【摘要】：目的：在循證醫(yī)學原則的基礎上,以針刀治療股骨頭缺血性壞死為研究對象,將系統(tǒng)文獻研究及問卷調查相結合,重點研究針刀在股骨頭缺血性壞死的治療中的規(guī)范化操作流程,探討針刀治療股骨頭缺血性壞死過程中存在的爭議,旨在編寫出針刀治療股骨頭缺血性壞死的規(guī)范化操作流程,為針刀治療股骨頭缺血性壞死提供安全、有效、簡單、詳細的規(guī)范化操作流程,為后期研究針刀治療股骨頭缺血性壞死的規(guī)范化工作奠定基礎。方法：將系統(tǒng)文獻研究與臨床問卷調查法有機結合,編寫臨床規(guī)范化操作流程。系統(tǒng)文獻研究方面：采用計算機檢索為主,通過互聯(lián)網(wǎng)數(shù)據(jù)庫,對國內外發(fā)表的針刀治療股骨頭缺血性壞死相關文獻進行全面檢索。采用人工閱讀的方法對文件進行初步篩選,制定文獻的納入標準及排除標準,進一步篩選文獻。對納入的文獻進行分類,按照美國衛(wèi)生研究和質量管理局標準(即AHCPR標準),文獻可以分為系列病例研究證據(jù)、個案報道、專委會或專家意見、隨機對照(RCT)研究證據(jù)和非隨機對照(CCT)研究證據(jù),并進行證據(jù)分級,證據(jù)分級主要按照美國衛(wèi)生研究和質量管理局標準(即AHCPR標準)和蘇格蘭學院間指南工作網(wǎng)的標準(即SIGN標準)。對高等級的證據(jù)文獻進行歸納總結,對部分高等級證據(jù)文獻沒有涉及的問題,參考低等級文獻。參考現(xiàn)有中醫(yī)治療規(guī)范化研究成果,初步確定推薦意見,編寫《針刀臨床治療股骨頭缺血性壞死規(guī)范化操作(初稿)》問卷調查方面：針對規(guī)范化操作方案初稿編寫過程中發(fā)現(xiàn)的一些爭議及問題,結合臨床操作,編寫《針刀治療股骨頭缺血性壞死臨床調查問卷》。通過郵寄、電子郵件、面談等方法與針刀專業(yè)專家學者進行意見交流。對回收的問卷,進行匯總、整理、歸納,將循證證據(jù)與臨床實踐相結合,編寫針刀治療股骨頭缺血性壞死操作流程及《針刀臨床治療股骨頭缺血性壞死規(guī)范化操作(修改稿)》。結果：1、針刀治療股骨頭缺血性壞死規(guī)范化操作流程的研究,對于針刀的發(fā)展、推廣意義重大。2、形成針刀治療股骨頭缺血性壞死操作流程圖。3、對針刀治療股骨頭缺血性壞死的臨床實驗性文獻進行系統(tǒng)的整理分析,結合專家意見,最終編寫完成了《針刀臨床治療股骨頭缺血性壞死規(guī)范化操作(修改稿)》。結論：1、將臨床研究性文獻系統(tǒng)研究與問卷調查相結合,是制定針刀治療股骨頭缺血性壞死的規(guī)范化操作的有效方法,實現(xiàn)了臨床與文獻研究的結合,為今后其他疾病治療的規(guī)范化操作流程的的編寫提供參考方法。推動了針刀治療技術規(guī)范化的工作。2、針刀治療股骨頭缺血性壞死操作流程及《針刀臨床治療股骨頭缺血性壞死規(guī)范化操作》是針刀治療股骨頭缺血性壞死規(guī)范化研究過程中的重要組成結構,為針刀治療股骨頭缺血性壞死的規(guī)范化奠定基礎。
[Abstract]:Objective: on the basis of the principle of evidence-based medicine, the treatment of avascular necrosis of the femoral head by needle knife was used as the research object, and the systematic literature study and questionnaire survey were used to study the treatment of avascular necrosis of the femoral head. The standardized operation procedure of acupuncture knife in the treatment of avascular necrosis of femoral head was studied emphatically, and the controversy existed in the treatment of avascular necrosis of femoral head with needle knife was discussed. The purpose of this study was to compile the standardized operation flow of acupuncture knife for treating avascular necrosis of femoral head. It provides a safe, effective, simple and detailed standardized procedure for the treatment of avascular necrosis of the femoral head by acupuncture, and lays a foundation for the later study on the standardization of acupuncture in the treatment of avascular necrosis of the femoral head. Methods: the systematic literature research and the clinical questionnaire were combined to compile the clinical standardized operation flow. In the aspect of systematic literature research, the related literatures about the treatment of avascular necrosis of femoral head at home and abroad were searched by computer retrieval and internet database. The method of manual reading was used to screen the documents, and the inclusion criteria and exclusion criteria of the documents were established, and the documents were further screened. According to the United States Health Research and quality Administration (AHCPR) standards, the literature can be divided into a series of case study evidence, case reports, panel or expert advice, Randomized controlled (RCT) study evidence and non-randomized controlled (CCT) study evidence, and the evidence classification, Evidence ratings are based mainly on the AHCPR standard of the United States Health Research and quality Authority and the standard of the Scottish Intercollege work Network (SIGN standard). The paper sums up the high-grade evidential literature, and refers to the low-grade literature for some problems which are not involved in the high-grade evidential literature. Referring to the existing research results on the standardization of TCM treatment, we have preliminarily determined the recommended opinions. Compiling "standardized Operation of Acupuncture Clinical treatment of Avascular Necrosis of femoral head (first draft)" questionnaire: in view of some disputes and problems found in the preparation of the first draft of the standardized operation, combined with clinical operation, To compile the questionnaire of clinical investigation on the treatment of avascular necrosis of femoral head with needle knife. Exchange views with experts and scholars of needleknife by mail, e-mail, interview and so on. The collected questionnaires were collected, sorted and summarized, and combined with the evidence based on evidence and clinical practice, the operation procedure of acupuncture for the treatment of avascular necrosis of the femoral head and the standardized operation for clinical treatment of avascular necrosis of the femoral head with needle knife (revised draft) were compiled. Results: 1. For the development of needle knife, the study of standardized operation procedure for the treatment of avascular necrosis of femoral head, It is of great significance to popularize. 2, to form the flow chart of the operation of acupuncture knife treatment of avascular necrosis of the femoral head. 3. To systematize and analyze the clinical experimental literature on the treatment of avascular necrosis of the femoral head by needle knife, and combine the expert opinion, Finally, the standardized operation (revision) of clinical treatment of avascular necrosis of femoral head by needle knife was completed. Conclusion: 1. Combining the systematic study of clinical research literature with questionnaire survey is an effective method to establish the standardized operation of acupuncture for the treatment of avascular necrosis of the femoral head, which realizes the combination of clinical and literature research. To provide a reference for the preparation of standardized procedures for the treatment of other diseases in the future. 2, the operation flow of acupuncture knife treatment of avascular necrosis of femoral head and "standardized operation of clinical treatment of avascular necrosis of femoral head" is standardization of acupuncture treatment of avascular necrosis of femoral head. Important components in the research process, To lay a foundation for standardization of acupuncture in the treatment of avascular necrosis of femoral head.
【學位授予單位】：成都中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.9

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