【作者】 胡永祥；

【导师】 原林；

【作者基本信息】 南方医科大学 ， 中西医结合临床， 2011， 博士

【摘要】 背景膝关节骨性关节炎(knee osteoarthritis, KOA)是中老年人的常见病,属于一种慢性退行性骨关节关节病,以关节软骨退变和关节周围骨质增生为病理特征。主要以膝关节疼痛、僵硬及活动受限为表现。祖国医学认为膝关节骨性关节炎属于痹症,骨痹,膝痹,痿证等范畴。本病为中老年人多发病、常见病,此病的患者,从年青到老年,从举步维艰到寸步难行,痛不堪言,生活质量难以得到保障,严重困扰患者健康生活。随着科技的进步,人类寿命的延长,退行性膝关节炎发生和临床诊断的机率也愈来愈高。在我国,50岁以上人群中,骨性关节炎的发病率仅次于心血管疾病,位居第二位。由于病因及发病机理尚未完全阐明,目前缺乏有效药物和方法治疗。中西医治疗方法虽多样,但疗效皆难以肯定,且存在复发率高。大部分退行性膝关节炎患者对非手术疗法的接受度及治疗期望较高,但由于疾病进行性的特点,大多退行性膝关节炎病患最终都需要手术治疗才能较好地解决问题。然而,从中医的角度而言,退行性膝关节炎是属于本虚标实之证,手术更会给中老年患者的带来元气的损伤,无疑是雪上加霜。新易筋疗法来治疗膝关节骨性关节炎的思路源于原林教授提出的筋膜学理论,即两系统理论,把有机体划分为支持与储备系统和功能系统。支持与储备系统是在个体发育过程中由中胚层的间充质分化成多个器官系统后所遗留部分形成的遍布全身的筋膜结缔筋膜支架,该支架构成以脂肪源干细胞为核心,在神经系统和免疫系统的参与下构成的一个新的功能系统。筋膜组织中的脂肪源干细胞是该系统的主要物质基础,功能器官损伤或是代谢过度皆可以通过趋化动员筋膜中储备的脂肪源干细胞增殖、分化,以对其补充修复。膝关节骨性关节炎的治疗目的在于改善功能,缓解疼痛,延缓软骨退化,避免或减少畸形。目前认为单一的治疗方法在膝骨性关节炎的康复治疗中效果欠佳,多数医家主张采用综合治疗方法,但治疗方法并不规范。笔者采用新易筋疗法治疗,亦属于一种综合的治疗方法。本文是在筋膜学理论的指导下,以骨科门诊收集78例膝关节骨性关节炎患者为研究对象进行临床研究。通过临床观察统计学分析,两组治疗方法都能改善膝关节骨性关节炎患者的症状,且实验组治疗效果比对照组明显,可以认为新易筋疗法是治疗膝关节骨性关节炎的一种较为理想的方法。而且新易筋疗法是一种手法加针刺的治疗方法,治疗效果好,副作用小,患者接受度高,值得推广。目的通过对临床病例的观察,探讨新易筋疗法法对膝关节骨性关节炎治疗有效性,为膝关节骨性关节炎的治疗研究提供了新的方法,为筋膜学说的进一步完善提供临床支撑。方法全部病例均来源于香港日光诊疗中心,采集时间是2008年9月至2010年9月。根据病例纳入标准和排除标准,选择78膝关节骨性关节炎患者。按照完全随机分配原则分为治疗组39例,对照组39例。治疗组男性18例,女性21例；对照组男性17例,女性22例。经统计学处理,两组患者年龄、性别、发病部位、病情程度无显著性差异,具有可比性。随即平均分成治疗组和对照组,经统计学处理,两组患者年龄、性别、病情分布、病程、患病部位等无显著性差异,具有可比性。治疗组患者采用新易筋法治疗,对照组患者单纯手法治疗。治疗组：运用新易筋疗法治疗,通过按摩手法松解下肢肌肉3-5分钟,牵引膝关节1-2分钟,屈曲膝关节,在病人耐受的情况下最大程度拔伸、牵拉、旋转膝关节,刺激膝关节囊,松弛膝关节周围肌肉韧带；通过针刺膝关节周围肌间隔处以及异常点,提高机体应激能力,促进机体损伤修复,留针15分钟；浮针刺膝关节附近皮神经镇痛止痛,以达到彻底松弛关节周围肌肉的作用；通过拔伸,理筋手法复位膝关节病变肌肉痉挛所致关节错位。3天一次,3周一个疗程。对照组采用单纯手法治疗,最大程度跨膝关节的肌肉拔伸、牵拉和关节旋转。两组患者均配合功能锻炼,鼓励患者做股四头肌锻炼。随诊时间2-6个月,记录和比较治疗组及对照组患者膝关节症状的改善情况,数据采用SPSS13.0统计软件进行统计分析。结果治疗组与对照组治疗后各项指标均有明显的改善,治疗前后差异明显(P<0.01)。两组总疗效经统计学处理P<0.05,具有显著性差异。治疗组VAS积分和症状积分治疗后较治疗前减少,经统计学处理P<0.01,有显著性差异；对照组VAS积分和症状积分治疗后较前减少,经统计学处理P<0.01.,有显著性差异；治疗后两组组VAS积分和症状积分差值比较经统计学处理P<0.01,有显著性差异,可认为治疗组治疗效果明显优于对照组。结论通过这次临床观察,可以发现新易筋疗法和单纯的手法都能改善膝关节骨性关节炎患者的症状,统计结果显示新易筋疗法治疗膝关节骨性关节炎优于单纯的手法。新易筋疗法对治疗膝关节骨性关节炎疗效确切,与单纯手法相比疗效更显著,值得临床应用。更多还原

【Abstract】 BackgroundKnee osteoarthritis (knee osteoarthritis, KOA) is a chronic degenerative joint common disease in the elderly, and its pathology traits are the degeneration of cartilage and bone hyperplasia around the joint. Country medicine considers that KOA is an arthralgia disease, which contains bone weakness, knee weakness, and atrophy and so on. The disease is frequently occurring in the elderly. The patients are from young to old, from move difficult to move an inch, and unspeakable pain, very hard to ensure the quality of life and have severe distress of their life. With advances in technology, human’s longevity become longer, the occurring of degenerative knee arthritis and the probability of clinical diagnosis is getting high. The incidence of osteoarthritis is only less than cardiovascular disease, ranking second, of people over 50 year-old in our country. The etiology and pathogenesis is not fully understood, so lack of effective drugs and methods for treatment in current. Although the diversity of Chinese and Western treatments, the effects are uncertain and there is high recurrence rate. Most degenerative knee arthritis patients have high expectation on the acceptance of non-surgical therapy and treatment. But because of the characterized by progressive of the disease, most degenerative knee arthritis patients required surgery to solve the problem at last. However, from the perspective of Chinese medicine, degenerative knee arthritis is the syndrome of the root (Ben) deficiency and the branch (Biao) sthenia. In this case, taking surgery in elderly patients will bring more injury of vitality, which is undoubtedly worse.New Yijin treatment for osteoarthritis of the knee from the original idea of Professor Lin’s fasciaology, that two systems theory, the whole organism can be divided into supporting-storing system and functional system. The supporting-storing system is a whole body connective tissue fasciae framework after mesenchymal-type cells differentiate into multiple organ systems during the development. Adipose derived stem cells (adipose-derived stem cells, ADSCs) are the core of this framework, which construct a new functional system by nervous system and immune system. And it is also the main foundation of fasciae tissue that the damage organs or excessive metabolism can be supplemented and repaired by the proliferation and differentiation of chemokine mobilized ADSCs.The purpose of the KOA treatment is to improve function, relieve pain and delay the degeneration of cartilage and to avoid or reduce deformity. Now, a single treatment of KOA is ineffective, most physicians advocate the use of comprehensive treatment, but the method is not standardized. NewYi Jin treatment is also a comprehensive treatment. This study is under the guidance of fascia theory, and 78 cases of KOA were collected to doing clinical studies.Through the clinical observation and statistical analysis, we can find both methods can improve the symptoms of KOA patients. And it shows that the experimental group was significantly better than the control group. So it can consider that the new Yi Jin treatment of KOA is an ideal method. And the new Yi Jin therapy is a treatment that contains acupuncture and manipulation, which has good treatment effect, little side effect, and high received by patients, worth to promoting.ObjectiveKnee osteoarthritis (knee osteoarthritis, KOA) is a chronic degenerative joint common disease in the elderly, and its pathology traits are the degeneration of cartilage and bone hyperplasia around the joint. Country medicine considers that KOA is an arthralgia disease, which contains bone weakness, knee weakness, and atrophy and so on. The etiology and pathogenesis is not fully understood, so lack of effective drugs and methods for treatment in current. New Yijin treatment of KOA is from the original idea of Professor Lin’s fasciaology. Through the observation of clinical cases to explore whether the new Yijin therapy is effective for KOA. It provides a new way for KOA treatment and clinical support for the improvement of fasciaology.MethodsAll cases were acquainted from sunlight treatment center in Hong Kong from September 2008 to September 2010.78 KOA patients were selected by the case inclusion and exclusion criteria. According to the completely random distribution, patients were divided into treatment group 39 and control group 39. There were 18 males,21 females in treatment group and 17 males,22 females in control group. Statistical analysis showed comparability that two groups of age, gender, hair, disease locations and severity of disease were no significant difference. Treatment group were treated by the new Yijin treatment, and manipulation therapy for the control group.Treatment group:treated by the new Yijin therapy, lower limb muscles were released by massage for 3 to 5 minutes, stretched knee for 1 to 2 minutes, buckling the knee, and pulling, stretching, rotating knee, stimulating knee joint capsule, relaxing the muscle ligaments around the knee in the case of patients’the maximum tolerated pulling. Improving the body stress ability to promote damage repair by acupuncture in muscle intervals around the knee and abnormal points, and then retaining needles for 15 minutes. Acupuncture analgesia by floating needles around the knee leather nerve, in order to achieve complete relaxation of the muscles around the joints. The manual reduction was done in joint dislocation, which caused by muscle spasm, by pulling. Once three day, three weeks a course.Manipulation therapy was done in control group, the pulling, stretching, rotating joints in the case of the maximum across the knee muscles. All patients have done functional exercise, encouraging them to do quadriceps exercises. Followed up for 2 to 6 months, to record and compare the improvement of knee symptoms between treatment group and control group. And the data analysis was done by SPSS 13.0 statistical software.ResultsThe indicators have shown improvement in treatment group and control group after treated, and significant differences in before and after treatment (P<0.01). The total effect of the two groups was significant difference by statistical analysis P <0.05. The VAS and symptom scores of treatment group were decreased after treatment, statistical analysis P<0.01, significant difference. The VAS and symptom scores of control group were decreased after treatment, statistical analysis P <0.01, significant difference.The statistical difference of VAS and symptom scores of the two groups have showed that statistical analysis P<0.01 after treatment. It can be considered that the effect of treatment group was better than control group.ConclusionThrough this clinical observation, we can find a new and simple Yijin treatment for KOA, which can improve the symptoms. Statistics shows that the new Yijin treatment of KOA was better than manipulation treatment. The New Yijin treatment of KOA is effective, and more significant effect than manipulation treatment that worth clinical application.更多还原