體外沖擊波療法配合展筋活血膝痹方外敷治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的臨床研究
發(fā)布時間：2019-05-18 12:25
【摘要】：目的:觀察體外沖擊波療法配合展筋活血膝痹方外敷治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的臨床療效,并初步探討展筋活血膝痹方外敷在治療膝關(guān)節(jié)骨性關(guān)節(jié)炎中的作用機理。方法:將符合《中華人民共和國中醫(yī)藥行業(yè)標(biāo)準(zhǔn)·中醫(yī)病癥診斷療效標(biāo)準(zhǔn)·膝關(guān)節(jié)骨性關(guān)節(jié)炎》的80例門診及住院病人通過隨機數(shù)字表法分為兩組,每組40例,分別為治療組:體外沖擊波療法配合展筋活血膝痹方外敷治療組;對照組:玻璃酸鈉配合展筋活血膝痹方外敷治療組,治療組,男性13例,女性27例,58膝,平均年齡(?x±s下同)67.0±5.1歲;對照組,男性16例,女性24例,49膝。平均年齡66.0±4.8歲。兩組患者的一般情況無統(tǒng)計學(xué)差別。兩組患者均先對疼痛的膝關(guān)節(jié)進(jìn)行外敷展筋活血膝痹方:伸筋草30g透骨草30g土鱉蟲15g紅花10g雞血藤60g生麻黃15g急性子9g威靈仙60g漢防己15g續(xù)斷20g木瓜20g獨活9g桂枝10g艾葉15g路路通15g白芷15g青風(fēng)藤25g海桐皮30g絡(luò)石藤15g川芎30g,以上中藥研粉,并用黃酒、陳醋按1:3調(diào)敷于患處,用TDP治療儀照射30分鐘,外敷治療治療結(jié)束后30分鐘,治療組患者在膝關(guān)節(jié)周圍痛點進(jìn)行定位,并在痛點及周圍予以沖擊波治療;對照組患者予以患膝玻璃酸鈉注射液灌注治療。展筋活血膝痹方外敷每日1次,20天為一療程;沖擊波治療每間隔3天1次,5次為一療程;玻璃酸鈉注射液灌注治療,每關(guān)節(jié)1支(2ml),1周灌注1次,5次為1療程,嚴(yán)格無菌操作。觀察指標(biāo)包括反映患者疼痛程度的VAS評分,反映患者療效持續(xù)的時間t(單位:周),反映患者膝關(guān)節(jié)骨性關(guān)節(jié)炎癥狀的體征積分。以癥狀、體征積分表為依據(jù)將兩組患者治療前進(jìn)行分級:輕度患者積分小于10分;中度患者積分大于等于10分小于20分;重度患者積分在20分及以上。分別統(tǒng)計兩組患者治療前后的VAS評分、癥狀體征積分及療效持續(xù)時間,將兩組患者所得數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析,VAS評分、癥狀體征積分按輕重等級進(jìn)行組間和組內(nèi)比較,療效持續(xù)時間按輕重等級進(jìn)行組間比較。結(jié)果:1兩組患者治療前VAS評分無明顯差異,無統(tǒng)計學(xué)意義(P0.05);治療組:組內(nèi)輕、中度患者治療前、后比較,VAS評分明顯下降,數(shù)據(jù)變化有統(tǒng)計學(xué)意義(P0.05),重度患者治療前、后比較,VAS評分下降,數(shù)據(jù)變化無統(tǒng)計學(xué)意義(P0.05);對照組:組內(nèi)輕、中度患者治療前、后比較,VAS評分下降,數(shù)據(jù)變化有統(tǒng)計學(xué)意義(P0.05),重度患者治療前、后比較,VAS評分無明顯變化,數(shù)據(jù)變化無統(tǒng)計學(xué)意義(P0.05);兩組患者中的輕、中度患者治療后的VAS評分比較具有顯著差異,有統(tǒng)計學(xué)意義(P0.05),兩組患者中的重度患者治療后的VAS評分比較無顯著差異,無統(tǒng)計學(xué)意義(P0.05)。2兩組患者治療前癥狀、體征積分無明顯差異,無統(tǒng)計學(xué)意義(P0.05);治療組:組內(nèi)輕、中度患者治療前、后比較,癥狀、體征積分明顯下降,數(shù)據(jù)變化有統(tǒng)計學(xué)意義(P0.05),重度患者治療前、后比較,癥狀、體征積分下降,數(shù)據(jù)變化有統(tǒng)計學(xué)意義(P0.05);對照組:組內(nèi)輕、中度患者治療前、后比較,癥狀、體征積分下降,數(shù)據(jù)變化有統(tǒng)計學(xué)意義(P0.05),重度患者治療前、后比較,癥狀、體征積分有變化,數(shù)據(jù)變化有統(tǒng)計學(xué)意義(P0.05);兩組患者中的輕、中度患者治療后的癥狀、體征積分比較具有顯著差異,有統(tǒng)計學(xué)意義(P0.05),兩組患者中的重度患者治療后的癥狀、體征積分比較無顯著差異,無統(tǒng)計學(xué)意義(P0.05)。3對兩組患者進(jìn)行最長為期52周的隨訪,結(jié)果治療組中輕、中、重度患者的療效持續(xù)時間較對照組中的輕、中、重度患者有明顯差異,數(shù)據(jù)有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1從緩解患者疼痛方面,體外沖擊波療法配合展筋活血膝痹方外敷對于輕、中度患者的療效明顯優(yōu)于關(guān)節(jié)腔玻璃酸鈉灌注配合展筋活血膝痹方外敷療法,且前者在緩解疼痛速度方面明顯快于后者。2從緩解患者癥狀、體征方面,體外沖擊波療法配合展筋活血膝痹方外敷對于輕、中度患者的療效明顯優(yōu)于關(guān)節(jié)腔玻璃酸鈉灌注配合展筋活血膝痹方外敷療法,且體外沖擊波療法配合展筋活血膝痹方外敷對癥狀、體征的緩解更為徹底。3體外沖擊波療法配合展筋活血膝痹方外敷在療效持續(xù)時間上明顯優(yōu)于玻璃酸鈉灌注配合展筋活血膝痹方外敷療法。4兩種方法對重度膝關(guān)節(jié)骨性關(guān)節(jié)炎患者療效不佳。
[Abstract]:Objective: To observe the clinical effect of external application on the treatment of knee osteoarthritis with the combination of extracorporeal shock wave therapy and the external application of Huoxue Huoxue, and to explore the mechanism of the external application in the treatment of knee osteoarthritis. Methods:80 out-patient and in-patient patients, which meet the criteria of the Chinese medicine industry standard of the People's Republic of China, in the diagnosis and treatment of knee osteoarthritis, were divided into two groups by a random digital method, and 40 cases in each group were treated as treatment group: In-vitro shock wave therapy combined with the external application treatment group of Huoxue Huoxue, the control group: the treatment group, the treatment group, the male 13 cases, the female 27 cases, the 58 knee, the average age (?) in the treatment group, the treatment group, the male 13 cases, the female 27 cases, the 58 knees and the average age (? X (s) 67.0-5.1 years; control group, male 16 cases, female 24 cases,49 knee. The mean age was 66.0 to 4.8 years. There was no statistical difference between the two groups. In the two groups, the knee joint of the pain is externally applied with the external application and the blood-activating and blood-promoting knee joint is applied to the knee joint. 15 g of Chinese ephedra,15 g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of radix angelicae pubescentis, 15g of radix angelicae pubescentis, 15g of radix angelicae pubescentis, 15g of argyi leaf, 15g of argyi leaf, 15g of radix angelicae pubescentis, 15g of argyi leaf, 15g of Chinese angelica root, 15g of Chinese medicine powder and 15g of Chinese medicinal powder, and is mixed with yellow wine, Chen Vinegar was applied to the affected part according to 1:3. The treatment group was treated with TDP treatment instrument for 30 minutes. The treatment group was treated with the pain point around the knee joint for 30 minutes after the treatment. The patients in the treatment group were treated with shock wave at the pain point and around the knee. The control group was treated with sodium hyaluronate injection. The external application of the Huoxue Huoxue Geng Decoction was once daily and 20 days as a course of treatment. The shock wave was treated for 3 days every 3 days and 5 times as a course of treatment. The sodium hyaluronate injection was treated with 1 branch (2 ml) for 1 week,5 times as a course of treatment and strict aseptic operation. The observations included a VAS score that reflects the degree of pain in the patient, a time t (unit: week) that reflects the duration of the patient's efficacy, and a sign integral that reflects the patient's knee osteoarthritis symptoms. The two groups of patients were graded according to the symptoms and the sign integral table: the score of mild patients was less than 10; the integral of the moderate patients was greater than or equal to 10, and the score was less than 20; and the integral of the severe patients was 20 minutes and above. The VAS scores, the symptoms and sign points and the duration of the treatment before and after the treatment of the two groups of patients were respectively counted, and the data obtained in the two groups were statistically analyzed, the VAS score and the symptom and sign points were compared between the groups and the group according to the severity grade, The duration of the efficacy was compared between groups according to the severity level. Results: There was no significant difference between the two groups before and after the treatment (P0.05); the treatment group: before and after the treatment of mild and moderate patients, the VAS score decreased significantly, the data change was statistically significant (P0.05), and the VAS score decreased after the treatment before and after the treatment of severe patients. There was no statistical significance in the data change (P0.05); the control group: before and after the treatment of mild and moderate patients in the group, the VAS score decreased, the data change was statistically significant (P0.05), and the change of the VAS score was not significantly changed before and after the treatment of the severe patients (P0.05); The VAS scores in the two groups were significantly different from those of the two groups (P0.05). There was no significant difference in the sign integral (P0.05); the treatment group: the group was mild in group, the group was mild in group, the score of the symptom and the sign of the group was significantly decreased, the data change was statistically significant (P0.05), and the scores of the patients before, after and after the treatment of the severe patients were lower, and the integral of the signs decreased. There was a significant difference in data change (P0.05); the control group: before and after the treatment of mild and moderate patients in the group, the scores of the symptoms, the signs and the change of the data were statistically significant (P0.05). There was a significant difference in the data of the two groups (P0.05). There was no significant difference in the symptoms and signs of the patients with severe and moderate in the two groups (P0.05). There was no significant difference between the two groups (P0.05). Conclusion:1 From the aspect of relieving the pain of the patient, the external application of the extracorporeal shock wave therapy combined with the expansion of the tendon and the blood-activating knee is better than that of the joint-cavity sodium hyaluronate infusion and the blood-activating and blood-activating-knee-type external application therapy for the patients with mild and moderate. in addition, in that aspect of relieve the symptom and the sign of the patient, the external application of the in-vitro shock wave therapy in combination with the expansion of the tendon and the blood-activating geniculate is obviously superior to the external application therapy of the joint-cavity sodium hyaluronate infusion and the blood-activating and blood-activating, in addition, in-vitro shock wave therapy is matched with that external application of the tendon-promoting blood-activating and blood-promoting geniculate to treat 3. In-vitro shock wave therapy combined with the external application of Huoxue Huoxue and Huoxue Huoxue Decoction is better than that of sodium hyaluronate in the duration of the treatment, and the effect of two methods on the patients with severe knee osteoarthritis is not good.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R684.3
[Abstract]:Objective: To observe the clinical effect of external application on the treatment of knee osteoarthritis with the combination of extracorporeal shock wave therapy and the external application of Huoxue Huoxue, and to explore the mechanism of the external application in the treatment of knee osteoarthritis. Methods:80 out-patient and in-patient patients, which meet the criteria of the Chinese medicine industry standard of the People's Republic of China, in the diagnosis and treatment of knee osteoarthritis, were divided into two groups by a random digital method, and 40 cases in each group were treated as treatment group: In-vitro shock wave therapy combined with the external application treatment group of Huoxue Huoxue, the control group: the treatment group, the treatment group, the male 13 cases, the female 27 cases, the 58 knee, the average age (?) in the treatment group, the treatment group, the male 13 cases, the female 27 cases, the 58 knees and the average age (? X (s) 67.0-5.1 years; control group, male 16 cases, female 24 cases,49 knee. The mean age was 66.0 to 4.8 years. There was no statistical difference between the two groups. In the two groups, the knee joint of the pain is externally applied with the external application and the blood-activating and blood-promoting knee joint is applied to the knee joint. 15 g of Chinese ephedra,15 g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of radix angelicae pubescentis, 15g of radix angelicae pubescentis, 15g of radix angelicae pubescentis, 15g of argyi leaf, 15g of argyi leaf, 15g of radix angelicae pubescentis, 15g of argyi leaf, 15g of Chinese angelica root, 15g of Chinese medicine powder and 15g of Chinese medicinal powder, and is mixed with yellow wine, Chen Vinegar was applied to the affected part according to 1:3. The treatment group was treated with TDP treatment instrument for 30 minutes. The treatment group was treated with the pain point around the knee joint for 30 minutes after the treatment. The patients in the treatment group were treated with shock wave at the pain point and around the knee. The control group was treated with sodium hyaluronate injection. The external application of the Huoxue Huoxue Geng Decoction was once daily and 20 days as a course of treatment. The shock wave was treated for 3 days every 3 days and 5 times as a course of treatment. The sodium hyaluronate injection was treated with 1 branch (2 ml) for 1 week,5 times as a course of treatment and strict aseptic operation. The observations included a VAS score that reflects the degree of pain in the patient, a time t (unit: week) that reflects the duration of the patient's efficacy, and a sign integral that reflects the patient's knee osteoarthritis symptoms. The two groups of patients were graded according to the symptoms and the sign integral table: the score of mild patients was less than 10; the integral of the moderate patients was greater than or equal to 10, and the score was less than 20; and the integral of the severe patients was 20 minutes and above. The VAS scores, the symptoms and sign points and the duration of the treatment before and after the treatment of the two groups of patients were respectively counted, and the data obtained in the two groups were statistically analyzed, the VAS score and the symptom and sign points were compared between the groups and the group according to the severity grade, The duration of the efficacy was compared between groups according to the severity level. Results: There was no significant difference between the two groups before and after the treatment (P0.05); the treatment group: before and after the treatment of mild and moderate patients, the VAS score decreased significantly, the data change was statistically significant (P0.05), and the VAS score decreased after the treatment before and after the treatment of severe patients. There was no statistical significance in the data change (P0.05); the control group: before and after the treatment of mild and moderate patients in the group, the VAS score decreased, the data change was statistically significant (P0.05), and the change of the VAS score was not significantly changed before and after the treatment of the severe patients (P0.05); The VAS scores in the two groups were significantly different from those of the two groups (P0.05). There was no significant difference in the sign integral (P0.05); the treatment group: the group was mild in group, the group was mild in group, the score of the symptom and the sign of the group was significantly decreased, the data change was statistically significant (P0.05), and the scores of the patients before, after and after the treatment of the severe patients were lower, and the integral of the signs decreased. There was a significant difference in data change (P0.05); the control group: before and after the treatment of mild and moderate patients in the group, the scores of the symptoms, the signs and the change of the data were statistically significant (P0.05). There was a significant difference in the data of the two groups (P0.05). There was no significant difference in the symptoms and signs of the patients with severe and moderate in the two groups (P0.05). There was no significant difference between the two groups (P0.05). Conclusion:1 From the aspect of relieving the pain of the patient, the external application of the extracorporeal shock wave therapy combined with the expansion of the tendon and the blood-activating knee is better than that of the joint-cavity sodium hyaluronate infusion and the blood-activating and blood-activating-knee-type external application therapy for the patients with mild and moderate. in addition, in that aspect of relieve the symptom and the sign of the patient, the external application of the in-vitro shock wave therapy in combination with the expansion of the tendon and the blood-activating geniculate is obviously superior to the external application therapy of the joint-cavity sodium hyaluronate infusion and the blood-activating and blood-activating, in addition, in-vitro shock wave therapy is matched with that external application of the tendon-promoting blood-activating and blood-promoting geniculate to treat 3. In-vitro shock wave therapy combined with the external application of Huoxue Huoxue and Huoxue Huoxue Decoction is better than that of sodium hyaluronate in the duration of the treatment, and the effect of two methods on the patients with severe knee osteoarthritis is not good.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R684.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 王天，
本文編號：2479998
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2479998.html
最近更新
教材專著
