本文選題：中醫(yī)微創(chuàng) + 針刀鏡��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:在中醫(yī)經(jīng)絡(luò)經(jīng)筋理論的指導(dǎo)下,運(yùn)用微創(chuàng)針刀鏡技術(shù)對膝關(guān)節(jié)內(nèi)側(cè)滑膜皺襞綜合征患者進(jìn)行鏡下診療,通過比較分析治療前后膝關(guān)節(jié)VAS評分和Lysholm評分,評估針刀鏡診療滑膜皺襞綜合征的臨床療效。探討微創(chuàng)針刀鏡治療膝關(guān)節(jié)內(nèi)側(cè)滑膜皺襞綜合征的作用機(jī)制、安全性及有效性,為臨床使用和治療提供可靠的理論依據(jù)和新的方法。方法:所有病例均選自2015年06月至2016年12月廣州市中西醫(yī)結(jié)合醫(yī)院骨傷科收治的膝關(guān)節(jié)內(nèi)側(cè)滑膜皺襞綜合征患者,將符合診斷、納入、排除標(biāo)準(zhǔn)的46例患者根據(jù)其就診時間的先后順序,用隨機(jī)對照法分成對照組和觀察組。對照組口服塞來昔布膠囊(連續(xù)服用2周)治療,觀察組在口服藥物治療基礎(chǔ)上行微創(chuàng)針刀鏡手術(shù)治療。選取治療前及治療后第2周、6周作為觀察時間點(diǎn),觀察患者治療前后VAS評分、膝關(guān)節(jié)功能Lysholm評分變化情況,并對比兩組患者治療前后評分變化;根據(jù)《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》對療效進(jìn)行評價,結(jié)果采用自身前后對照及組間對照并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:對照組治療期間有兩例患者因疼痛加重,自行退出研究,余全部完成本次臨床觀察的治療。在臨床療效方面,對照組總有效率為52.38%;觀察組總有效率為95.65%,有顯著性差異(P0.05)。兩組患者經(jīng)治療2周后VAS評分均較治療前均下降,具顯著性差異(P0.05);觀察組VAS評分與對照組對比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。6周后對照組VAS評分與治療前經(jīng)配對T檢驗(yàn)無統(tǒng)計(jì)學(xué)(P0.05);觀察組治療前后對比具顯著差異(P0.05),與對照組治療后比較具有顯著統(tǒng)計(jì)差異(P0.05)。兩組患者經(jīng)治療后Lysholm評分均較治療前均增加;在2周后的時間點(diǎn)上觀察組Lysholm評分與治療前對比具顯著差異(P0.05),與對照組對比差異無統(tǒng)計(jì)學(xué)意義(P0.05);在6周時間點(diǎn)上觀察組Lysholm評分與治療前、對照組對比均具顯著差異(P0.05),而對照組治療前后對比無統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組療效優(yōu)良率為91.3%。說明針刀鏡聯(lián)合塞來昔布膠囊治療滑膜皺襞綜合征療效確切,可明顯緩解膝疼痛癥狀,改善膝關(guān)節(jié)功能,在提高患者的日常生活能力及遠(yuǎn)期療效方面明顯優(yōu)于對照組。結(jié)論:應(yīng)用中醫(yī)微創(chuàng)針刀鏡治療膝關(guān)節(jié)內(nèi)側(cè)滑膜皺襞綜合征,能明顯提高其的診斷準(zhǔn)確率,有效膝關(guān)節(jié)疼痛、改善關(guān)節(jié)功能,提高患者生活質(zhì)量。中醫(yī)微創(chuàng)針刀鏡是一種集安全性,有效性、操作簡便、術(shù)后功能恢復(fù)快等優(yōu)點(diǎn)的診療手段,值得臨床進(jìn)一步推廣使用。
[Abstract]:Objective: under the guidance of the theory of meridian and meridian meridians of traditional Chinese medicine, the patients with medial synovial fold syndrome of knee joint were treated with minimally invasive needle knife technique. The VAS score and Lysholm score of knee joint before and after treatment were compared and analyzed. To evaluate the clinical effect of needle knife in diagnosis and treatment of synovial plica syndrome. To explore the mechanism, safety and effectiveness of minimally invasive needle knife in the treatment of medial synovial fold syndrome of knee joint, and to provide a reliable theoretical basis and new method for clinical use and treatment. Methods: all cases were selected from June 2015 to December 2016 in the Department of Orthopedics and Trauma, Guangzhou Integrated Chinese and Western Medicine Hospital. The patients with medial synovial fold syndrome of the knee joint were included in the diagnosis. 46 patients with exclusion criteria were divided into control group and observation group according to the order of visit time. The control group was treated with celecoxib capsule for 2 weeks, while the observation group was treated with minimally invasive needle knife surgery on the basis of oral drug therapy. The VAS score and knee function Lysholm score before and after treatment were observed at 6 weeks before and after treatment, and the scores before and after treatment were compared between the two groups. The curative effect was evaluated according to the criteria of diagnosis and treatment of TCM disease syndrome. Results: two patients in the control group withdrew from the study due to the aggravation of pain. The total effective rate was 52.38 in the control group and 95.65 in the observation group (P 0.05). After 2 weeks of treatment, VAS scores in both groups were lower than those before treatment. There was no significant difference in VAS score between the observation group and the control group (P 0.05). There was no significant difference in the VAS score between the control group and the control group before and after treatment (P 0.05), and there was no significant difference between the observation group and the control group before and after treatment (P 0.05). There was significant statistical difference after treatment (P 0.05). After treatment, the Lysholm scores of the two groups were higher than those before treatment. At the time point after 2 weeks, the Lysholm score of the observation group was significantly different from that of the control group before treatment (P 0.05), but there was no significant difference between the observation group (P 0.05) and the control group (P 0.05), and at the point of 6 weeks, the Lysholm score of the observation group was significantly higher than that of the control group (P < 0.05). There were significant differences between the control group and the control group, but there was no significant difference between the control group and the control group before and after treatment. The excellent and good rate of observation group was 91.3%. The results showed that the treatment of synovial plica syndrome with needle scalpel and celecoxib capsule was effective, which could relieve the pain of knee and improve the function of knee joint. It was superior to the control group in improving the ability of daily living and long-term curative effect. Conclusion: the treatment of medial synovial fold syndrome with traditional Chinese medicine minimally invasive needle knife can obviously improve the accuracy of diagnosis, effective knee pain, improve the function of joint and improve the quality of life of the patients. Traditional Chinese medicine minimally invasive needle knife endoscope is a method of diagnosis and treatment with the advantages of safety, effectiveness, simple operation and quick functional recovery after operation, which is worthy of further clinical application.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.9

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