【作者】 廖佑杰；

【导师】 符文彬；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 骨性关节炎(Osteoarthritis, OA)是一种退行性关节疾病,又称增生性关节炎、退行性关节炎,是一种主要侵害关节软骨、骨和滑膜组织,导致关节疼痛、畸形和功能障碍,从而影响病人活动能力的慢性进行性骨关节病,肩增龄性疾患。据统计,50岁以上人群中,骨性关节炎在可导致长期残疾的疾病中仅次于心血管疾病排名第二。基于此项调查,骨性关节炎致残比例在人群中约占2%-6%。因此,骨性关节炎是导致中老年人群功能残疾、造成经济损失和影响社会发展的主要疾病之一。骨性关节炎具有临床、病理和影像学多重定义；在其疾病发生与发展过程中,在全身因素和局部因素综合作用下,关节软骨发生生化、代谢和结构改变,最终出现关节软骨软化、破溃和局部剥脱以及关节边缘骨与软骨赘生物形成等病理改变,并引起相应临床症状。骨性关节炎的治疗目标是控制疼痛、改善关节功能和生活质量,尽可能避免治疗的毒副作用。目前,骨性关节炎缺乏确切有效的治愈手段。但是,针对患者设计的个体化治疗方案可以减轻疼痛、保持或改善关节活动度,减缓关节功能的受损。而当内科保守治疗无效,日常活动进行性受限时,应该考虑关节镜清理、截骨术和关节置换手术等外科治疗。目前,软骨移植、氨基葡萄糖、针对炎性因子或细胞内与炎症相关的信号分子的生物治疗手段的研究进展也为骨性关节炎的治疗开辟了新的研究方向。目的通过随机对照研究评价从心胆论治针灸方法对膝骨性关节炎(osteoarthritis, OA)的临床疗效,以期为临床治疗该病提供有力的参考。研究方法采用随机对照的临床研究方法,将符合纳入标准的OA患者60例为研究对象按1∶1比例随机分为两组,分为心胆论治治疗组(治疗组)和常规针刺对照组(对照组),每组各30例。治疗组选用内关(左右交替)、阳陵(患侧)、气海和水分针刺治疗,针后加心俞、胆俞(均双侧)麦粒灸,心俞、胆俞(均左右交替)皮内针治疗；对照组选用外膝眼、阴陵泉、内外膝眼、阿是穴(均为患侧),针后加脾俞、膀胱俞(均双侧)麦粒灸,脾俞、膀胱俞(均左右交替)皮内针治疗；每周治疗2次,5次为1个疗程,共治疗3个疗程,两组治疗方法和疗程相同。治疗前和疗程结束后分别观察患者的一般情况、中医临床症状、WOMAC Index of OA(加拿大)临床症状测定评分标准、膝退行性骨关节炎症状分级量化表、疼痛量表和生存质量,并随时记录研究过程中的不良反应及副作用,分类资料用x2检验,等级资料用两样本比较Wilcoxon秩和检验(校正),两样本均数比较用t检验或Wilcoxon秩和检验,自身前后比较用配对t检验或Wilcoxon配对秩和检验。统计计算采用SPSS17.0统计软件完成统计分析。结果治疗前,心胆论治治疗组和常规针刺对照组在一般项目、临床症状、WOMAC Index of OA(加拿大)临床症状测定评分、膝退行性骨关节炎症状分级量化表、McGill简氏疼痛量评分和生存质量SF-36积分均有可比性(P>0.05)；三个疗法后,发现：1、在中医症状评分方面：治疗前两组中医症状评分比较,差异没有统计学意义(P>0.05),两组间具有可比性；两组治疗后与治疗前比较中医症状评分均降低,差异具有统计学意义(P<0.01),说明治疗组和对照组均能改善OA患者症状,且治疗组的作用优于对照组(P<0.05)。2、在中医症状、体征量表评分方面,两组患者中医症状、体征量表评分判定疗效比较,P<0.05,差别有统计学意义。“3、在膝骨性关节炎WOMACI指数方面,治疗前两组膝骨性关节炎WOMACI指数比较,差异没有统计学意义(P>0.05),两组间具有可比性；两组治疗后与治疗前比较膝骨性关节炎WOMACI指数均降低,差异具有统计学意义(P<0.01),说明治疗组和对照组均能改善OA患者膝骨性关节炎WOMACI指数,且治疗组的作用优于对照组(P<0.05)。4、在McGill简氏疼痛量评分方面,治疗后,治疗组McGill简氏疼痛量评分与治疗前相较明显降低,P>0.001；对照组组内治疗前后McGill简氏疼痛量评分比较,P<0.001；治疗后两组间McGill简氏疼痛量评分比较,P<0.05。5、在X光片检查分度变化方面,两组患者X光片检查分度比较,P>0.05,差别没有统计学意义。6、在生存质量量表SF-36积分方面,治疗前后比较,治疗组在生理机能、生理职能、躯体疼痛、一般健康状况、社会功能、情感职能、精力、精神健康等七个方面均明显提高,差异具有显著性(P<0.01～0.001)；对照组在所有的组成成分积分也均有提高,其中只有在生理机能、精力方面、躯体疼痛三个方面与治疗前比较时,差异具有显著性(P<0.05～0.001)。②两组治疗后比较,治疗组在所有数据上均高于对照组,且在生理机能、生理职能、躯体疼痛、精力、情感职能、精神健康六方面具有显著性差异(P<0.05～0.001)结果表明治疗组在提高生活质量方面优于对照组。结论心胆论治治疗组和常规对照组除X光片检查分度,对膝骨性关节炎病患者的中医症状评分、功能障碍、WOMACI指数、McGill简氏疼痛量评分和生存质量量表SF-36积分均有改善作用,其中治疗组疗效优于对照组。更多还原

【Abstract】 ObjectiveEvaluation of a randomized controlled clinical study of acuPuncture treatment from the heart on the method of bile osteoarthritis (osteoarthritis, OA) efficacy in order to Provide reference for clinical treatment. Research MethodsA randomized controlled clinical research methods, the OA Patients met the inclusion criteria for the study 60 Patients were randomly divided into two grouPs according to the ratio of 1:1, on the Treatment of bile into the heart treatment grouP (treatment grouP) and routine acuPuncture grouP (control grouP),30 Patients in each grouP. Used in the treatment grouP off (left turn), Yang Ling (affected side), air sea and water acuPuncture, needles, add Xinshu Dan shu(both sides) moxibustion, Xinshu Dan shu (both left and right alternate) intradermal acuPuncture; the control grouP used the eye outside the knee, Yin Ling Quan, internal and external knee eyes, Ashi Points (all iPsilateral), needle added Pishu, Pangguangshu (both sides) moxibustion, Pishu, Pangguangshu (both left and right turn) intradermal needle theraPy; two treatment methods and treatment the same. Before and after treatment were observed with treatment, including laboratory tests, including general Project, clinical symPtoms, WOMAC Index of OA (Canada) Determination of the clinical symPtoms score, grading the symPtoms of knee osteoarthritis quantization tables, Pain scale, and quality of life, and to keeP records of adverse reactions during the study and side effects, using statistical software SPSS17.0 software for statistical analysis.ResultsBefore treatment, the grouP by treatment based on the theory of heart and gall bladder from TCM concePy and control-grouP Projects in general, clinical symPtoms, WOMAC Index of OA (Canada) Determination of rates of clinical symPtoms, symPtoms of knee osteoarthritis grading quantization table, McGill amount of Jane’s Pain score and quality of life (SF-36) Points were comParable (P> 0.05);After three treatments, found that:1, In terms of Chinese medicine symPtom scores:Chinese medicine symPtom score before treatment, the difference was not statistically significant (P> 0.05), were comParable between the two grouPs; the two grouPs before and after treatment, clinical symPtoms and treatment scores were lower, the difference statistically significant (P<0.01), that the treatment grouP and control grouP of Patients can imProve symPtoms of OA, and the effect of the treatment grouP than the control grouP (P<0.05).2, In the clinical symPtoms and signs scale score, the two grouPs of Patients with clinical symPtoms and signs, to determine efficacy scale scores comPared, P<0.05, difference statistically significant.3, WOMACI index in knee osteoarthritis:the treatment of osteoarthritis of the knee WOMACI first two indices, the difference was not statistically significant (P> 0.05), comParable between the two grouPs; the two grouPs before and after treatment of knee Osteoarthritis WOMACI index lower, the difference was statistically significant (P<0.01), that the treatment grouP and control grouP Patients with knee OA can imProve osteoarthritis WOMACI index, and the effect of the treatment grouP than the control grouP (P<0.05.)4, in the amount of the McGill Pain score, Jane’s, the treatment, the treatment grouP, the amount of McGill, Jane’s Pain score was significantly lower comPared with that before treatment, P> 0.001; before and after treatment the control-grouP in the amount of McGill, Jane’s Pain scores, P< 0.001; between the two grouPs after treatment, the amount of McGill, Jane’s Pain scores, P<0.05.5, In the indexing change of X-ray examination, the two grouPs were sub-degree X-ray examination comParison, P> 0.05, difference not statistically significant.6, In the quality of life scale SF-36 Points, the before and after treatment, the treatment grouP in Physical function, Physical function, bodily Pain, general health, social function, emotional function, energy, mental health were significantly increased in seven areas The difference was significant (P<0.01 ~ 0.001); control Points in all comPonents also have increased only in the Physiological function, energy, the body in three asPects of Pain before treatment, the difference was significant (P<0.05 ~ 0.001).②the two grouPs after treatment, the treatment grouP were higher in all the data, and in Physiological function, Physiological function, bodily Pain, energy, emotional function, mental health has six significant differences (P <0.05 ~ 0.001) The results showed that the treatment grouP in imProving the quality of life better than the control grouP.Conclusion1. Heart and gallbladder on the Treatment of conventional treatment grouP, control grouP of Patients can imProve symPtoms of OA, and the efficacy of the treatment grouP than the control grouP.2. Heart and gallbladder on the Treatment of conventional treatment grouP, control grouP Patients with OA can imProve Pain, stiffness and dysfunction, reduced knee WOMACI index, and the efficacy of the treatment grouP than the control grouP.3. Heart and gallbladder on the Treatment of conventional treatment grouP, control grouP of OA joint X-ray films were quite effective indexing changes.4. Heart and gallbladder on the Treatment of conventional treatment grouP, the control grouP on the SF-36 has changed the role of each comPonent, and the efficacy of the treatment grouP than the control grouP.The results show:from the heart-gall bladder acuPuncture treatment of OA treatment can be more effective imProvement of microcirculation, elimination of venous stasis state, not only the blood circulation and metabolism have imProved, so that locally generated material to clear the Pain caused to relieve knee joint local Pain, swelling and other symPtoms; while also imProving Patient quality of life and Pain scores. And easy to oPerate, no side effects, Patient easy to accePt, is a safe and effective method, it is worth in clinical Practice and further research.更多还原