針刀聯(lián)合臭氧關(guān)節(jié)腔內(nèi)注射治療膝骨性關(guān)節(jié)炎的臨床療效研究
發(fā)布時間：2018-12-17 11:59
【摘要】：骨性關(guān)節(jié)炎最早是由Garrod在1890年提出的[1]。膝關(guān)節(jié)骨性關(guān)節(jié)炎(Knee Osteoarthritis)是累及關(guān)節(jié)軟骨、滑膜及關(guān)節(jié)周圍組織的一種慢性無菌性炎癥,又稱增生性膝關(guān)節(jié)炎、老年性膝關(guān)節(jié)炎、退行性膝關(guān)節(jié)炎、肥大性膝關(guān)節(jié)炎。按美國風濕病協(xié)會[2]分類,KOA可分為原發(fā)性和繼發(fā)性兩大類;前者確切病因尚不明確,可能與性別、年齡、職業(yè)、種族、遺傳和勞損等因素相關(guān);后者可繼發(fā)于膝關(guān)節(jié)損傷、半月板損傷、關(guān)節(jié)內(nèi)或關(guān)節(jié)周圍骨折、關(guān)節(jié)韌帶損傷、先天畸形或關(guān)節(jié)感染等。臨床根據(jù)病情的程度主要表現(xiàn)為膝關(guān)節(jié)疼痛,負重尤甚,關(guān)節(jié)僵硬,活動受限,關(guān)節(jié)內(nèi)有骨摩擦音,日久肌肉痿廢不用,關(guān)節(jié)畸形等癥狀,嚴重者導致下肢殘疾。有調(diào)查顯示,60歲以上的人群中OA的患病率可達50%,75歲的人群達80%,其中20%~30%有臨床癥狀,致殘率高達53%[3]。有統(tǒng)計顯示在全球范圍的致殘疾病中膝關(guān)節(jié)骨性關(guān)節(jié)炎排名第十一位[4]。膝關(guān)節(jié)骨性關(guān)節(jié)炎給患者的身心帶來的摧殘不言而喻,因此針對該病的有效治療顯得尤為關(guān)鍵。目前膝關(guān)節(jié)骨性關(guān)節(jié)炎的治療方法主要包括:物理治療、藥物治療、手術(shù)治療、小針刀微創(chuàng)療法、關(guān)節(jié)腔注射療法、中醫(yī)中藥治療、軟骨或軟骨細胞治療、基因治療等。長期口服藥物治療存在藥物毒副作用及耐藥性的問題,手術(shù)治療主要針對病情嚴重者,但手術(shù)治療存在費用高、風險大、康復時間相對較長的弊端,中醫(yī)中藥治療相比而言是一種綠色、安全、有效的療法,并廣泛應(yīng)用于膝骨性關(guān)節(jié)炎的治療中,但也存在一些諸如治療周期長、療效不持久等問題。臨床上常依據(jù)患者病情選擇一種或多種治療方法聯(lián)合治療。目前,針刀聯(lián)合臭氧、玻璃酸鈉等治療膝關(guān)節(jié)炎已較為廣泛地應(yīng)用于臨床,通過治療方案的改進,也取得了不錯的療效。本課題正是在現(xiàn)有研究的基礎(chǔ)上,進一步探討針刀聯(lián)合臭氧關(guān)節(jié)腔內(nèi)注射治療膝骨性關(guān)節(jié)炎的臨床療效。研究目的觀察針刀聯(lián)合臭氧關(guān)節(jié)腔內(nèi)注射治療膝骨性關(guān)節(jié)炎的臨床療效。研究方法從十堰市太和醫(yī)院康復治療中心門診部選取60例符合本試驗診斷標準和納入標準的單膝骨性關(guān)節(jié)炎患者,按隨機數(shù)字表均分為兩組,采用單盲法(盲病人)每組各30例。治療前兩組患者的年齡、性別、病程等一般資料比較,經(jīng)統(tǒng)計學分析,差異均無統(tǒng)計學意義(p0.05),兩組受試者具有可比性。簽署知情同意書。治療組采用針刀聯(lián)合臭氧關(guān)節(jié)腔內(nèi)注射治療:先行針刀治療,針刀術(shù)后即行臭氧關(guān)節(jié)腔內(nèi)注射,間隔7天行下一次治療,2次為1療程。對照組采用針刀松解術(shù)治療,治療2個療程。利用膝關(guān)節(jié)疼痛評分VAS量表及膝關(guān)節(jié)功能障礙評分Lysholm量表對患者膝關(guān)節(jié)疼痛及功能障礙進行評分,評估兩組患者療程結(jié)束后病情狀況。研究結(jié)果治療組和對照組治療膝骨性關(guān)節(jié)炎均有較好的療效。治療組總有效率為93.33%,對照組總有效率為76.67%,可見治療組療效較對照組更優(yōu)(p0.05)。兩組治療前后VAS評分均降低(p0.05),Lysholm評分均升高(p0.05),治療組VAS評分降低較對照組更明顯(p0.01),治療組Lysholm評分升高較治療組更顯著(p0.01),說明針刀聯(lián)合臭氧關(guān)節(jié)腔內(nèi)注射治療KOA較單純針刀治療KOA在改善患者疼痛及功活動方面效果更佳。結(jié)論治療組及對照組均能改善膝骨性關(guān)節(jié)炎的疼痛等癥狀,提高其日�；顒幽芰�,但針刀聯(lián)合臭氧關(guān)節(jié)腔內(nèi)注射治療膝骨性關(guān)節(jié)炎的療效優(yōu)于對照組針刀術(shù)治療,值得臨床推廣運用。
[Abstract]:Osteoarthritis was first proposed by Garros in 1890[1]. Knee Osteoarthritis (Knee Osteoarthritis) is a kind of chronic aseptic inflammation involving the articular cartilage, the synovium and the surrounding tissues of the joint, also known as proliferative and knee-arthritis, senile knee arthritis, degenerative knee arthritis, and hypertrophic knee arthritis. According to the classification of the American Institute of Rheumatology[2], KOA can be divided into primary and secondary categories; the exact cause of the former is not clear and may be related to factors such as sex, age, occupation, race, heredity and strain; the latter can be secondary to knee injury, meniscal injury, In-articular or periarticular fracture, joint ligament injury, congenital malformation, or joint infection, etc. The clinical condition is mainly characterized by the pain of the knee joint, the weight of the bearing, the rigidity of the joint, the limitation of the activity, the bone friction sound in the joint, no use of the long-time muscle, no use of the joint, and the like, and the severe person has the disability of the lower limb. According to the survey, the prevalence of OA in the population over 60 years of age can reach 50%, the 75-year-old population is 80%, of which 20% to 30% have clinical symptoms, and the disability rate is 53%[3]. There is a statistical display of the eleventh[4] of the knee osteoarthritic arthritis in the global range of disabling diseases. The physical and psychological damage of the knee-bone arthritis to the patient is self-evident, and therefore the effective treatment of the disease is particularly critical. At present, the treatment method of the knee joint bone arthritis mainly comprises the physical treatment, the medicine treatment, the operation treatment, the small needle knife minimally invasive therapy, the joint cavity injection therapy, the traditional Chinese medicine treatment, the cartilage or the chondrocyte treatment, the gene therapy and the like. the traditional Chinese medicine is a green, safe and effective therapy compared with the traditional Chinese medicine treatment, It is widely used in the treatment of knee-bone arthritis, but there are some problems such as long treatment period, long curative effect and the like. A combination of one or more treatment methods is often selected based on the patient's condition. At present, the treatment of knee arthritis with the combination of the needle knife with ozone and sodium hyaluronate has been widely used in the clinic, and has achieved good curative effect through the improvement of the treatment plan. On the basis of the existing research, this paper further discusses the clinical curative effect of needle-knife combined with ozone joint in the treatment of knee-bone arthritis. Objective To observe the clinical effect of needle-knife combined with ozone joint in the treatment of knee-bone arthritis. In the study, 60 patients with single-knee osteoarthria were selected from the outpatient department of the Taihe Hospital of the Shiyan city and the hospital, and each group was divided into two groups according to the random digital form, and 30 cases of each group were used in single blind method (blind patient). There was no significant difference in the age, sex and course of the two groups in the first two groups (p0.05), and the two groups were comparable. Sign the informed consent form. The treatment group was treated with a needle-knife combined with an ozone-joint cavity for treatment: the first-hand knife treatment, the operation of the needle-knife, the internal injection of the ozone joint cavity, the next treatment at the interval of 7 days, and the second time being a course of treatment. In the control group, the needle knife was used for the treatment of 2 treatment courses. The patient's knee pain and dysfunction were assessed by using the knee pain score VAS scale and the Lysholm scale of the knee joint dysfunction score, and the condition of the two groups of patients was assessed. The results showed that the treatment group and the control group had good curative effect on the treatment of knee-bone arthritis. The total effective rate of the treatment group was 93.3%, the total effective rate of the control group was 70.67%, and the curative effect of the treatment group was better than that of the control group (p0.05). The VAS scores of the two groups decreased (p0.05) and the Lysholm scores increased (p0.05), and the VAS score of the treatment group was lower than that of the control group (p0.01), and the increase of the Lysholm score in the treatment group was higher than that of the treatment group (p0.01). It is indicated that the treatment of KOA with the combination of needle-knife and ozone joint in the treatment of KOA is more effective in improving the pain and work activity of the patient. Conclusion The treatment group and the control group can improve the pain and other symptoms of the knee-bone arthritis, and improve the daily activity, but the curative effect of the needle-knife combined with the ozone joint cavity for treating the knee-bone arthritis is superior to that of the control group, which is worthy of clinical popularization and application.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.9
本文編號：2384168
[Abstract]:Osteoarthritis was first proposed by Garros in 1890[1]. Knee Osteoarthritis (Knee Osteoarthritis) is a kind of chronic aseptic inflammation involving the articular cartilage, the synovium and the surrounding tissues of the joint, also known as proliferative and knee-arthritis, senile knee arthritis, degenerative knee arthritis, and hypertrophic knee arthritis. According to the classification of the American Institute of Rheumatology[2], KOA can be divided into primary and secondary categories; the exact cause of the former is not clear and may be related to factors such as sex, age, occupation, race, heredity and strain; the latter can be secondary to knee injury, meniscal injury, In-articular or periarticular fracture, joint ligament injury, congenital malformation, or joint infection, etc. The clinical condition is mainly characterized by the pain of the knee joint, the weight of the bearing, the rigidity of the joint, the limitation of the activity, the bone friction sound in the joint, no use of the long-time muscle, no use of the joint, and the like, and the severe person has the disability of the lower limb. According to the survey, the prevalence of OA in the population over 60 years of age can reach 50%, the 75-year-old population is 80%, of which 20% to 30% have clinical symptoms, and the disability rate is 53%[3]. There is a statistical display of the eleventh[4] of the knee osteoarthritic arthritis in the global range of disabling diseases. The physical and psychological damage of the knee-bone arthritis to the patient is self-evident, and therefore the effective treatment of the disease is particularly critical. At present, the treatment method of the knee joint bone arthritis mainly comprises the physical treatment, the medicine treatment, the operation treatment, the small needle knife minimally invasive therapy, the joint cavity injection therapy, the traditional Chinese medicine treatment, the cartilage or the chondrocyte treatment, the gene therapy and the like. the traditional Chinese medicine is a green, safe and effective therapy compared with the traditional Chinese medicine treatment, It is widely used in the treatment of knee-bone arthritis, but there are some problems such as long treatment period, long curative effect and the like. A combination of one or more treatment methods is often selected based on the patient's condition. At present, the treatment of knee arthritis with the combination of the needle knife with ozone and sodium hyaluronate has been widely used in the clinic, and has achieved good curative effect through the improvement of the treatment plan. On the basis of the existing research, this paper further discusses the clinical curative effect of needle-knife combined with ozone joint in the treatment of knee-bone arthritis. Objective To observe the clinical effect of needle-knife combined with ozone joint in the treatment of knee-bone arthritis. In the study, 60 patients with single-knee osteoarthria were selected from the outpatient department of the Taihe Hospital of the Shiyan city and the hospital, and each group was divided into two groups according to the random digital form, and 30 cases of each group were used in single blind method (blind patient). There was no significant difference in the age, sex and course of the two groups in the first two groups (p0.05), and the two groups were comparable. Sign the informed consent form. The treatment group was treated with a needle-knife combined with an ozone-joint cavity for treatment: the first-hand knife treatment, the operation of the needle-knife, the internal injection of the ozone joint cavity, the next treatment at the interval of 7 days, and the second time being a course of treatment. In the control group, the needle knife was used for the treatment of 2 treatment courses. The patient's knee pain and dysfunction were assessed by using the knee pain score VAS scale and the Lysholm scale of the knee joint dysfunction score, and the condition of the two groups of patients was assessed. The results showed that the treatment group and the control group had good curative effect on the treatment of knee-bone arthritis. The total effective rate of the treatment group was 93.3%, the total effective rate of the control group was 70.67%, and the curative effect of the treatment group was better than that of the control group (p0.05). The VAS scores of the two groups decreased (p0.05) and the Lysholm scores increased (p0.05), and the VAS score of the treatment group was lower than that of the control group (p0.01), and the increase of the Lysholm score in the treatment group was higher than that of the treatment group (p0.01). It is indicated that the treatment of KOA with the combination of needle-knife and ozone joint in the treatment of KOA is more effective in improving the pain and work activity of the patient. Conclusion The treatment group and the control group can improve the pain and other symptoms of the knee-bone arthritis, and improve the daily activity, but the curative effect of the needle-knife combined with the ozone joint cavity for treating the knee-bone arthritis is superior to that of the control group, which is worthy of clinical popularization and application.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.9
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