【作者】 邱幼妮；

【导师】 吴旭；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 退行性膝关节炎是中老年人的常见病,严重影响生活质量。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。目前中西医治疗方法虽多样,但疗效皆难以确定,且存在复发率高的遗憾。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意愿较高,但由于疾病进行性的特点,许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。近几年来玻璃酸钠注射疗法的崛起,应用于退行性膝关节炎可产生良好的治疗效果,提高生活质量,减缓退化的速度;但它却存在了价钱昂贵、需反复补充注射的缺点。从中医的角度而言,退行性膝关节炎是属于本虚标实之证,故选择标本同治的治疗是必须的,针灸治疗则有此疗效,既可达到标本同治的目的,又可免除长期服药之虑,故针灸对退行性膝关节炎而言,是一种较佳的选择。若将玻璃酸钠注射结合针灸治疗可以提高单独治疗之效,或许因此可以降低玻璃酸钠注射之频率,减少手术机会,减轻社会成本,亦可嘉惠此类病患人员,提供更佳治疗选择。本试验是将确诊为退行性膝关节炎之患者分为三组,第一组为针灸组,每周针灸3次;第二组为玻璃酸钠注射组,每周注射玻璃酸钠1次;第三组为玻璃酸钠加针灸组,每周针灸3次并结合每周注射玻璃酸钠1次;每组各30例,试验时间为五周。分别于试验前,试验第二周末、第四周末、第五周末记录每位患者之膝关节功能评估表(百分表)及症状指标:僵硬、压痛与肿胀等指标。研究结果显示:1.三种治疗方法对退行性膝关节炎皆为一有效治疗方法。(1)从实验结果得知,经过五周治疗,不论从膝关节功能或症状表现皆可看出,个组前后之比较皆有统计上的差异。(2)随着治疗时间的延伸,患者膝关节功能是逐渐改善。(3)根据试验统计结果,注射玻璃酸钠组疗效较针灸组为佳。2.玻璃酸钠加针灸组之患者膝关节功能改善优于单纯玻璃酸钠组及针灸组。两者配合相得益彰,可以达到加乘之效。既可有急则治其标之意,又有缓则治其本之涵。试验患者之膝关节功能及症状皆有明显改善,可提高单一治疗之效,对于临床治疗亦可提供更佳及多样的选择。结论:由于玻璃酸钠配合针灸治疗退行性膝关节炎之疗效提高,期以用于临床可提高患者之生活质量,减轻疼痛,改善精神、情绪状态,并且降低医疗成本。更多还原

【Abstract】 Degenerative osteoarthritis of knee is one of the most common diseases of the elderly and worsen the quality of life. With the advance of science, the life expectancy of people has been prolonged. Therefore, the incidence of degenerative osteoarthritis of knee increase . There are several options for treating degenerative osteoarthritis of knee from traditional and modern medical methods, but the curative effect can not be confirmed and recurrence rate is high. The most patients of degenerative osteoarthritis of knee progressing preferred to accept the non-operative treatments. As character of the disease progression, the most patients of degenerative osteoarthritis of knee need operative treatment to solve their problems finally.With the intra-articular injection of hyaluronic acid has rapidly gained popularity recently, its effect of getting the good results and better life quality , decreasing the speed of degeneration are noted. However, it’s shortcomings include high price and frequent injections.With respect of traditional Chinese medicine, the osteoarthritis of knee belongs to the syndrome of root cause deficiency and manifestation excess, adopting the treatment both manifestation and root cause is necessary.Acupuncture with moxibustion has the treatment effect and can get the purpose of the treatment both manifestation and root cause . Besides, it also can decrease the complications of long-term drug intake.Therefore,acupuncture with moxibustion is a good choice for treatment of these patients. If we combine the acupuncture, moxibustion with hyaluronic acid to treat these patients, the effect maybe better compare with used alone .Maybe the frequency of injection and the possible operation can be reduced,and lower the social loading and increase the patients’benefits, it provides the best treatment choice. The patients in our trials were randomized into 3 groups, the first group is acupuncture with moxibustion group, the patients in this group received 3 times acupuncture with moxibustion treatment weekly. The second group is hyaluronic acid group, the patients in this group received injection of hyaluronic acid once every week. The third group is combined group, the patients received acupuncture with moxibustion and hyaluronic acid injection. Every groups enrolled 30 cases , the trials period is five weeks. The knee function scale and 3 symptom items (swollen, tenderness and stiffness) were used to evaluate these patients in pre-test, the end of secondweek, the end of forth week, and the end of fifth week respectively.The results of study were stated as below:1. All three methods for treating osteoarthritis of knee are effective .(1)According to the results of this study, after 5 weeks treatment, the patients in every group got obvious improvement statistically in clinical presentation , no matter the knee function test or symptoms presentation .(2)With the treatment time , the patients’ function of knee improved progressively.(3)According to the statistical results , the efficacy of hyaluronic acid injection is better than that of acupuncture with moxibustion.2.The combined group is superior in the improvement of knee function and symptoms to acupuncture with moxibustion group and hyaluronic acid group. Based on the results of this test, we find that the combined group can get cumulative effect from the other two different treatment methods. Not only get the mean of the treating manifestation on acute stage ,but also the connotation of treating root cause on chronic stage. Much improvement in the function score and the symptoms in the patients of combination treatment, make us believe that combined treatment is better than single treatment. This viewpoint provides a new option for treating these patients.In conclusion, As the efficacy of combined treatment was superior, the patients’ life quality, pain relief , spirits and emotion statement improved and the expenses of medical treatment be reduced.更多还原