【作者】 陈世铭；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 目的：通过随机对照研究,观察治疗前后患者膝关节疼痛、僵硬症状及膝关节功能,步行距离,生活质量等评分改变情况,从而研究温针灸治疗阳虚寒凝型膝骨关节炎的临床疗效。方法：收集60例合格之膝骨性关节炎患者,按1：1随机分配至温针灸治疗组及单纯针灸组两组,两组皆取穴：阴陵泉、阳陵泉、内、外膝眼、血海及梁丘等共6个穴位治疗。观察指标运用患者自评量表WOMAC、中文版简明健康状况调查表(SF-36)和6分钟持续步行距离等三个量表来评估膝骨关节炎症状、肢体功能及生活质量等,在治疗前、治疗4周时进行评估。临床疗效评定分析采用尼莫地平法,分为临床痊愈、显效、有效无效四级,同时,对不良反应进行观测。结果：分析60例患者的研究结果显示,在治疗组和对照组两组患者中性别、年龄、患病时间、膝患部等构成,其差异性无统计学意义(P>0.05),组间具有可比性。治疗后患者膝关节疼痛症状、僵硬状况及膝关节功能显着改善,步行距离增加,生活质量提高。治疗组、对照组在试验4周后比较WOMAC、SF-36评分和6分钟步行距离等三个量表,除4周之6分钟步行距离外,均分别与治疗前有统计学差异(P<0.05)。治疗组与对照组在试验4周后比较WOMAC、SF-36评分和6分钟步行距离,除SF-36精神健康分数外,差异均有统计学意义(P<0.05)。4周后,治疗组临床基本痊愈者9例,显效者12例,有效者7例,无效者2例,总有效率93.3%。对照组临床基本痊愈者2例,显效者10例,有效者14例,无效者4例,总有效率86.6%。经统计学分析,差异无统计学意义(P>0.05)。温针灸与单纯针刺在总体疗效上无明显差异,二者均具有较好的临床疗效。此外,温针灸组与单纯针灸组无一例出现不良反应。说明温针灸与单纯针刺均具有较高的安全性。综合分析,温针灸与普通针刺均具有较好的临床疗效。温针灸的总体疗效与单纯针刺组无异,但在改善关节的疼痛、僵硬症状及关节或活动度方面,则明显优于单纯针刺组。结论：温针灸能改善阳虚寒凝型膝骨关节炎患者的临床症状和功能,达到止痛,提高生活质量的效果,且未发现明显临床副作用,是一值得推广的临床治疗方法。更多还原

【Abstract】 Objection:To investigate the clinical effect of Warm Needle Moxibustion in treating Knee Osteoarthritis by randomized control study.Methods:This research was undertaken in Taipei Medical University Hospital (TMUH) in Taiwan,60 patients with knee osteoarthritis were randomly assigned (1:1 ratio) to receive Warm Needle Moxibustion plus acupuncture (treatment group) or acupuncture (control group) in 2 courses (5 times a week,2 weeks as a course). The clinical effect was evaluated by three different observation forms, WOMAC Index Of Osteoarthritis (WOMAC), SF-36 in Chinese and 6-minute walk on week 0,2 and 4. The therapeutic effect was evaluated with Nimodipine calculating method. The safety parameters were well monitored and analyzed.Results:All randomly assigned participants were analyzed. There is no statistic difference between treatment and control group in age, gender, and the disease average course (P>0.05). Warm needle moxibustion plus acupuncture significantly improved clinical symptoms, stiffness, function, walking distance and quality of life (P<0.05).The scores in WOMAC, SF-36 in Chinese version are significantly improved in treatment and placebo group after 2 and 4 weeks of treatment. (P<0.05) The score in 6-minute walk is significantly improved in treatment and placebo group after 4 weeks of treatment. Treatment group significantly improved scores in WOMAC and 6-minute walk compared with placebo. (P<0.05)After two courses of treatment, the response rate of treatment group is 93.3%. Among the 30 patients,9 were clinically and basically recovered, 12 had obvious effect,7 had fair effect and 2 had no response. The response rate of controlled group is 86.6%. Among the 30 patients,2 were clinically and basically recovered,10 had obvious effect,14 had fair effect and 4 had no response. Warm needle moxibustion plus acupuncture is a more beneficial for knee OA treatment with acupuncture alone.No adverse effects happened in both groups during the research. Conclusion The clinical research shows that warm needle moxibustion plus acupuncture is more helpful for knee OA. The treatment is well tolerated and offers improved clinical symptoms, stiffness, function, walking distance and quality of life.更多还原