本文選題：清宮正骨手法 + 膝關節(jié)骨性關節(jié)炎��； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:通過對膝痹病(膝關節(jié)骨性關節(jié)炎)的流行病學、發(fā)病機制、臨床特點、中西醫(yī)診療現(xiàn)狀等方面的理論研究,總結得出膝關節(jié)骨性關節(jié)炎為中老年人常見病、多發(fā)病,其患病率呈逐年升高趨勢,本病導致的膝關節(jié)腫痛、變形及活動障礙,使患者生活質量明顯下降,由于病因尚未明了,目前尚無特異性療法,且多數(shù)療法存在各類缺欠和不足,探求一種療效確切、低毒副作用、經(jīng)濟實惠的治療方法,是當前本病研究的焦點與難點。本課題研究的主要目的在于探討清宮正骨手法對膝痹病(膝關節(jié)骨性關節(jié)炎)的關節(jié)疼痛、關節(jié)僵硬、日�；顒拥确矫娴挠绊懽饔�,進一步觀察和評價其治療效果,為本研究的治療方法在臨床上的推廣應用提供科學依據(jù)。方法:選取符合入組標準的患者作為研究對象共80例,按照隨機數(shù)字表法隨機分成清宮正骨手法(研究組)和雙氯芬酸鈉緩釋片聯(lián)合關節(jié)腔注射玻璃酸鈉(對照組)2組,其中研究組為40人,對照組為40人。兩組均采用視覺模擬評分(VAS)、WOMAC骨關節(jié)炎指數(shù)評分及療效評價標準,在治療開始前及療程結束后1周對患者膝關節(jié)癥狀、體征、活動功能等進行評分及記錄,統(tǒng)計分析其臨床療效。每個患者在治療開始前和治療結束后1周都進行安全性項目監(jiān)測,詳細記錄研究過程中出現(xiàn)的不良事件,以評估治療方法的安全性。結果:臨床研究結果顯示:(1)研究組治療40例患者中臨床控制3例,2例無效,觀察時間窗內總效率為95.00%;對照組治療40例患者中臨床控制1例,6例無效,觀察時間窗內有效率為85.00%;兩組在臨床治療效果比較上,研究組優(yōu)于對照組,且差異有統(tǒng)計學意義(P0.05)。(2)經(jīng)過治療后兩組患者VAS評分、WOMAC評分中疼痛積分、僵硬積分、日�；顒臃e分及總積分均較治療前有明顯下降,且差異有統(tǒng)計學意義(P0.05);兩組患者VAS評分改善程度對比,差異無統(tǒng)計學意義(P0.05);兩組患者WOMAC積分改善程度比較,研究組優(yōu)于對照組,且差異有統(tǒng)計學意義(P0.05);兩組患者WOMAC積分中疼痛、僵硬的改善程度對比,差異無統(tǒng)計學意義(P0.05);兩組患者WOMAC積分中日�；顒拥母纳瞥潭缺容^,研究組顯著優(yōu)于對照組,且差異有統(tǒng)計學意義(P0.05)。(3)經(jīng)兩種不同方法治療的患者不良事件發(fā)生率比較方面,清宮正骨手法組僅有2位患者對中藥過敏,出現(xiàn)輕度的皮膚紅疹;而在西藥治療的對照組有8位患者出現(xiàn)嗜睡、胃痛、惡心嘔吐或關節(jié)穿刺點紅腫等不良反應,經(jīng)停藥后癥狀可消失。兩組患者在研究治療過程中不良反應發(fā)生率比較,研究組低于對照組,且差異有統(tǒng)計學意義(p0.05)。結論:綜上所述,通過本課題的臨床研究可以得出清宮正骨手法治療膝痹病(膝關節(jié)骨性關節(jié)炎)比西藥對照組顯示出更好的療效,且能更顯著地改善患者膝關節(jié)日�；顒庸δ�,提升患者的生活質量。清宮正骨手法治療膝痹病(膝關節(jié)骨性關節(jié)炎)的臨床治療效果顯著、確切,無毒副作用,是膝痹病的一種有效治療方法,值得臨床進一步推廣應用。
[Abstract]:Objective: to conclude that osteoarthritis of the knee is a common disease of the middle aged and old people, and the prevalence rate is increasing year by year, and the knee joint swelling and pain, deformability and activity disorder caused by this disease, through the theoretical study of the epidemiology, pathogenesis, clinical characteristics and the diagnosis and treatment of Chinese and Western medicine. The quality of life of the patients is obviously reduced, because the cause of the disease is not yet clear, there is no specific therapy at present, and there are many kinds of deficiency and deficiency in most therapies. It is the focus and difficulty of the current research of the disease. The main purpose of this study is to explore the bone manipulation of the palace. To further observe and evaluate the therapeutic effect of knee arthralgia (knee osteoarthritis) on joint pain, joint stiffness and daily activity, and to provide scientific basis for the application of this study in clinical application. Methods: 80 patients were selected according to the standard of entry group, according to the random number. The method was randomly divided into 2 groups: the study group and the Diclofenac Sodium Sustained Release Tablets joint cavity injection of sodium hyaluronate (control group). The study group was 40 and the control group was 40. The two groups were treated with visual analogue score (VAS), WOMAC bone arthritis index score and evaluation criteria, before the treatment began and 1 weeks after the end of the course of treatment. Scores and records of the patients' knee symptoms, signs and activity functions were recorded and recorded, and their clinical efficacy was statistically analyzed. Each patient monitored the safety items before the treatment and 1 weeks after the end of the treatment. The adverse events were recorded in detail to assess the safety of the treatment. Results: the results of clinical studies showed: (1) In the study group, there were 3 cases of clinical control in 40 patients, 2 cases ineffective, the total efficiency was 95% in the observation time window, 1 in the control group, 6 ineffective, and 85% in the observation time window. In the two group, the study group was superior to the control group in comparison with the control group, and the difference was statistically significant (P0.05). (2) after treatment (2) After the treatment, the scores of pain in the two groups of the two groups, the score of pain in the WOMAC score, the stiffness integral, the score of daily activity and the total score were significantly lower than before the treatment (P0.05), and the difference in the degree of improvement of the two groups was not statistically significant (P0.05), and the improvement of the WOMAC integral in the two groups was better than that of the control group. Group, and the difference was statistically significant (P0.05); there was no significant difference in pain and stiffness improvement in the two groups of WOMAC scores (P0.05); the improvement of daily activities in the two groups was significantly better than that in the control group, and the difference was statistically significant (P0.05). (3) patients treated with two different methods. In comparison with the incidence of adverse events, only 2 patients were allergic to traditional Chinese medicine and had mild skin rash, while 8 patients in the control group treated with western medicine had adverse reactions such as somnolence, stomach pain, nausea and vomiting, or red and swelling joint punctures, and the symptoms disappeared after withdrawal. The two groups were not treated in the course of the treatment. Compared with the control group, the study group was lower than the control group, and the difference was statistically significant (P0.05). Conclusion: in summary, the clinical study of this subject can be used to show that the treatment of knee arthralgia (osteoarthritis of knee joint) is better than the western medicine control group, and it can improve the daily life of the knee joint more significantly. The clinical effect of the treatment of knee arthralgia (knee osteoarthritis) is significant, accurate, nontoxic side effect, and it is an effective treatment for knee arthralgia, which is worthy of further clinical application.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R274.9

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