本文選題：膝骨性關(guān)節(jié)炎 + “易層”貼敷　； 參考：《南京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：背景：隨著人口老齡化的進(jìn)程,膝骨性關(guān)節(jié)炎(KOA)發(fā)病率逐年增加,嚴(yán)重困擾著中老年患者的正常生活。KOA患者以疼痛為主訴,故對疼痛的控制是治療KOA的根本。目的：通過“易層”貼敷及扶他林軟膏對比治療具有膝關(guān)節(jié)置換指征的中重度KOA患者,對其臨床療效進(jìn)行客觀評估及統(tǒng)計(jì)分析。探索中重度KOA患者膝關(guān)節(jié)疼痛性質(zhì)及“易層”貼敷療法緩解局部疼痛的療效。方法：選取滿足本課題納入標(biāo)準(zhǔn)的病例32例,隨機(jī)分為治療組(易層貼敷組)16例及對照組(扶他林組)16例。藥物治療3周。分別于就診第1天、第7天、第14天、第21天、2月、3月六個(gè)節(jié)點(diǎn),比較兩組WOMAC評分、NPQ疼痛評分、關(guān)節(jié)功能分級改善情況,評估兩種藥物緩解中重度KOA疼痛的手術(shù)替代療效。結(jié)果：(1)兩組病例在性別上、年齡上、患膝的左右無明顯差異性(P0.05)。(2)兩組病例治療前,在走平路、行走樓梯、晚問休息、坐著或平臥著、站立時(shí)疼痛評分、WOMAC疼痛總評分、WOMAC,總評分、NPQ評分無差異性(P0.05)。而治療第21天與就診第1天相比均有統(tǒng)計(jì)學(xué)意義(P0.05),說明兩利藥物對中重度KOA患者疼痛均有較好的控制作用。(3)兩組病例第7天在平路上行走、上下樓梯、晚間睡覺、坐著或躺著、站立時(shí)疼痛評分、WOMAC疼痛總評分、WOMAC總分相比均有統(tǒng)計(jì)學(xué)意義,扶他林組評分低于易層貼敷組,說明扶他林對KOA的疼痛控制起效時(shí)間較易層貼敷短。(4)易層貼敷組第2月及第3月行走樓梯、站立時(shí)疼痛評分、WOMAC疼痛總評分、WOMAC總評分與第21天相比,均無差異性(P0.05),而扶他林組均有統(tǒng)計(jì)學(xué)差異(P0.05),說明在停藥后,扶他林組病例關(guān)節(jié)疼痛復(fù)發(fā)率較高。(5)首次就診時(shí)兩組NPQ疼痛評分均0,可以認(rèn)為兩組病例疼痛性質(zhì)為神經(jīng)病理性疼痛,兩組治療第21天NPQ評分與治療后2月、3月比較有統(tǒng)計(jì)學(xué)意義,但易層貼敷組評分持續(xù)下降,扶他林組評分持續(xù)上升。(6)首次就診、就診第21天、第2月時(shí),兩組關(guān)節(jié)功能分級比較均無統(tǒng)計(jì)學(xué)意義(P0.05)。第3月兩組分級情況有統(tǒng)計(jì)學(xué)意義(P0.05)。(7)治療后兩組有效率均為100%,而易層貼敷組的顯效率為50%,高于扶他林組的12.5%,有統(tǒng)計(jì)學(xué)意義(P0.05),說明“易層”貼敷療法對中重度KOA疼痛的控制效果優(yōu)于扶他林。結(jié)論：中重度KOA患者膝關(guān)節(jié)局部疼痛性質(zhì)為神經(jīng)病理性疼痛。“易層”貼敷及扶他林軟膏在改善中重度膝骨性關(guān)節(jié)炎患者疼痛癥狀以及提高生活質(zhì)量方面均有顯著療效,然而“易層”貼敷在長期控制關(guān)節(jié)疼痛、改善關(guān)節(jié)功能方面優(yōu)勢更加明顯。
[Abstract]:Background: with the aging of the population, the incidence of knee osteoarthritis (KOA) is increasing year by year, which seriously puzzles the normal life of middle-aged and elderly patients. Koa patients mainly complain of pain, so the control of pain is the fundamental to treat KOA. Objective: to evaluate and analyze the clinical effect of moderate and severe KOA patients with knee replacement indication by using "change layer" and Futalin ointment. Objective: to explore the nature of knee joint pain in moderate and severe KOA patients and the curative effect of "easy layer" application to relieve local pain. Methods: Thirty-two patients who met the criteria were randomly divided into two groups: the treatment group (16 cases) and the control group (16 cases). Drug therapy for 3 weeks. At the first day, the 7th day, the 14th day, the 21st day, the second month and the third month, the WOMAC score and the joint function grade were compared between the two groups to evaluate the effect of the two drugs on the relief of moderate and severe KOA pain. Results (1) there was no significant difference between the two groups in terms of sex, age, left and right knee. (P0.05) before treatment, the two groups of patients were walking the level road, walking the stairs, asking late to rest, sitting or lying on their backs. There was no difference in total score of NPQ and total score of WOMAC (P 0.05). On the 21st day of treatment, there was significant difference between the first day and the first day of treatment, indicating that the two drugs had better control effect on pain in patients with moderate and severe KOA.) on the 7th day, the two groups of patients walked on the level road, went up and down stairs, slept at night, sat or lay down. There was significant difference in the total score of WOMAC and the total score of WOMAC in standing group, and the score of Futalin group was lower than that of the change layer application group. The results showed that the onset time of KOA pain control was shorter than that of the easy-layer application. 4) the treadmill group walked the stairs in the 2nd and 3rd months, and the total pain score of WOMAC when standing was compared with that on the 21st day. There was no difference between the two groups (P 0.05), but there was a statistical difference between the two groups (P 0.05), which indicated that the recurrence rate of joint pain was higher in the Fu Thalin group than in the control group. The NPQ pain scores of the two groups were all 0 at the first visit. The nature of the pain in the two groups could be considered as neuropathic pain. The NPQ score on the 21st day of treatment was significantly higher than that on the 2nd and 3rd month after treatment, but the score of the change layer application group continued to decrease, and the score of the Futalin group continued to rise. 6) the first visit was made on the 21st day and the 2nd month after the treatment. There was no significant difference in articular function grade between the two groups (P 0.05). After the treatment, the effective rate of the two groups was 100, while that of the other group was 50, which was higher than that of the Futalin group (12.5g, P 0.05), which indicated that the "change layer" patch therapy had pain in moderate and severe KOA. The control effect of pain is better than that of Fu Thalin. Conclusion: the local pain of knee joint in moderate and severe KOA patients is neuropathic pain. "Yi layer" and Futalin ointment have significant effects on improving pain symptoms and quality of life in patients with moderate and severe knee osteoarthritis, but "change layer" is used to control joint pain for a long time. The advantages of improving joint function are more obvious.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R684.3

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