【作者】 邱世宗；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿， 2009， 博士

【摘要】 研究目的膝关节骨性关节炎是由于膝关节软骨的退行性病变,连带引起软骨下骨、关节边缘、滑液膜和关节周围结构相关变化的疾病,是中老年人最常见的关节炎,尤其停经后的妇女更为常见。本病常引起膝关节疼痛和功能障碍,一般治疗目标是减少疼痛、不适,和改善关节活动功能。由过去文献显示该病的临床特征主要表现为关节疼痛与关节活动障碍,这也是造成病患痛苦的主要症候。本研究的目的在评估推拿整复手法对改善膝关节骨性关节炎的病情,提高关节之活动度,减轻疼痛程度,以提高患者的生活质量,缩短膝关节骨性关节炎治疗疗程方面的优势,为推拿整复手法治疗膝关节骨性关节炎的治疗提供理论依据。研究方法文献研究综述了古代和现代中医家对膝关节骨性关节炎的病因病机及其治疗的认识。中医外治法治疗该病的临床研究进展及作用机制;突出推拿手法和针灸治疗该病的临床研究现状;综述了现代医学对膝关节骨性关节炎的发病机制认识和治疗情况,在此基础上进行评述和展望。临床研究选取膝关节骨性关节炎患者60例为研究对象,将患者按照纳入标准和排除标准,随机分为2组,治疗组36例和对照组24例。治疗组采用推拿整复手法,对照组采用针刺治疗。分别对治疗前及治疗后4周和8周的疼痛、关节肿胀、活动障碍等症状体征进行评分记录,对治疗前后减分情况进行疗效评定。退化性关节炎量表指数(OA index)与Lequesne氏膝关节骨性关节炎功能量表指数(AFI)做为评定标准,使用台湾简明版世界卫生组织生活质量问卷(Taiwan-version of WHOQOL-BREFQuestionnaire)以了解病患之生活质量改善程度,比较各组治疗前后差异。研究结果1.文献研究结果文献研究表明,现代医学治疗多使用,传统的中医治疗存在一定优势,尤其是中医外治法,临床疗效肯定。推拿、针灸的治疗避免了药物的副作用,多靶点、整体调节,是较好的外治疗法。2.临床研究结果(1)治疗组在治疗4周后显效18人,有效13人,无效5人。总有效率为86.1%;治疗8周后显效21人,有效12人,无效3人,总有效率为91.7%。对照组治疗4周后显效8人,有效12人,无效4人,总有效率为83.3%。治疗8周后显效13人,有效8人,无效3人,总有效率为87.5%。(2)台湾简明版世界卫生组织生活质量问卷结果分析结果显示:两组治疗前后积分没有显著性差异(P＞0.05),治疗后,两组积分比较也没有显著性差异(P＞0.05)。(3) WOMAC膝关节骨性关节量表指数中整体情况的评定结果:治疗组在治疗后4周和治疗后8周分别与治疗前比较,均有显著性差异(P＜0.01);对照组在治疗后4周与治疗前比较有统计学差异(P＜0.05),在治疗后8周与治疗前比较有显著性差异(P＜0.01),治疗后两组比较没有显著性差异(P＞0.05)。WOMAC膝关节骨性关节量表指数中总分的评定结果:治疗组在治疗后4周较治疗前没有统计学差异(P＞0.05),治疗8周后较治疗前有统计学差异(P＜0.05);对照组在治疗后4周和8周较治疗前均无统计学差异(P＞0.05),两组治疗后比较也无统计学差异(P＞0.05)。(4) Lequesne氏膝关节骨性关节炎功能量表总分比较结果:治疗组在治疗后4周较治疗前有统计学差异(P＜0.05),治疗后8周较治疗前有显著性差异(P＜0.01);对照组在治疗后4周和8周分别与治疗前比较均无统计学差异(P＞0.05)。结论中医推拿整复手法与针刺治疗对膝退化性关节炎的症状体征指标均有显著的有效率。避免了药物的副作用,是理想的治疗方法。中医推拿整复手法与针刺治疗在改善台湾简明版世界卫生组织生活质量问卷积分方面,作用相当;在WOMAC膝关节骨性关节量表指数中整体情况和总分的评定中,中医推拿整复手法在治疗后较治疗前有显著变化,而针刺治疗在治疗后较治疗前变化不显著;在Lequesne氏膝关节骨性关节炎功能量表总分比较中,中医推拿整复手法在治疗后较治疗前有显著变化,而针刺治疗在治疗后较治疗前变化不显著。说明对于膝关节骨性关节炎的治疗中医推拿整复手法具有一定优势。应进一步推广和深入研究。更多还原

【Abstract】 AimKnee osteoarthritis is a regressive pathological change of the articular cartilage of knee,and it causes the relevant diseases in subchondral cartilage, edge of joint,and synovium and peri-joint regions.It is the most common arthritis among middle-aged and elderly people,especially women after menopause.This disease often causes pain and malfunction of knee joint. Generally,the therapy is to reduce pain and discomfort and to improve the movement function of the knee joint.According to the previous study of knee osteoarthritis,the clinical characteristics of this disease were mainly the joint pain and joint movement dysfunction which are also the major syndromes that cause the pain for patients.The purpose of this research is to assess the advantages of Chinese Tuina and restitution therapy in treating knee osteoarthritis,increasing the activity level of joints,reducing the pain, improving the patient’s quality of the life and shortening the course of treatment and to provide theoretical basis for KOA treatment with Tuina and restitution.Methods:Literature review synthesizes the opinions of modern and ancient Chinese Medicine experts on the etiology,pathogenesis and treatment of KOA;clinical research development and function mechanism of Chinese Medicine external treatment therapies;stress the current clinical research status with Tuina and acupuncture;KOA morbidity mechanism and treatment with modern medicine and comment and prospect based on that.The author chooses 60 cases of KOA patients in clinic and randomly groups them into 2 groups according to inclusion and exclusion criteria.The treatment group takes 36 cases and the controlled group 24 cases.Tuina and restitution therapies are adopted in the treatment group and the acupuncture therapies are adopted in the controlled group.Grade on symptoms like pain,joint swelling and distension,movement dysfunction,etc.before treatment and 4 and 8 weeks after treatment.Efficacy evaluation is given on the deduction before and after treatment.OA Index and Lequesne’ s AFI are adopted as judgment criteria.The Taiwan-version of WHOQOL-BREF Questionnaire is adopted to investigate the patients’ life quality improvement and compare the differences of each group before and after treatment.Result:1.Literature Review ResultLiterature review shows that in KOA treatment,modern medicine is mainly adopted;Chinese Medicine treatment has certain advantages,especially Chinese Medicine external treatment which has definite clinical efficacy. Tuina and acupuncture treatment avoid the side effects of medication and have multiple targets and comprehensive adjustment,so are the good external therapy.2.Clinical Research Result(1) After 4 week’ s treatment,in the Treatment Group,18 cases’ excellence, 13 cases’ utility and 5 cases’ failure.The total utility rate is 86.1%. After 8 weeks,21 cases’ excellence,12 cases’ utility and 3 cases’ failure.The total utility rate is 91.7%.In the controlled group,after 4 weeks’ treatment,8 cases’ excellence,12 cases’ utility and 4 cases’ failure.The total utility rate is 83.3%.After 8 weeks’ treatment,13 cases’ excellence,8 cases’ utility and 3 cases’ failure.The total utility rate is 87.5%.(2) The result analysis of investigation with Taiwan-version of WHOQOL-BREF Questionnaire shows that the grades of two groups before and after treatment don’ t have significant difference(P>0.05),so is that after treatment.(3) WOMAC KOA Scale index on general situations:in the treatment group,the indexes have significant difference(P<0.01) 4 and 8 weeks after treatment; in the comparison group,the indexes have statistical difference(P<0.05) 4 weeks after treatment and have significant difference(P<0.01) 8 weeks after treatment.The indexes after treatment in the two groups don’ t have significant difference(P>0.05).WOMAC KOA Scale Index Total Score:in the treatment group,the indexes haven’ t statistical difference(P>0.05) 4 weeks after treatment;it has statistical difference 8 weeks after treatment (P<0.05);in the comparison group,the indexes haven’ t statistical difference (P>0.05) 4 and 8 weeks after treatment.There’ s also no statistical difference (P>0.05) between the 2 groups 4 and 8 weeks after treatment.(4) Lequesne AFI result shows that in the treatment group,the indexes have statistical difference(P<0.05) 4 weeks after treatment and have significant difference(P<0.01) 8 weeks after treatment.In the comparison group,the indexes haven’ t statistical difference(P>0.05) 4 and 8 weeks after treatment.Conclusion:The Chinese Medicine Tuina and Restitution Therapy and Acupuncture have significant efficacy on regressive arthritis treatment which avoid the side effects of medication and are the ideal curative methods.The Chinese Medicine Tuina and Restitution Therapy and Acupuncture have equivalent effect in Taiwan-Version of WHOQOL-BREF Questionnaire score.In WOMAC KOA Scale index of general situation and total score,Chinese Medicine Tuina and Restitution has significant change compared with that before treatment,while acupuncture not significant.In Lequesne AFI,Chinese Medicine Tuina and Restitution has significant change compared with that before treatment,while acupuncture not significant.These show that in KOA treatment,Chinese Medicine Tuina and Restitution has certain advantages and should be further promoted and researched.更多还原