【作者】 曾兆晖；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 研究目的：期望通过本研究充分发挥中医针灸疗法优势对膝关节骨性关节炎进行治疗,并为进一步拓展和推广其日后临床应用打下基础。研究方法：文献研究综述了中医学、现代医学对膝关节骨性关节炎的认识和治疗,以及经筋理论的研究进展。临床研究选取符合纳入标准的病例60例,将其随机分为两组,即治疗组和对照组。治疗组以经筋理论为指导,以“以痛为腧”为原则,依据导师庄礼兴教授临床经验,循膝关节相关的经筋系统进行排查,每次选取4个痛点进行手法操作。快速刺入病灶点,针刺深度要达到骨膜,并沿经筋循行路线于该病灶点上下各1寸处傍刺。得气后留针30分钟,每隔5分钟行针一次,手法为捻转泻法,以患者能耐受为度。对照组为常规针刺组,参照石学敏主编《针灸学》(第五版),选择犊鼻、内膝眼、阳陵泉、足三里。针刺手法、补泻手法同治疗组,针刺深度按常规进行,同时不需傍刺。治疗共3个疗程,观察治疗前后McGill简化疼痛量表中的目测类比疼痛评分(VAS)、临床症状评分、WOMAC (Western Ontario and McMaster Universities)膝关节骨性关节量表以及临床疗效评价。研究结果：VAS评分比较：治疗前两组比较,无明显差异(P>0.05),提示两组患者疼痛程度相当。经治疗后评分均较治疗前明显下降,差异具有统计学意义(P<0.01,P<0.05),提示两种治疗方法均可以有效的缓解疼痛症状。治疗后两组比较P<0.05,提示2组治疗效果比较差异有统计学意义,以治疗组缓解疼痛程度明显。临床症状评分结果：治疗前两组比较,无明显差异(P>0.05),提示两组患者临床症状相当。经治疗后评分均较治疗前明显下降,差异具有统计学意义(P<0.01,P<0.05),提示两种治疗方法均可以有效的改善临床症状。治疗后两组比较P<0.05,提示两组治疗效果比较差异有统计学意义,以治疗组改善明显。WOMAC评分结果：疼痛症状评分方面,治疗前两组比较,无明显差异(P>0.05),提示两组患者疼痛评分相当。经治疗后评分均较治疗前明显下降,差异具有统计学意义(P<0.01,P<0.05),提示两种治疗方法均可以有效的改善疼痛症状。治疗后两组比较P<0.05,提示两组治疗效果比较差异有统计学意义,以治疗组改善明显。僵硬症状评分方面：治疗前两组比较,无明显差异(P>0.05),提示两组患者僵硬症状评分相当。经治疗后评分均较治疗前明显下降,差异具有统计学意义(P<0.05),提示两种治疗方法均可以有效的改善僵硬症状。治疗后两组比较P>0.05,提示两组治疗效果比较差异无统计学意义,效果相当。日常生活评分结果：治疗前两组比较,无明显差异(P>0.05),提示两组患者日常生活的困难评分相当。经治疗后评分均较治疗前明显下降,差异具有统计学意义(P<0.01,P<0.05),提示两种治疗方法均可以有效的改善日常生活的困难程度。治疗后两组比较P<0.05,提示两组治疗效果比较差异有统计学意义,以治疗组改善明显。在临床疗效方面,治疗组可以达到76.67%,高于对照组63.33%；作为一种退行性改变,本病治愈率不高,在显效率方面,治疗组优于对照组(P<0.05)。研究结论：疼痛作为本病最早出现、最主要的症状,应作为衡量本病治疗效果的重要方面。在本研究中,VAS评分、临床症状评分、WOMAC中对于疼痛的评分均显示两组在治疗后疼痛症状均得到明显改善,通过组间比较可以进一步发现,采用经筋理论指导下的针刺方法止痛效果更加理想。本病多见于中老年人,是影响中老年人生存质量的重要因素。随着人口的老龄化,其发病率逐年上升。因此提高患者生活质量,延缓病情发展是治疗该病的重要目标。本研究中,治疗后两组患者日常生活的困难评分较治疗前明显下降,差异具有统计学意义,提示两种治疗方法均可以有效的改善日常生活的困难程度。组间比较发现以治疗组改善明显。本研究显示,治疗组可以达到76.67%,高于对照组63.33%；作为一种退行性改变,本病治愈率不高,在显效率方面,治疗组优于对照组。经筋刺法治疗膝关节骨性关节炎临床疗效确切；可以显著减轻疼痛症状、改善临床症状、提高生活质量,且操作简便,无不良反应,患者易于接受,是值得推广的疗法。更多还原

【Abstract】 Objective:Knee osteoarthritis (KOA) is a kind of joint pathological changes marked by jiarticular cartilage degeneration and bone hyperplasia. The disease is most common in middle aged to elderly people. With the extension of human life, the incidence rises gradually. Concerned investigation shows, in our country the incidence of KOA is around 5% in the people over age 50, and 25% in those over 60 years old for women,15% for men.At present,effective methods to reverse bone hyperplasia is still deficient, but for the reactive changes of surrounding tissue there can be kinds of methods. The common ones include drug interention, traditional Chinese medicine, joint flush and surgical treatment. Long-term use of drugs, particularly sedation, can easily produce a lot of complications; joint flush and surgical treatment are just partly used, because some older adults with basic disease can not tolerate, therefore chinese medicine becomes more and more important, for it can improve clinical symptoms and quality of life. Twelve meridian musculatures are part of meridian system, which get nutrition from twelve meridians, connet with joints of four limbs to hold skeleton and keep in touch with body, perfrom movement function. The essence of disease about this system is syndromes caused by the damage of muscle system that corresponding to twelve meridians. The musculature theory provides a simple and feasible way to treat knee osteoarthritis, and sets a firm theoretical basis. Therefore, it is significant to use the theory to guide the treatment of knee osteoarthritis.Reseaches about meridional muscle region puncture in improving the musculature theory of "Neijing " and on the clinical observations are poor, so it is necessary to do deeper research on the clinical experiences of acupuncture doctors, to clear up and promote, in order that it can be widely used. For all above, this study selected randomized controlled method to observe the effect of meridional muscle region puncture in treating KOA.Methods:The literature research summarized the understandings and treatments about KOA in traditional Chinese medicine and modern medicine, the development of musculature theory.Clinical research part:60 cases fitted with the criteria were randomly divided into the treatment group and control group. The treatment group was guided by the musculature theory, with the rule"where there is a pain, there is a acupoint" as principle and clinical experiences from Tutor Prof. Zhuang Lixing. Ssearched for four pain pionts which located at the musculature that along with the knee joint. Inserted the needle quickly at the pain piont and deep into the periosteum, and inserted another two needles above and below the pain piont, all these pionts were at the same musculature. Retained the needles for 30 minutes after the arrival of qi,and rotated the needles with tonifying method every 5 minutes. Patients could endure for degrees. The control group were treated with conventional acupuncture and pionts such like Dubi, Neixiyan, Yanglingquan, Zusanli according to the reference" acupuncture amd moxibustion" (fifth edition, Ed. Shi Xuemin).The acupunture method, tonifying and reducing methods are the same as the treatment group, differences were to insert the needles into conventional acupuncture depth without lateral needling. Treated for three treatments. Before and after treatment, odserved the the visual analogy pain scale(VAS) in the McGill Simplified scale, clinical symptoms scores, WOMAC, KOA scale, then evaluated the clinical curative effect.Results:The results showed that pain in both groups were significantly improved after treatment according to the VAS scores, clinical symptoms scores and WOMAC, with a better effect of relieving pain in the treatment group for guided by the musculature theory.In terms of improving the quality fo life, Scores evaluating daily life’s difficulties reduced with a statistically significance after treatment pointed out that both methods could help improve the difficulty in daily life. Compared with control group, treatment group is better in improvement. In the clinical curative effect, the total effective rate was over 60%, of which 76.67% went into the treatment group, and the effective rate of treatment group was higher than that of control group; As a degenerative change, the recovery rate is not high, but the treatment group was higher according to the significant efficiency.Conclusion:Meridional muscle region puncture for Knee Osteoarthritis is actually effective; It can significantly reduce pain symptom, improve clinical symptoms and quality of life, simple but without adverse reaction, easy to be accepted, is worthy of widely clinical application.更多还原