本文選題：膝骨性關(guān)節(jié)炎 + 毫火針療法��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：本文從文獻(xiàn)研究、理論探討和臨床試驗(yàn)三個(gè)方面對膝骨關(guān)節(jié)炎的中西醫(yī)結(jié)合治療進(jìn)行了較為系統(tǒng)和深入的研究。論文的第一部分為前言。首先介紹其病理、臨床表現(xiàn)、對患者的影響和發(fā)病率的增加,指出膝骨關(guān)節(jié)炎的治療及預(yù)防保健的重要性。其次介紹了膝骨關(guān)節(jié)炎的早中后期的西醫(yī)治療辦法及其不足以及針灸治療膝骨關(guān)節(jié)炎的優(yōu)點(diǎn)。然后介紹了針對膝骨關(guān)節(jié)炎的病因,采用火針療法對膝骨關(guān)節(jié)炎患者有良好的止痛作用但對關(guān)節(jié)活動(dòng)度的改善欠佳,并對能改善關(guān)節(jié)活動(dòng)功能的運(yùn)動(dòng)療法進(jìn)行簡要介紹,從而引出本文對火針與火針配合運(yùn)動(dòng)療法對膝骨關(guān)節(jié)炎的療效差異的研究目的和臨床意義。論文的第二部分為文獻(xiàn)研究和理論探討。本文從祖國醫(yī)學(xué)對膝骨關(guān)節(jié)炎的認(rèn)識、病因病機(jī)和治療方法及現(xiàn)代醫(yī)學(xué)對膝骨關(guān)節(jié)炎的認(rèn)識、流行病學(xué)特點(diǎn)、發(fā)病機(jī)制和治療方法等進(jìn)行了一系列探討。從在祖國醫(yī)學(xué)認(rèn)為,膝骨性關(guān)節(jié)炎屬于痹癥的范疇,古代醫(yī)學(xué)文獻(xiàn)對痹癥的論述頗多。指出病因涉及各個(gè)方面,包括外感和內(nèi)傷;其病位在膝關(guān)節(jié),病變則多數(shù)涉及肝、腎、脾臟;病屬本虛標(biāo)實(shí);肝腎虧虛、氣血虛弱是該病的病理基礎(chǔ),風(fēng)寒濕邪是常見誘發(fā)因素,瘀血阻絡(luò)是發(fā)病關(guān)鍵;根據(jù)其病機(jī)特點(diǎn),治療以補(bǔ)虛瀉實(shí)為治則,溫陽散寒、活血通絡(luò)為治法。具體治療方法又有中藥、針刺療法、電針、溫針灸、針?biāo)幗Y(jié)合、小針刀療法、穴位注射法、火針療法。在現(xiàn)代醫(yī)學(xué)方面,先論述了膝骨關(guān)節(jié)炎的病理和臨床表現(xiàn)、流行病學(xué)特點(diǎn),指出病因與多種因素有關(guān),可能的致病因素和發(fā)病機(jī)制有關(guān)節(jié)應(yīng)力平衡失調(diào)、自由基的作用、免疫反應(yīng)的作用和骨質(zhì)疏松。治療方法包括非藥物治療、藥物治療。運(yùn)動(dòng)療法屬于非藥物療法之一,包括肌肉鍛煉、關(guān)節(jié)活動(dòng)度鍛煉、水中運(yùn)動(dòng)療法等,是改善膝骨關(guān)節(jié)炎患者臨床癥狀及關(guān)節(jié)功能的有效治療方法。膝骨關(guān)節(jié)炎的療法多樣,其中火針療法能有效減輕患者疼痛,運(yùn)動(dòng)療法可以改善關(guān)節(jié)活動(dòng)度,有效延緩膝骨關(guān)節(jié)炎的發(fā)作。論文第三部分通過運(yùn)用火針療法配合運(yùn)動(dòng)療法來治療膝骨關(guān)節(jié)炎,探討其臨床意義。目的:研究毫火針和運(yùn)動(dòng)療法治療膝骨關(guān)節(jié)炎的效果和安全性,并對比毫火針結(jié)合運(yùn)動(dòng)療法對照單純毫火針治療是否可以更好的改善膝骨關(guān)節(jié)炎患者的臨床癥狀和日常功能及活動(dòng)能力,是否能更有效緩解患者疼痛,從而為臨床上治療膝骨關(guān)節(jié)炎提供一種更為有效、簡便的治療方案。方法:從根據(jù)研究方案,入選本研究的對象共60人,隨機(jī)分為2組,對照組30人,觀察組30人。對照組進(jìn)行毫火針療法,觀察組進(jìn)行毫火針配合運(yùn)動(dòng)療法。兩組患者取相同的主穴,即阿是穴、膝眼、梁丘、陽陵泉。根據(jù)不同證型加用相應(yīng)穴位,即腎虛髓虧患者加用懸鐘,瘀血阻絡(luò)患者加用血海,陽虛寒凝患者加用足三里。觀察組選取主穴和相應(yīng)證型的配穴后實(shí)施火針療法,點(diǎn)刺過程時(shí)間控制在0.5秒內(nèi),深約為0.2～0.5cm,點(diǎn)刺結(jié)束后快速以萬花油外涂針孔,每星期治療3次,每隔天治療1次,4周治療為一療程。觀察組每次火針療法(與對照組同)完成后進(jìn)行運(yùn)動(dòng)療法,即先仰臥位直腿牽伸乆繩肌訓(xùn)練后俯臥位牽伸股四頭肌訓(xùn)練,用藥時(shí)間與對照組相同。1療程結(jié)束后評定療效。根據(jù)膝關(guān)節(jié)骨性關(guān)節(jié)炎治療效果的判定標(biāo)準(zhǔn)JOA和直觀模擬量表VAS對治療前和治療后情況進(jìn)行分析,采用尼莫地平法作為療效評定,并且通過統(tǒng)計(jì)學(xué)進(jìn)行分析。結(jié)果:臨床觀察和統(tǒng)計(jì)學(xué)分析結(jié)果顯示,二組患者治療前后JOA和VAS評分比較,P0.01,說明兩種治療方法均有效;治療后觀察組臨床改善率為0.76±0.24,明顯高于對照組的0.62±0.17;安全性方面,觀察組未見不良反應(yīng)。結(jié)論:毫火針療法和火針配合運(yùn)動(dòng)療法對膝骨關(guān)節(jié)炎的治療均有較好的療效。相比之下,火針配合運(yùn)動(dòng)療法療效優(yōu)于單純的火針療法。毫火針配合運(yùn)動(dòng)療法在膝骨關(guān)節(jié)炎的治療中能發(fā)揮其獨(dú)特、綜合、全面的優(yōu)勢,是一種安全微創(chuàng)、行之有效、值得推廣的綠色健康療法。
[Abstract]:This paper makes a systematic and in-depth study on the combination of traditional Chinese and Western medicine for knee osteoarthritis from three aspects of literature, theory and clinical trials. The first part of this paper is preface. First, it introduces its pathology, clinical manifestation, the effect of the patients and the increase of the incidence, and points out the treatment and preventive health care of the knee osteoarthritis. Secondly, it introduces the treatment of knee osteoarthritis in the early and middle and late stages of Western medicine and its shortcomings as well as the advantages of acupuncture and moxibustion for the treatment of knee osteoarthritis. Then it introduces the cause of the knee osteoarthritis, with a good analgesic effect on the patients with knee osteoarthritis with the use of fire needle therapy, but it is not better to improve the activity of the knee joint and to improve the effect. The movement therapy of the function of the joint activity is briefly introduced, which leads to the purpose and clinical significance of the study on the difference of the curative effect between the fire needle and the fire needle in combination with the motion therapy of the knee osteoarthritis. The second part of the paper is the literature study and the theoretical discussion. Modern medicine has made a series of discussions on the understanding, epidemiological characteristics, pathogenesis and treatment methods of knee osteoarthritis. From the Chinese medicine, the knee osteoarthritis belongs to the category of arthralgia, and the ancient medical literature deals with arthralgia. It points out that the etiology involves various aspects, including external and internal injuries; the disease is in the knee joint, Most of the diseases involve the liver, kidney and spleen; the disease belongs to the virtual standard, the deficiency of the liver and kidney, the weakness of Qi and blood is the pathological basis of the disease, the wind cold and damp evil is the common inducing factor, the blood stasis obstructing the collaterals is the key to the disease. Electroacupuncture, warm acupuncture, acupuncture and medicine combination, small needle knife therapy, acupoint injection, and fire needle therapy. In modern medicine, the pathological and clinical manifestations and epidemiological characteristics of knee osteoarthritis are discussed first. The etiology is related to a variety of factors, possible pathogenic factors and the pathogenesis of joint stress imbalance, free radical effect and immune response. The effects and osteoporosis. The treatment includes non drug therapy and drug therapy. Exercise therapy belongs to one of the non drug therapies, including muscle exercise, joint activity exercise, and water exercise therapy. It is an effective treatment method to improve the clinical symptoms and joint function of patients with knee osteoarthritis. The treatment can effectively relieve the pain of the patients. Exercise therapy can improve the degree of joint activity and effectively delay the attack of knee osteoarthritis. In the third part, the clinical significance of the treatment of knee osteoarthritis is discussed by using fire needle therapy and exercise therapy. Objective: To study the effect and safety of the millefire needle and the transport therapy for the treatment of knee osteoarthritis. Compared with the milli needle combined with exercise therapy, it can better improve the clinical symptoms, daily function and activity ability of the patients with knee osteoarthritis and whether it can more effectively relieve the pain of the patients, thus providing a more effective and simple treatment for the clinical treatment of knee osteoarthritis. A total of 60 subjects were selected and divided into 2 groups randomly, 30 in the control group and 30 in the observation group. The control group was treated with the milli fire needle therapy and the observation group was treated with the milli fire needle and exercise therapy. The same main points were taken in the two groups, that is, the acupoints, the knee, the beam hillock, and the Yang Ling spring. The root of the different syndrome types was added to the corresponding acupoints, that is, the kidney deficiency pulp loss patients plus suspension. The patients with blood stasis and collaterals were added to the blood sea, the patients with Yang deficiency and cold coagulation were added with Zusanli. The observation group selected the main points and the corresponding syndromes to carry out the fire needle therapy. The time of the pricking process was controlled in 0.5 seconds, about 0.2 to 0.5cm. After the prick, 3 times a week, 1 times a week, and 4 weeks for one treatment. In the observation group, the exercise therapy was carried out each time after the treatment was completed (with the control group), that is, the four head muscle training in the prone position after the supine straight leg was drafted by the straight leg, and the medication time was evaluated after the same.1 course of treatment with the control group. According to the criterion JOA of the treatment effect of osteoarthritis of the knee joint and the visual analogue scale VAS Analysis of the conditions before and after treatment, using nimodipine as the evaluation of curative effect, and through statistics analysis. Results: the results of clinical observation and statistical analysis showed that the scores of JOA and VAS before and after treatment in the two groups were compared, P0.01, indicating that the two treatments were all effective, and the clinical improvement rate of the observation group was 0.76 + 0.24 after treatment. It was significantly higher than that of the control group of 0.62 + 0.17, and the safety of the observation group had no adverse reaction. Conclusion: the treatment of knee osteoarthritis with the combination of fire needle therapy and fire needle combined with sports therapy has better effect on the treatment of knee osteoarthritis. By comparison, the effect of the fire needle combined with exercise therapy is better than the simple fire needle therapy. It is a safe, minimally invasive, effective, and green health therapy that is worthy of promotion.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R684.3

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