【作者】 李季叔；

【导师】 金宏柱；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 目的:本课题研究通过系统文献回顾,并进行分析归纳,通过临床研究,对“柔筋养精”思想在膝关节OA的治疗中的疗效进行评价和探讨。针对目前膝关节OA治疗方法现状,为膝关节OA的消除和减轻症状形成一个行之有效的疗法。方法:1.资料来源本课题在韩国首尔市三星洞三星医院选择90名志愿患者作为本实验的对象,中医辨证分型均为肝肾亏虚,寒湿痹阻型。随机分为三组:治疗组共计30例,完成27例,脱落3例,对照1组共计30例,完成28例,脱落2例。对照2组共计30例,完成26例,脱落4例。2.实验对象纳入标准①符合退行性膝关节炎西医诊断标准。②符合退行性膝关节炎中医肝肾不足证,或寒湿阻络证。③签署进入研究知情同意书。3.治疗方法(1)治疗组:柔筋推拿法、中药熏洗和中医运动处方,连续治疗3个疗程。(2)对照1组:常规推拿治疗方法。连续治疗3个疗程。(3)对照2组:口服西乐葆,连续治疗3个疗程,每疗程中间休息2天。4.临床疗效观察:选择简式MPQ疼痛问卷表、“Lequesne MG”膝骨关节炎严重程度计分标准、膝骨性关节炎治疗效果判定标准(JOA)和健康调查简易表MOS SF—36结果:1.对总体疗效比较、MPQ疼痛问卷评价、膝骨关节炎严重程度改善程度的评价,结果显示治疗组优于对照1组、2组;对照1组和2组比较中总体疗效和MPQ疼痛问卷评价,二者无差异;对照1组在膝骨关节炎严重程度改善程度的评价中优于对照2组。2.三组在膝骨性关节炎治疗效果判定标准(JOA)中治疗后较治疗前均显著降低(P＜0.01),且治疗组治疗后和对照1组、2组比较均有非常显著性差异(P＜0.05);对照1组、2组无显著差异;三组在对疼痛(步行)治疗后较治疗前有显著差异,但三组治疗后对对疼痛(步行)改善无明显差异(P＞0.05);治疗组治疗后较治疗前在疼痛(上下楼)改善上有显著差异(P＜0.05),治疗组和对照组相比有显著差异(P＜0.05),2组对照组治疗后对疼痛(上下楼)改善无明显差异(P＞0.05);治疗组、对照1组在膝关节屈曲角度上治疗前后有显著差异(P＜0.05),分别和对照2组相比有显著差异(P＜0.05),治疗组和对照1组在膝关节屈曲角度上改善相比较有明显差异(P＜0.05);治疗组治疗前后在肿胀改善上有明显差异(P＜0.05),和2组对照组相比较均有明显差异(P＜0.05),对照1组和2组在治疗前后肿胀改善无明显差异(P＞0.05),2组比较无明显差异(P＞0.05)。3.通过对生存质量的分析,结果显示:治疗后4周治疗组和2个对照组生存质量调查比较,PF、RP、VT和MH的差异有统计学意义(P＜0.05),治疗组优于对照组,其它维度的差异均无统计学意义;对照1组和对照2组生存质量调查比较,PF、RP、VT的差异有统计学意义(P＜0.05),对照1组优于对照2组,其余无统计学意义。治疗后12周三组生存质量调查比较,VT的差异有统计学意义(P＜0.05),治疗组优于对照组,其它维度的差异均无统计学意义。治疗后4周三组前后生存质量改变比较,组内比较对照1组GH、MH,对照2组PF、GH、VT、MH无明显差异性改变(P＞0.05),其余均有差异性改变(P＜0.05)。治疗组和对照1组、2组比较PF、RP、BP、VT、MH有明显差异性改变(P＜0.05),RP,SF、RE无明显差异性改变。对照1组和2组比较PF、RP、VT有明显差异性改变(P＜0.05)。治疗后12周三组前后生存质量改变比较,组内比较治疗组和对照组RP、BP、VT、RE均有差异性改变(P＜0.05),其他则无明显差异性改变。组间比较治疗组和对照1组、2组在VT上有明显差异(P＜0.05),其余均无明显差异性改变。结论:(1)阐明“柔筋养精”法对膝关节OA的作用的立论成立。(2)通过对疗效评价,确定了“柔筋养精”法对膝关节OA的临床疗效。(3)为膝关节OA的的消除和减轻形成一个行之有效的临床治疗思想和方法。在“柔筋养精”的学术思想指导下对膝关节OA进行综合治疗是简便易行、具有较好疗效的治疗方法,具有较高的经济效益和社会效益。更多还原

【Abstract】 Objective: This research through a systematic literature review and analysis of induction, through clinical research of "relieving tendons to nourish essence" thinking in the treatment of KOA efficacy evaluation and discussion. View of the current methods of treatment of KOA, Forming an effective therapy that can eliminate and mitigate the symptoms of KOA.Method:1. SourceThis subject choosing 90 voluntary patients from the Samsune Hospital in Seoul, Korea as the object of the experiment. TCM Syndrome Types are insufficiency of liver and kidney, stagnation of cold and damp. Randomly make two groups: treatment group 30 cases, 27 cases completed, detached 3 cases, control group 1 a total of 30 cases, 28 cases completed, 2 cases lost. Control group 2 a total of 30 cases, 26 cases completed, 4 cases lost.2. standards①Be in line with the Western diagnostic criteria of KOA.②Be in line with the TCM Syndrome Types :insufficiency of liver and kidney, or chill and dampness obstructing the collaterals.③signed informed consent entered the study book.3. Treatment(1) treatment group: softing tendons , Chinese medicine Washing and Chinese medicine exercise prescription for the treatment .Continuous 3 treatments.(2) control group 1: conventional massage treatment. Continuous 3 treatments.(3) control group 2: oral Celebrex,continuous 3 treatments, each two days rest between treatments.4. Clinical Observation: Choice of short-form pain questionnaire MPQ, "Lequesne MG" the severity of osteoarthritis of the knee QMS, knee osteoarthritis treatment criteria (JOA) and the Health Survey Summary Table MOS SF-36Results: (1) Effect on the overall comparison, MPQ pain evaluation questionnaire,the severity of osteoarthritis of the knee to improve the level of evaluation, results showed that the treatment group is superior; control group 1 and group 2 have no differencethe on the overall efficacy and MPQ pain questionnaire evaluation ; control group 1 the severity of osteoarthritis of the knee to improve the evaluation is better than the control group2. (2) Three groups knee osteoarthritis treatment criteria (JOA) in the treatment than before treatment were significantly lower (P <0.01), and the treatment group and control group 1, group 2 there was a significant difference (P <0.05); there is no significant difference between control groups;Three groups in the pain (walk) after treatment than before treatment were significantly different, but the three groups after the treatment of pain (walk) to improve the non-significant difference (P> 0.05); Treatment group after treatment than before treatment in pain (on down) to improve the significant differences (P <0.05), Treatment group and control group were significantly different when compared(P <0.05), two control groups after treatment of pain (on down) to improve the non-significant difference (P> 0.05); Treatment group, control group 1, from the angle of knee flexion before and after treatment were significantly different (P <0.05), respectively, and the control group 2 were significantly different (P <0.05), treatment group and control group 1 in angle of knee flexion improvement has significant difference compared to (P <0.05); Treatment group before and after the swelling has significant difference in improvement (P <0.05), and compared to the two control groups had significant difference (P <0.05), control group 1 and group 2 before and after treatment to improve the swelling was no significant difference (P > 0.05), two groups had no significant difference (P> 0.05). (3) Through the quality of life analysis, results showed that: 4 weeks after treatment the treatment group and two control groups compared the quality of life survey, PF, RP, VT and MH have statistically significant differences (P <0.05), the treatment group is better than that of the control Group, differences in other dimensions were not statistically significant; control group 1 and control group 2 Comparison of quality of life survey, PF, RP, VT difference has statistical significance (P <0.05), control group 1 was better than the control group 2, and the remaining non-statistical significance. 12 Weeks after the treatment three groups compared the quality of life survey, VT difference has statistical significance (P <0.05), the treatment group better than the control group, the other dimension there was no statistically significant differences. Three groups after treatment for 4 weeks before and after the change in quality of life compared,Comparison of the control group 1 GH, MH, the control group 2 PF, GH, VT, MH no significant difference in change (P> 0.05), the remaining differences have to change (P <0.05). Treatment group and control group PF, RP, BP, VT, MH changes have significant difference (P <0.05), RP, SF, RE change was no significant difference. Control group 1 and control group 2 PF, RP, VT has significant differences in changes (P <0.05). Three groups after treatment for 12 weeks before and after the change in quality of life compared,Comparison of the control group and control group RP, BP, VT, RE changes are the difference (P <0.05), there is no significant difference in other changes. Group comparison between treatment group and two control groups have significant differences in VT on (P <0.05), there was no significant difference in the remaining changes.Conclusion: (1) Stated that "Relaxing tendons to nourish essence" on the role of KOA arguments to set up. (2) Through the evaluation to determine the "Relaxing tendons to nourish essence" on the clinical efficacy of KOA. (3) Forming an effective clinical treatment of thought and methods that can eliminate and mitigate KOA. Under the guidance of academic thought "Relaxing tendons to nourish essence" the integrated treatment of KOA are easy and has good treatment effect, with higher economic and social benefits.更多还原