本文選題：膝骨性關(guān)節(jié)炎 + 黃芪桂枝五物湯　； 參考：《云南中醫(yī)學院》2017年碩士論文

【摘要】：目的:1.客觀的評價黃芪桂枝五物湯聯(lián)同膝關(guān)節(jié)鏡清理術(shù)治療早中期KOA的臨床療效。2.探究黃芪桂枝五物湯結(jié)合膝關(guān)節(jié)鏡清理術(shù),對于KOA的特色優(yōu)勢與其作用特點,為膝關(guān)節(jié)鏡清理術(shù)與黃芪桂枝五物湯在臨床上結(jié)合使用提供循證醫(yī)學依據(jù)。方法:選取2015年12月至2017年2月在云南中醫(yī)學院第一附屬醫(yī)院骨一科及骨四科的采取膝關(guān)節(jié)鏡治療,中醫(yī)辨證屬于氣血不足證的住院患者60例,按照隨機數(shù)字表法分為兩組,治療組30例,對照組30例。兩組患者在性別、年齡、病程、X線分級、VAS評分、WOMAC評分和膝關(guān)節(jié)溫差方面無明顯差異(p0.05),治療前整體情況具有可比性。黃芪桂枝五物湯(黃芪30g、桂枝10g、芍藥10g、生姜25g、大棗4枚,每劑湯藥制成3袋合劑,每袋100ml,每天服用2次)結(jié)合膝關(guān)節(jié)鏡方案作為治療組,做完手術(shù)之后第二天服用中藥;對照組則使用塞來昔布結(jié)合膝關(guān)節(jié)鏡治療。兩組都定期評價患者治療前后療效。結(jié)果:1.VAS評分:試驗組患者治療1周后VAS評分與對照組相比不具有顯著性差異(p0.05);試驗組患者治療2周、3周、4周后VAS評分,與對照組相比,具有顯著性差異(p0.05);試驗組與對照組治療4周后的VAS評分與治療前相比均具有顯著性差異(p0.05)。2.WOMAC綜合評分:試驗組患者治療1周后WOMAC綜合評分與對照組相比不具有顯著性差異(p0.05);試驗組患者治療2周、3周、4周后WOMAC綜合評分,與對照組相比,具有顯著性差異(p0.05);試驗組與對照組治療4周后的WOMAC綜合評分與治療前相比均具有顯著性差異(p0.05)。3.膝關(guān)節(jié)皮溫差:試驗組患者治療1天后、治療10天后皮溫差與對照組相比,無明顯差異(p0.05);試驗組治療4天、7天后膝關(guān)節(jié)溫差與對照組相比,具有顯著性差異(p0.05)。4.療效評定:治療1周后WOMAC評分療效評定與對照組相比無顯著統(tǒng)計學差異(p0.05);試驗組治療2周、3周、4周后WOMAC評分療效評定與對照組相比具有統(tǒng)計學差異(p0.05)。5.安全性評定:住院治療及之后的隨訪中,未發(fā)現(xiàn)患者有明顯的不良反應(yīng),兩組各個患者治療前后的安全性評價指標和實驗室檢驗指標均未超出正常值范疇。結(jié)論:1.在緩解患者癥狀,改善膝關(guān)節(jié)功能方面,膝關(guān)節(jié)鏡術(shù)后配合使用黃芪桂枝五物湯的效果較之塞來昔布的療效更顯著。2.進一步證實膝關(guān)節(jié)鏡清理術(shù)對于早中期KOA的治療具有顯著的效果。3.住院治療及患者出院后的隨訪中,黃芪桂枝五物湯和膝關(guān)節(jié)鏡清理術(shù)都有明顯的療效,把二者結(jié)合一并用于治療療效更加確切。黃芪桂枝五物湯阻斷產(chǎn)生疼痛的相關(guān)病理因子,膝關(guān)節(jié)鏡清理了大部分的產(chǎn)生疼痛的累積因素。但值得注意的是,原始病例資料中個別患者評分甚至有所回升,功能評分有所下降,這種治療方法并沒有從根本上改變的膝關(guān)節(jié)的退變過程,隨著時間遷移,患者的KOA有可能加重,但兩者結(jié)合治療的總體療效顯著。4.中藥名方黃芪桂枝五物湯的安全性高,沒有明顯的不良反應(yīng)。
[Abstract]:Purpose 1. Objective to evaluate the clinical efficacy of Huangqi Guizhi Wuwu decoction combined with knee arthroscopy in the treatment of KOA in early and middle period. To explore the characteristics of Huangqi Guizhi Wuwu decoction combined with arthroscopic debridement for KOA, and to provide evidence based medicine basis for the clinical application of Astragalus Guizhi Wuwu decoction and knee arthroscopic debridement combined with Huangqi Guizhi Wuwu decoction. Methods: from December 2015 to February 2017, 60 inpatients who were treated with knee arthroscopy in the first affiliated Hospital of Yunnan Institute of traditional Chinese Medicine were divided into two groups according to the method of random digital table. There were 30 cases in the treatment group and 30 cases in the control group. There was no significant difference between the two groups in sex, age, course of disease and VAS score, WOMAC score and knee joint temperature difference (P 0.05), and the overall situation was comparable before treatment. Huangqi Guizhi Wuwu decoction (Astragalus 30 g, Guizhi 10g, Paeoniflorin 10g, ginger 25g, jujube 4) was made into 3 bags of mixture, 100 ml per bag, 2 times a day) combined with knee arthroscopy as the treatment group, the second day after the operation took Chinese medicine; The control group was treated with celecoxib combined with knee arthroscopy. Both groups regularly evaluated the efficacy before and after treatment. Results 1. VAS score: there was no significant difference in VAS score between the experimental group and the control group after 1 week of treatment (p0.05), while the VAS score in the trial group was significantly different from that in the control group after 2 weeks and 3 weeks, and 4 weeks after treatment, compared with the control group. There were significant differences in VAS scores between the test group and the control group after 4 weeks of treatment. 2. WOMAC comprehensive score: there was no significant difference in the WOMAC score between the trial group and the control group after 1 week of treatment. The WOMAC scores of the patients in the trial group were evaluated after 2 weeks and 3 weeks of treatment and 4 weeks after treatment. Compared with the control group, there was a significant difference in the WOMAC scores between the experimental group and the control group after 4 weeks of treatment, and there was a significant difference between the experimental group and the control group after 4 weeks of treatment compared with before treatment. Knee joint skin temperature difference: after 1 day of treatment, 10 days after treatment, there was no significant difference in skin temperature difference between the test group and the control group, and there was significant difference in the knee joint temperature difference between the experimental group and the control group after 4 days and 7 days. Evaluation of curative effect: there was no significant difference in WOMAC score between the treatment group and the control group after 1 week of treatment (p 0.05), but there was significant difference in the evaluation of the effect of WOMAC score between the two groups after 2 weeks and 3 weeks and 4 weeks after treatment compared with the control group (P 0.05. 5). Safety assessment: no significant adverse reactions were found during hospitalization and follow-up. The safety evaluation indexes and laboratory test indexes of each group before and after treatment did not exceed the normal range. Conclusion 1. In relieving symptoms and improving knee function, the effect of Huangqi Guizhi Wuwu decoction combined with Huangqi Guizhi Wuwu decoction after knee arthroscopy was more significant than that of celecoxib. It is further confirmed that arthroscopic debridement has a significant effect on the treatment of KOA in early and middle stage. 3. 3. During hospitalization and follow-up, Huangqi Guizhi Wuwu decoction and knee arthroscopic debridement have obvious curative effect. Huangqi Guizhi Wuwu decoction blocked the related pathological factors of pain, and knee arthroscopy cleaned up most of the cumulative factors of pain. However, it is worth noting that the scores of individual patients in the original case data have even recovered, and the functional score has declined. This treatment method does not fundamentally change the process of degeneration of the knee joint, and it moves over time. Patients with KOA may be aggravated, but the combined treatment of the overall efficacy is significant. 4. 4. Huangqi Guizhi Wuwu decoction, a famous prescription of traditional Chinese medicine, has high safety and no obvious adverse reactions.
【學位授予單位】：云南中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R684.3

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