本文選題：膝骨性關(guān)節(jié)炎　切入點(diǎn)：固本通經(jīng)　出處：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的觀察“固本通經(jīng)”針刺法結(jié)合三步推拿法治療膝骨性關(guān)節(jié)炎的臨床療效,探究其有效性,為臨床治療膝骨性關(guān)節(jié)炎提供有效的方法。方法對(duì)湖北中醫(yī)藥大學(xué)附屬門診國(guó)醫(yī)堂2014年12月至2016年11月就診的78例膝骨性關(guān)節(jié)炎患者,按照就診的先后順序隨機(jī)分為治療組和對(duì)照組,每組各39例。治療組采用“固本通經(jīng)”針刺法結(jié)合三步推拿法治療,針刺選穴為:內(nèi)膝眼、犢鼻、鶴頂、梁丘、血海、陰陵泉、陽陵泉、關(guān)元、三陰交、懸鐘。各穴位行提插捻轉(zhuǎn)補(bǔ)瀉手法,以患者得氣為度。三步推拿法主要參考中國(guó)中醫(yī)科學(xué)院張濤研究員的手法治療,由松解、調(diào)整、整理三步組成。針刺治療留針20min,推拿治療10min。對(duì)照組采用常規(guī)針刺結(jié)合三步推拿法治療,針刺選穴膝眼、梁丘、陽陵泉、血海、阿是穴、大杼,寒濕證配腰陽關(guān),瘀血證配膈俞,肝腎虧虛配肝俞、腎俞、氣海。針刺留針20min,推拿治療10min。囑患者每日于家中行股四頭肌鍛煉方法。以上治療每周3次,4周為1個(gè)療程,1個(gè)療程后評(píng)定療效。治療組和對(duì)照組患者治療前后均進(jìn)行VAS、JOA、WOMAC評(píng)分,比較兩組治療前后評(píng)分差異,并采用統(tǒng)計(jì)軟件SPSS19.0進(jìn)行數(shù)據(jù)分析。結(jié)果1.比較治療組和對(duì)照組的性別、年齡、病程以及治療前的VAS評(píng)分、JOA評(píng)分、W0MAC評(píng)分,經(jīng)統(tǒng)計(jì)學(xué)分析,差異均無統(tǒng)計(jì)學(xué)意義(p0.05),具有可比性。2.臨床療效:經(jīng)過1個(gè)療程的治療,治療組36例患者臨床治愈7例(19.4%),有效18例(50%),好轉(zhuǎn)9例(25%),無效2例(5.6%),總有效率為94.4%;對(duì)照組38例患者臨床治愈3例(7.9%),有效12例(31.6%),好轉(zhuǎn)14例(36.8%),無效9例(23.7%),總有效率為76.3%。兩組臨床療效比較,經(jīng)卡方檢驗(yàn),差異具有統(tǒng)計(jì)學(xué)意義(p0.05),提示治療組療效優(yōu)于對(duì)照組。3.兩組治療前后的VAS評(píng)分比較:治療組治療前VAS評(píng)分為4.27±1.45,治療后為1.33±1.01;對(duì)照組治療前VAS評(píng)分為4.45±1.01,治療后為1.14±0.72。兩組治療前后VAS評(píng)分進(jìn)行比較,均有顯著性差異(p0.05),說明“固本通經(jīng)”針刺法結(jié)合三步推拿法以及常規(guī)針刺結(jié)合三步推拿法均能在一定程度上改善膝骨性關(guān)節(jié)炎的疼痛癥狀,但兩組的療效差異沒有統(tǒng)計(jì)學(xué)意義(p0.05)。4.兩組治療前后的JOA評(píng)分比較:治療組治療前JOA評(píng)分為60.28±5.73,治療后為88.06±5.25;對(duì)照組治療前JOA評(píng)分為59.47±8.69,治療后為72.37±4.89。兩組治療前后JOA評(píng)分進(jìn)行比較,均有顯著性差異(p0.05),說明兩組均能一定程度地改善膝骨性關(guān)節(jié)炎的臨床癥狀,但治療組效果優(yōu)于對(duì)照組(p0.05)。說明“固本通經(jīng)”針刺法結(jié)合三步推拿法在改善患者步行、爬樓梯、屈曲角度等綜合方面較常規(guī)針刺結(jié)合三步推拿法對(duì)膝骨性關(guān)節(jié)炎的效果更好。5.兩組治療前后的W0MAC評(píng)分比較,治療組治療前W0MAC評(píng)分為48.50±3.74,治療后為17.41±3.56;對(duì)照組治療前W0MAC評(píng)分為47.61±4.03,治療后為29.59士3.67。兩組治療前后W0MAC評(píng)分進(jìn)行比較,均有顯著性差異(p0.05),說明兩組均能一定程度地改善膝骨性關(guān)節(jié)炎的疼痛和功能指數(shù),但治療組在改善患者僵硬、生理功能等綜合方面較對(duì)照組療效好。結(jié)論本研究表明,治療組和對(duì)照組均能有效治療膝骨性關(guān)節(jié)炎,兩種療法均能有效緩解患者膝關(guān)節(jié)的疼痛,但本研究并沒有顯示哪種療法止痛效果更好,在改善患者步行、爬樓梯、屈曲角度、活動(dòng)時(shí)的疼痛感、僵硬、生理功能等綜合方面,治療組療效優(yōu)于對(duì)照組。
[Abstract]:Objective To observe the effect of "the path" acupuncture method combined with the clinical curative effect of three step massage in the treatment of knee osteoarthritis, to explore its effectiveness, to provide effective methods for clinical treatment of knee osteoarthritis. Methods 78 cases of patients with arthritis of Hubei University of TCM affiliated outpatient from December 2014 to November 2016 Guoyitang in accordance with the treatment of knee osteoarthritis. The order were randomly divided into treatment group and control group, 39 cases in each group. The treatment group was treated by "three step massage therapy combined with the pressure of acupuncture, acupuncture point selection: in the eye of the knee, calf nose, crane, Liangqiu, sea of blood, Yin Ling Quan, Yanglingquan, Guanyuan and Sanyinjiao, hang a bell. Each acupoint for lifting thrusting twirling reinforcing and reducing, to patients with gas for degrees. Three step massage main reference China Zhang Tao Academy of traditional Chinese medicine, massage therapy, by loosening, adjustment, finishing three steps. Acupuncture needle 20min, massage therapy 10mi N. control group with routine acupuncture treatment combined with three step massage, acupuncture point selection and eye of the knee, Yanglingquan, Xuehai, Liangqiu, Ashi, Dazhu, Yaoyangguan with cold dampness syndrome, blood stasis syndrome with Geshu, liver and kidney deficiency with liver Yu, Shenshu, Qihai. Acupuncture massage therapy for 20min, 10min. Huanzhe daily in a bank stock four myo exercise method. More than 3 times a week, 4 weeks for 1 courses, 1 courses of treatment. The curative effect was evaluated after treatment group and control group before and after treatment were VAS, JOA, WOMAC score, the difference score before and after treatment between the two groups, and the use of statistical software SPSS19.0 data analysis results 1.. Comparison of treatment group and control group in gender, age, course of disease and treatment before the VAS score, JOA score, W0MAC score, the statistical analysis, there were no significant differences (P0.05), with comparable clinical efficacy of.2.: after 1 courses of treatment, the treatment group of 36 cases of patients with clinical 娌繪剤7渚，

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