【摘要】：目的:觀察針刀松解治療膝關(guān)節(jié)骨性關(guān)節(jié)炎氣滯血瘀證的臨床療效并與針刺治療對(duì)比。探討針刀治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的機(jī)理以期為患者探尋更有效、簡(jiǎn)單、方便的治療方案,以改善病人的生活質(zhì)量。方法:選取2015年5月-2015年10月期間山東大學(xué)附屬千佛山醫(yī)院疼痛科門(mén)診和住院患者中符合膝關(guān)節(jié)骨性關(guān)節(jié)炎中醫(yī)診斷標(biāo)準(zhǔn)和西醫(yī)診斷標(biāo)準(zhǔn),并屬于中醫(yī)氣滯血瘀證的患者72例。將72例患者按照隨機(jī)對(duì)照的原則,分為針刀組和針刺組。經(jīng)統(tǒng)計(jì)學(xué)分析針刀組與針刺組在年齡、性別、病程、影像學(xué)分級(jí)等方面的差別沒(méi)有統(tǒng)計(jì)學(xué)意義。治療方案:針刀組采用小針刀松解治療,針刺組采用單純針刺治療。針刀組5天治療一次,共治療3次;針刺組每天針刺一次,針刺15天。評(píng)價(jià)指標(biāo):WOMAC骨關(guān)節(jié)炎指數(shù)評(píng)分量表評(píng)分、《中藥新藥臨床研究指導(dǎo)原則》骨關(guān)節(jié)炎的疾病療效判定標(biāo)準(zhǔn)。評(píng)價(jià)時(shí)間:(1)治療前對(duì)針刀組和針刺組進(jìn)行評(píng)價(jià);(2)針刀組于第3次治療后的第5天進(jìn)行評(píng)價(jià),針刺組于第15次治療后的第2天進(jìn)行評(píng)價(jià),評(píng)價(jià)結(jié)束后進(jìn)行治療前后組內(nèi)的對(duì)比和兩組之間的對(duì)比;(3)治療結(jié)束1個(gè)月后再次進(jìn)行評(píng)價(jià),并做組間比較。結(jié)果:(1)治療結(jié)束后第一次評(píng)價(jià)組內(nèi)比較:(1)治療后針刀組和針刺組的WOMAC骨關(guān)節(jié)炎三項(xiàng)指數(shù)評(píng)分和本組治療前比較均有降低,同時(shí)組內(nèi)比較P0.05,說(shuō)明針刀組和針刺組的治療有統(tǒng)計(jì)學(xué)意義,都能夠改善患者的臨床癥狀。(2)臨床療效:經(jīng)治療后針刀組的總有效率為91.67%;針刺組的總有效率為83.33%。(2)治療結(jié)束后第一次評(píng)價(jià)組間比較:(1)針刀組在WOMAC骨關(guān)節(jié)炎三項(xiàng)指數(shù)評(píng)分方面均優(yōu)于針刺組,P0.05說(shuō)明針刀組和針刺組比較有統(tǒng)學(xué)意義,針刀組的治療效果優(yōu)于針刺組。(2)臨床療效:針刀組的總有效率為91.67%,針刺組的總有效率為83.33%。P0.05有統(tǒng)計(jì)學(xué)意義說(shuō)明和針刺組比較有更好的臨床療效。(3)治療結(jié)束后第二次評(píng)分組內(nèi)比較:(1)針刀組和針刺組在WOMAC骨關(guān)節(jié)炎三項(xiàng)指數(shù)評(píng)分方面和治療前比較,P0.05,說(shuō)明在治療結(jié)束1個(gè)月后,針刀組和針刺組患者的臨床癥狀仍然比治療前減輕。(2)臨床療效:針刀組患者在治療后1個(gè)月,總有效率為88.89%。針刺組治療后1個(gè)月,總有效率為77.78%。(4)治療結(jié)束后第二次評(píng)分組間比較:(1)針刀組在WOMAC骨關(guān)節(jié)炎三項(xiàng)指數(shù)評(píng)分面均優(yōu)于針刺組,P0.05說(shuō)明針刀組的治療效果在1個(gè)月后仍?xún)?yōu)于針刺組。(2)臨床療效:針刀組患者總有效率為88.89%。針刺組患者總有效率為77.78%。P0.05,說(shuō)明針刀組和針刺組相比,在治療后1個(gè)月臨床癥狀減輕更明顯。結(jié)論:針刀松解治療膝關(guān)節(jié)骨性關(guān)節(jié)炎氣滯血瘀證,可以明顯改善患者的疼痛、僵硬的臨床癥狀,提高患者的生活質(zhì)量,是一種較好的的治療方案。
[Abstract]:Objective: to observe the clinical effect of acupuncture-knife loosening on qi stagnation and blood stasis syndrome of knee osteoarthritis and compare with acupuncture treatment. To explore the mechanism of needle knife in the treatment of knee osteoarthritis in order to find a more effective, simple and convenient treatment for patients, in order to improve the quality of life of patients. Methods: from May 2015 to October 2015, the patients in the Department of pain, Qianfoshan Hospital, affiliated to Shandong University, met the criteria of traditional Chinese medicine and western medicine for diagnosis of knee osteoarthritis. And belongs to the TCM Qi stagnation blood stasis syndrome of 72 cases. According to the principle of random control, 72 patients were divided into acupuncture group and acupuncture group. There was no significant difference in age, sex, course of disease and imaging grade between acupuncture group and needle knife group. Treatment plan: the acupuncture group was treated with small needle knife, and the acupuncture group was treated with simple acupuncture. The acupuncture group was treated once every 5 days for 3 times, and the acupuncture group was treated once a day for 15 days. Evaluation measures: WOMAC Osteoarthritis Index scoring scale, Clinical Research guidelines of New drugs of traditional Chinese Medicine, criteria for judging the curative effect of Osteoarthritis. Evaluation time: (1) the acupuncture group and acupuncture group were evaluated before treatment; (2) the acupuncture group was evaluated on the 5th day after the third treatment, and the acupuncture group on the second day after the 15th treatment. (3) one month after the end of treatment, the evaluation was done again, and the comparison between groups was made. Results: (1) comparison of the first evaluation group after treatment: (1) the scores of WOMAC osteoarthritis index in acupuncture group and acupuncture group were lower than those before treatment, and there was a significant difference between the two groups (P 0.05). The results show that the treatment of acupuncture group and acupuncture group have statistical significance, can improve the clinical symptoms of patients. (2) Clinical efficacy: after treatment, the total effective rate of acupuncture knife group is 91.67; The total effective rate of the acupuncture group was 83.33. (2) the comparison of the first evaluation group after treatment: (1) the acupuncture group was superior to the acupuncture group in three indexes of WOMAC osteoarthritis. P05 indicated that the acupuncture group and acupuncture group have general significance, the treatment effect of acupuncture group is better than acupuncture group. (2) Clinical effect: the total effective rate of acupuncture knife group is 91.67. The total effective rate of acupuncture group is 83.33%.P0.05 has statistical significance compared with acupuncture group has better clinical efficacy. (3) after the end of treatment the second score group comparison: (1) acupuncture group and acupuncture group in WOMAC The three index scores of osteoarthritis were compared with those before treatment. P0.05, indicating that the clinical symptoms of the patients in the acupuncture group and the acupuncture group were still alleviated one month after the treatment. (2) Clinical efficacy: the total effective rate of the acupuncture knife group was 88.89 after one month of treatment. The total effective rate of acupuncture group was 77.78 months after treatment. (4) the comparison of the second score group after the end of treatment: (1) the three index scores of WOMAC osteoarthritis in the acupuncture group were better than those in the acupuncture group. P05 indicated that the treatment effect of acupuncture group was still better than that of acupuncture group after 1 month. (2) Clinical efficacy: the total effective rate of acupuncture knife group was 88.89. The total effective rate of the acupuncture group was 77.78. P0.05, which indicated that the clinical symptoms of the acupuncture group were more obviously alleviated than that of the acupuncture group. Conclusion: the treatment of Qi stagnation and blood stasis syndrome of knee osteoarthritis with acupuncture knife loosening can obviously improve the pain, stiff clinical symptoms and improve the quality of life of the patients. It is a better treatment scheme.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R246.9

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