本文關(guān)鍵詞： 膝骨關(guān)節(jié)炎 中西醫(yī)結(jié)合 通絡(luò)治痹湯 步態(tài)分析　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:跟隨社會不斷進步,人口老齡化問題的不斷加深,膝骨關(guān)節(jié)炎(Kneeosteoarthritis,KOA)已有迅速增加趨勢,隨著患者年齡的增長以及病情的不斷進展,患者多出現(xiàn)關(guān)節(jié)畸形,功能障礙,本病晚期致殘率高,嚴(yán)重影響患者日常生活,對患者個體以致整個社會帶來一定的壓力。根據(jù)前期臨床研究的結(jié)論,早期積極有效的治療對于本病的干預(yù)有著著實可觀的收獲。因此,運用湯藥對疾病進行早期安全靈活的干預(yù),對治療本病有著非常重要的意義。本研究旨在明確通絡(luò)治痹湯加味聯(lián)合局部注射玻璃酸鈉治療KOA的臨床觀察,進而探討此一臨床治療方法,有望為病患提供更加安全有效的治療措施。目的:通過對步態(tài)分析數(shù)據(jù)以及VAS疼痛視覺模擬評分和Lequesne指數(shù)評分的收集整理,臨床觀察經(jīng)辨證后使用通絡(luò)治痹湯加味治療KOA的能效,通過真實客觀的臨床與實驗評價體系,證實應(yīng)用中醫(yī)辨證論治體系治療KOA的優(yōu)勢。方法:臨床收集共120例符合條件病例,隨機分為治療組和對照組,兩組數(shù)量各為60例。治療組通過對患者辨證論治,予口服通絡(luò)治痹湯加減方結(jié)合注射玻璃酸鈉;對照組予藤黃健骨丸口服結(jié)合注射玻璃酸鈉;治療時間為5周。所有病例于治療前后進行疼痛視覺模擬評分(VAS評分)、Lequesne膝關(guān)節(jié)骨性關(guān)節(jié)炎嚴(yán)重指數(shù)評分及步態(tài)分析,由此觀察通絡(luò)治痹湯加味辨證治療KOA的臨床療效。結(jié)果:1.VAS評分顯示,兩組治療后此項評分降低,P值0.01;且治療組治療后評分較對照組更低,P值0.01。說明治療組所接受的治療措施能夠更為有效地緩解患者主觀疼痛感。2.Lequesne評分顯示,兩組治療后此項評分降低,P值0.01;且治療組治療后評分較對照組更低,P值0.01。說明治療組能更加顯著改善患者患膝功能,提高生活能力。3.步態(tài)參數(shù)結(jié)果顯示,與治療前比較,所檢參數(shù)均有好轉(zhuǎn),P值0.01;且治療組的步行能力、平衡能力的改善程度均較對照組高,P值0.05。因此治療組更能夠顯著改善患者步行能力,間接表達出顯著的治療效果。結(jié)論:1.加味通絡(luò)治痹湯結(jié)合玻璃酸鈉治療膝骨關(guān)節(jié)炎能明顯改善病患膝骨關(guān)節(jié)炎局部的主觀癥狀,并且能改善患者步行姿態(tài)。2.基于同時接受玻璃酸鈉治療的基礎(chǔ)上,治療組運用辨證施治后口服加味通絡(luò)治痹湯的方法優(yōu)于對照組診斷明確后單純服用中成藥藤黃健骨丸的治療方法。
[Abstract]:Background: with the development of society and the aging of population, Kneeosteoarthritis (KOAA) of knee osteoarthritis has been increasing rapidly. With the age of patients and the progress of disease, patients often have joint deformity and dysfunction. The high rate of disability in the late stage of the disease seriously affects the daily life of the patients, exerts certain pressure on the individual patients and the whole society. According to the conclusion of the previous clinical research, Early active and effective treatment has had a substantial gain in the intervention of the disease. Therefore, early safe and flexible intervention on the disease with decoction and medicine, The purpose of this study was to make clear the clinical observation of Tongluo Zhibi decoction combined with local injection of sodium hyaluronate in the treatment of KOA. Objective: to collect gait analysis data, VAS pain visual analogue score and Lequesne index score. After clinical observation, the energy efficiency of treating KOA with Tongluo decoction was observed, and the advantages of treating KOA with TCM syndrome differentiation system were confirmed through real and objective clinical and experimental evaluation system. Methods: 120 cases of KOA were collected clinically. Treatment group and control group were randomly divided into two groups, 60 cases in each group. The treatment group was treated by syndrome differentiation, the treatment group was treated by oral Tongluo Zhibi decoction combined with injection of sodium hyaluronate, the control group was treated with Fuhuangjianggu pills and injection of sodium hyaluronate; The duration of treatment was 5 weeks. All the patients were evaluated with visual analogue pain score and VAS score, and Lequesne knee osteoarthritis severity index score and gait analysis before and after treatment. Therefore, the clinical effect of Tongluo treating Bi decoction on syndrome differentiation was observed. Results: 1. The score of VAS showed that. After treatment, the scores of the two groups decreased by 0.01, and the scores of the treatment group after treatment were lower than those of the control group. The results showed that the therapeutic measures accepted in the treatment group were more effective in alleviating the subjective pain of the patients. 2. The Lequesne score showed that the patients' subjective pain was alleviated more effectively in the treatment group than in the control group. After treatment, the score of the treatment group was lower than that of the control group, and the score of the treatment group was lower than that of the control group. The results showed that the treatment group could significantly improve the knee function and improve the living ability of the patients. The gait parameters showed that compared with before treatment, the gait parameters showed that the patients in the treatment group were significantly better than those in the control group. The parameters were improved by 0.01, and the improvement degree of walking ability and balance ability of the treatment group were higher than that of the control group. Therefore, the treatment group could significantly improve the walking ability of the patients, and the improvement degree of the balance ability of the treatment group was higher than that of the control group. Conclusion Jiawei Tongluo Zhibi decoction combined with sodium hyaluronate can obviously improve the local subjective symptoms of knee osteoarthritis. And can improve the patient's walking posture. 2. Based on the treatment of sodium hyaluronate at the same time, The treatment group was superior to the control group in taking the traditional Chinese patent medicine Fuhuang Jiangu pill only after the treatment of syndrome differentiation and treatment by oral administration of Jiawei Tongluo Zhibi decoction.
【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】：2017
【分類號】：R274.9

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