【作者】 薛莲；

【导师】 梁忠；

【作者基本信息】 湖北中医药大学 ， 中医学， 2011， 硕士

【摘要】 目的膝关节骨性关节炎属中医“痹证”、“骨痹”范畴,是中老年人群的常见病、多发病。现代医学认为,本病可分为原发性膝关节炎和继发性膝关节炎,前者病因尚未明确,可能与性别、年龄、职业、肥胖、免疫等因素相关；后者可继发于各种膝关节及其周围组织损伤。中医认为本病的发生是由于正虚感受风寒湿邪,闭阻经脉而成,治疗以祛邪扶正为主。西医对本病的治疗多只能缓解症状,不能改善关节功能。因此对比观察温针灸与西药双氯芬酸钠缓释片治疗膝关节骨性关节炎的综合临床疗效,以寻求一种简便有效、副作用小的治疗方法。方法参照美国风湿病协会对膝关节骨性关节炎的诊断标准及自拟的纳入标准和排除标准,选取60例膝关节骨性关节炎的患者,并将其随机分为两组,治疗组给予温针灸治疗,选取肾俞、梁丘、血海、犊鼻、内膝眼、曲泉、阴陵泉、阳陵泉、足三里、三阴交10穴,并于肾俞、内外膝眼、足三里及三阴交处针柄上插一小段艾条施灸；对照组给予口服双氯芬酸钠缓释片治疗。10天为一个疗程,3个疗程后对比观察疗效。依照中医疗效判定标准比较两组的有效率,并依照HSS评分标准,从疼痛、行走、活动度、肌力、屈曲畸形、稳定性6个方面对患者治疗前后进行综合评分,并重点观察对疼痛、功能及屈曲畸形的评分。将其分为四级：大于80分为优,70～79分为良,60～69分为中,小于59分为差,比较治疗前后各积分段的人数变化。结果1.两组患者经治疗后疼痛评分均升高(P<0.05),组间比较无显著性差异(P>0.05)。2.两组患者治疗后关节功能评分治疗组明显升高(P<0.05),对照组无明显改变(P>0.05),组间比较差异有统计学意义(P<0.05)。3.两组患者治疗后关节屈曲畸形评分治疗组明显升高(P<0.05),对照组无明显改变(P>0.05),组间比较差异有统计学意义(P<0.05)。4.两组患者治疗后综合评分优、良级均升高,组间比较差异有统计学意义(P<0.05)。5.两组患者经治疗后,治疗组显效率及总有效率均高于对照组,疗效比较差异有统计学意义(P<0.05)。结论两种疗法治疗膝关节骨性关节炎在止痛方面效果相似,但温针灸组在改善患膝功能及关节畸形方面优于口服双氯芬酸钠缓释片组,即温针灸组在综合评分方面的疗效明显优于口服药组。且温针灸组的显效率及总有效率均明显高于对照组。温针灸不仅能缓解疼痛,还能改善患肢功能,提高患者生活质量。更多还原

【Abstract】 ObjectiveKnee osteoarthritis,called "Arthralgia" by traditional Chinese medicine, is one of the common diseases happened to elderly population. In modern medicine, the knee osteoarthritis can be divided into primary and secondary knee osteoarthritis. The cause of the former is not yet clear, but we suspect it maybe related to gender, age, occupation, obesity, immune and other factors. The latter can secondary to the trauma of types of knee joint and surrounding tissue. In traditional chinese medicine, the incidence of this disease is due to evil influence, including wind, cold and dampness,which attacked the body and closed meridians. The treatment of knee osteoarthritis according to the theory of western medicine that can only alleviate the symptoms, but not improve the function of joint. Therefore, we designed this study to contrast the differences of the integrated clinical composite efficacy between the group treated by acupuncture with moxibustion and by taking diclofenac sodium sustained-release tablets. MethodsReference to the American Rheumatism Association for the diagnosis of osteoarthritis of the knee and self-prepared standards on bringed in and excluded,60 patients with osteoarthritis of the knee were divided into two groups randomly. One of the group was treated by acupuncture with moxibustion, selecting the acupuncture points including shen shu, liang qiu, xue hai, nei xiyan,wai xiyan, qu quan, yin lingquan, yang lingquan, zu sanli, san yinjiao,and inserting a short moxa on the of needle handle at shen shu,nei xiyan, wai xiyan, zu sanli, san yinjiao. The other group was treated by taking diclofenac sodium sustained-release tablets,10 days as a course of treatment, and than contrasting the effects after 3 courses. Accordancing to the standard of HSS,we comprehensive reviews of patients through the pain, walking, mobility, muscle strength, flexion deformity and stability, The patients will be divided into four levels:Excellent (greater than 80), good(70 to 79), common(60 to 69) and poor (less than 59). We can conclude the rerult by constrasting the difference integral between before and after treatment, and the levels of rate of change.Results1. After treatment, there were obviously increased in score of pain between the two groups (P<0.05). And there were no significantly differences between the two groups (P< 0.05).2. After treatment, there were obviously increased in score of Joint function in treatment group(P< 0.05), but no significient change in the control group(P> 0.05).There were statistical differences between the two groups (P<0.05). 3. After treatment, there were obviously increased in score of flexion deformity in treatment group,but no significient change in the control group(P>0.05). There were statistical differences between the two groups (P<0.05).4. After treatment, there were increased in score of Comprehensive evaluation among the two groups. And the score of treatment group was significantly higher than the control group (P<0.05).5. After treatment, the treatment group was significantly higher than the control group on the effective rate and total rate.ConclusionTwo treatments for knee osteoarthritis are effective, and are similar in relieving the pain. but rhe group treated by acupuncture with moxibustion is superior to the group treated by painkiller in improving the function of the sick knee and deformity joint. The group treated by acupuncture with moxibustion is significantly better than the group treated by painkiller In terms of comprehensive evaluation. Acupuncture with Moxibustion can not only ease the pain, but also improve limb function and improve quality of life.更多还原