieved good clinical effect, can effectively relieve pain and improve joint function. The advantages of injection and needle knife therapy combine drugs and needle scalpel together. It can not only play the blood circulation and sparsely tendons, but also have loose solution and adhesion to improve the stress unevenness, and can also achieve anti-inflammatory effects through the medicine. Although the short term effect of traditional Chinese medicine is good, it lacks the clinical unified curative effect evaluation standard, and the clinical report lacks rigorous scientific research design and unification. This study used water needle scalpel to treat KOA, and observed the VAS score, Lequesne knee osteoarthritis severity index (ISOA index of severity for osteoarthritis of hip and) and other related indexes, in order to evaluate the clinical efficacy of water needle knife in the treatment of knee osteoarthritis. A total of 30 patients were included in three clinical hospitals, and 90 patients were included in this test. All the patients were treated by the standard operating procedures and the above doctors were treated by a unified method, two times a week for two weeks. The VAS evaluation was recorded at the first day of treatment and the end of the treatment for two days respectively. The ISOA index (ISOA index of severity for osteoarthritis of hip and knee) was used to evaluate the clinical efficacy of the water needle knife in the treatment of knee osteoarthritis according to the data of the patients' observation index. The data were recorded by the Excel 2003 table, and the data were analyzed. The standard deviation was compared with the t test. The P value less than 0.05 was considered statistically significant. Results: the relative indexes before and after treatment were compared: the VAS pain score and the ISOA index decreased significantly after treatment, and the difference was statistically significant compared with that before treatment (P0.05), indicating that the patients were in the clinical trial center. After the treatment of three clinical trial centers, the VAS pain score and the ISOA index were significantly decreased after the treatment, and the difference was statistically significant (P0.05). The results showed that the patients were treated significantly with water Acupotomy. The ISOA index was divided into daily life pain and walking distance. Three parts of daily activity were scored. The scores of the three parts were significantly decreased after the data of each group after treatment and the data after the treatment. The difference was statistically significant compared with that before treatment (P0.05). It showed that water needle knife treatment had significant therapeutic effects on the walking ability, daily activity, and daily life pain. According to the ISOA severity grading standard, the test patients were divided into four groups, heavy, heavy and heavy. The scores of each group were significantly decreased after treatment. Compared with before treatment, the difference was statistically significant (P0.05). According to the evaluation standard of curative effect, the total effective rate of Baotou group was 100%, the total effective rate of Guangzhou group was 100%, and the total effective rate of Wenzhou group was 93%. The total efficiency of the test was 97%.. No adverse events were found in all clinical trial centers. Conclusion: the results of this study showed that the treatment of KOA with water Acupotomy could significantly alleviate the symptoms of knee joint pain in patients, and to some extent improve the function of the knee joint, including the improvement of walking ability and the improvement of daily activity function. It is the clinical improvement of the knee. Osteoarthritis pain symptoms and function of a safe and effective way.

【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R684.3

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