本文選題：膝骨性關(guān)節(jié)炎　切入點：經(jīng)筋　出處：《遼寧中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:通過觀察比較傳統(tǒng)推拿療法與經(jīng)筋推拿療法在膝骨性關(guān)節(jié)炎(KOA)患者治療前后的VAS評分、WOMAC評分、紅外熱成像溫度變化以及療效評價差異,探討經(jīng)筋推拿手法在KOA治療中的優(yōu)勢。材料與方法:將2016年1月~2017年3月期間遼寧中醫(yī)藥大學各附屬醫(yī)院和沈陽軍區(qū)總醫(yī)院北方醫(yī)院收入的150名符合試驗標準的住院患者,隨機分為傳統(tǒng)推拿組和經(jīng)筋推拿組,每組各有患者75名。傳統(tǒng)推拿組治療取穴參照《推拿治療學》,重點穴位為膝關(guān)節(jié)局部的血海、梁丘、內(nèi)外膝眼、鶴頂、陽陵泉、阿是穴及遠端的伏兔、足三里穴等。經(jīng)筋推拿組診療方法選點參照薛立功著《中國經(jīng)筋學》,醫(yī)者自上而下對患者足陽明、太陽、少陽和三陰經(jīng)筋在腹部、腰背部、膝踝部等循行部位運用揉按、彈撥、點滑的手法進行整體理筋,消除肌肉、筋膜的痙攣和緊張,然后著重對膝外前側(cè)、膝外中側(cè)、膝外后側(cè)以及膝內(nèi)側(cè)的結(jié)筋病灶點進行點按、橫向滑撥等手法進行逐一消灶。兩組患者治療時間均為25min/次,日1次,1周7次,療程之間間隔1日,共治療4周。療程結(jié)束后,觀察記錄兩組患者治療前、后的(1)膝關(guān)節(jié)疼痛程度(VAS分值);(2)WOMAC評分;(3)以紅外熱成像技術(shù)觀測患者膝關(guān)節(jié)外前側(cè)、外中側(cè)、外后側(cè)、內(nèi)側(cè)體表溫度觀察點的溫度(℃);(4)療效評價:采用VAS指數(shù)和WOMAC評分的改善值百分率進行臨床癥狀測定評分,即改善值/治療前值×100%(改善值為治療前值-治療后值),將各指標的改善值百分率計算平均百分率后進行療效評價,分四個等級。治愈:改善百分率為≥90%;顯效:改善百分率為90%~50%;好轉(zhuǎn):改善百分率為50%~30%;未愈:改善百分率為≤30%。結(jié)果:1.兩組患者治療后VAS評分較治療前明顯降低(P0.05);治療后經(jīng)筋推拿組和傳統(tǒng)推拿組VAS評分比較,經(jīng)筋推拿組明顯低于傳統(tǒng)推拿組(P0.05)。2.兩組患者治療后WOMAC評分較治療前明顯降低(P0.05);治療后經(jīng)筋推拿組和傳統(tǒng)推拿組WOMAC評分比較,經(jīng)筋推拿組明顯低于傳統(tǒng)推拿組(P0.05)。3.兩組患者治療后膝關(guān)節(jié)外前側(cè)、外中側(cè)、外后側(cè)、膝內(nèi)側(cè)共22個體表溫度觀察點的溫度值較治療前明顯降低(P0.05);治療后經(jīng)筋推拿組和傳統(tǒng)推拿組體表觀察點溫度值比較,經(jīng)筋推拿組明顯低于傳統(tǒng)推拿組(P0.05)。4.經(jīng)筋推拿組治愈18例,顯效46例,好轉(zhuǎn)8例,未愈3例,總有效率為96%;傳統(tǒng)推拿組治愈15例,顯效20例,好轉(zhuǎn)34例,未愈6例,總有效率為92%。經(jīng)卡方檢驗有統(tǒng)計學差異(P0.05),經(jīng)筋推拿組的療效明顯優(yōu)于傳統(tǒng)推拿組。結(jié)論:1.在減輕KOA患者疼痛方面,經(jīng)筋推拿療法優(yōu)于傳統(tǒng)推拿療法。2.在改善KOA患者功能障礙方面,經(jīng)筋推拿療法優(yōu)于傳統(tǒng)推拿療法。3.在紅外熱成像體表溫度觀察點溫度改變方面,經(jīng)筋推拿療法優(yōu)于傳統(tǒng)推拿療法。4.在KOA患者療效方面,經(jīng)筋推拿療法優(yōu)于傳統(tǒng)推拿療法。
[Abstract]:Objective: to observe and compare the VAS score, the temperature change of infrared thermal imaging and the difference of curative effect between traditional massage therapy and meridian massage therapy in patients with osteoarthritis of knee before and after treatment. To explore the advantage of meridian massage in the treatment of KOA. Materials and methods: from January 2016 to March 2017, 150 inpatients who met the test standard were collected from the affiliated hospitals of Liaoning University of traditional Chinese Medicine and the North Hospital of Shenyang military region General Hospital. They are randomly divided into the traditional massage group and the meridian massage group, with 75 patients in each group. The traditional massage group takes points for reference to massage therapy. The key points are the local blood sea of the knee joint, Liang Qiu, the inner and outer knee eyes, the crane roof, and the Yangling spring. Ashi acupoint and distal Fu rabbit, Zusanli acupoint, etc. Selected points for diagnosis and treatment in the meridian and massage group refer to Xue Ligong's "Chinese Meridian Science". The doctor from the top down to the foot Yangming, Sun, Shaoyang and Sanyin meridians are in the abdomen and back of the waist. The knee ankle and so on along the line place uses the kneading press, the bouncing, the point slippery hand to carry on the whole to regulate the tendon, eliminates the muscle, the fascia spasm and the tension, then emphatically carries on the click to the outside knee anterior side, the knee outside the middle side, the knee outside the posterior side and the knee medial side and the knee medial side nodal fascia focal point carries on the click to press, The treatment time of the two groups was 25min/ times, 7 times a day, the interval between the courses of treatment was 1 day, the total treatment was 4 weeks. After the course of treatment, the patients in the two groups were observed and recorded before the treatment. The pain degree of the knee joint was evaluated by VAS score and WOMAC score. The anterior, middle and posterior sides of the knee joint were observed by infrared thermal imaging technique, and the results were as follows: (1) the anterior side, the middle side and the posterior side of the knee joint were measured by infrared thermal imaging. Evaluation of Therapeutic effect of the observation Point of medial body Surface temperature: the clinical symptom score was measured by VAS index and the percentage of improvement value of WOMAC score. That is, the improvement value / pre-treatment value 脳 100 value (the improvement value is pre-treatment value-after treatment value), after calculating the average percentage of the improvement value of each index, the curative effect was evaluated. There are four grades: cure: improvement percentage is 鈮，

本文編號：1655946