【作者】 易志勇；

【导师】 韩清民；

【作者基本信息】 广州中医药大学 ， 中医骨伤科学， 2010， 硕士

【摘要】 目的：以膝骨关节炎患者为研究对象,采用病例对照的临床研究方法,严格质量控制,对诊断对象的纳入标准,排除标准及疗效标准等进行严格规范,采用以中药巴布贴为主,辅以药物内服等的综合治疗方案,评价其有效性、安全性,并系统整理膝骨关节炎经筋贴敷方法。应用经筋理论来指导膝关节骨关节炎的巴布剂贴敷疗法,以确定经筋贴敷疗法的方法。方法：本研究于2009年2月-2010年2月期间对广州中医药大学附属骨伤科医院门诊和住院的膝骨关节炎患者进行调查,从115例膝关节骨关节炎患者中,按照骨关节炎诊治指南(2007年版)膝关节OA的诊断标准和经筋辨证理论,选取90例足阳明经筋KOA患者,应用经筋贴敷疗法。以膝骨关节炎经筋辨证理论为指导,给予巴布贴外敷,又随机分为3小组,分别按经筋贴敷表贴1,2,3块药膏。使用WOMAC功能评估,每星期测定一次,连续观察一个月,1月后总结1次功能状况。本次临床观察的足阳明经筋病变组,参照国家卫生部发布的《中药新药临床研究指导原则》,采用SPSS11.5软件建立数据库,并运用方差分析及秩和检验。通过临床观察,分析这种最常见经筋病变在经筋理论指导下的贴敷疗效,以求初步归纳常见经筋病变的贴敷方法,为下一步研究提供依据。结果：本次调查共获得有效资料115份,其中足阳明经筋型膝骨关节炎病人90例,其中4例因皮肤过敏合而不能完成临床观察。分析结果如下：1.治疗4周后WOMAC评分A、B、C三组组均较治疗前显著降低,B组和C组有效率数高于A组,组间比较,差异有显著意义(P＜0.01)；2.A、B、C三组治疗前疼痛评分、僵直评分、活动难度评分和总评分,经过方差分析,P>0.05,无明显差异性,具有可比性。A、B、C三组治疗后疼痛评分、活动难度评分和总评分,经过方差分析,P<0.01,提示有显著差别；僵直评分治疗后评分对比,P>0.05,提示无差别。3.足阳明经筋在膝部广布髌骨周围,我们在临床上发现的,很多KOA患者前期表现多以髌股关节的病变为主,主要表现为膝前方髌骨周围和膝关节内侧疼痛。结论：本研究调查了90例足阳明经筋痹症KOA患者应用经筋理论贴敷疗法,得出如下结论：1.膝骨关节炎患者存在足阳明经筋、足太阳经筋、足少阳经筋、足三阴经筋四种单一经筋证型和多种复合证型,在上述所有经筋病变中,足阳明经筋病变最广,故我们重点针对该经筋进行临床观察和治疗；2.在临床实践中,我们运用经筋辨证指导运用中药巴布贴外治膝骨关节炎,除了根据“以痛为腧”行痛点外敷,还在根据其经筋传变规律,在其传变经筋的循行部位再贴一、二贴药膏,以阻止其传变。根据这种方法,我们在临床运用时取得了不错的疗效。相比单一按照痛点外敷疗法有其优越性,疗效更加明确,尤其在缓解膝关节疼痛和功能活动方面。3.鉴于本次研究的病例数有限,而且病程长、病情重的患膝多为几条经筋联合病变,分析起来很复杂,为使问题简化,提高研究的可行性,故选取本次辨证中最常见的足阳明经筋病变进行临床观察,初步归纳足阳明经筋病变的疼痛和病灶主要是膝前方髌骨周围和膝关节内侧为主,但是仍需要长期的临床观察及科学的多中心临床实验研究,才能系统地建立完整的经筋辨证体系。更多还原

【Abstract】 Objective:Patients with knee osteoarthritis study, using case-control clinical research methods, strict quality control, the object of the inclusion criteria for diagnosis, exclusion criteria and efficacy standards strictly regulate, adopt the practice of Chinese medicine Babu posted mainly supported by, acupuncture, medicine Oral and other comprehensive treatment program, evaluate its effectiveness, safety, and the system order by the tendons of knee osteoarthritis sticking method. Application of theory to guide the knee joint by tendons osteoarthritis Babu sticking therapy to determine the method of treatment by the tendons sticking.Methods:In this study, in February 2009-February 2010 during the Traditional Chinese Medicine University Affiliated Orthopaedic Hospital outpatient and hospitalization in patients with knee osteoarthritis to investigate, from 115 cases of patients with knee osteoarthritis, according to osteoarthritis Treatment Guidelines (2007 edition) diagnostic criteria for knee OA and dialectical theory by the tendons, selected 90 patients with KOA Meridian tendons were applied by the tendons sticking therapy. With osteoarthritis of the knee by tendons syndrome theory as a guide, Babu affixed to external application, then randomly divided into 3 groups, respectively, by the tendons sticking by SMD 1,2,3 block cream. Assessed using the WOMAC function, tested once a week, continuous observation of one month, January 1, after summing up functional status. The clinical observation of the Stomach Meridian tendon lesion group, according to the national Ministry of Health issued the "Guidelines for clinical research new Chinese medicine,& quot; SPSS11.5 software used to establish a database, and using analysis of variance and rank sum test. In the third section, through clinical observation, analysis of this most common disease in the meridians by the tendons under the guidance of sticking effects, in order to summarize common initial lesion by the tendons sticking method, provide a basis for further study.Results:The survey obtained 115 valid data, which Meridian is osteoarthritis of the knee tendons were 90 cases of illness,4 cases of skin allergies and can not complete the clinical observation combined. The results are as follows:1. After 4 weeks, WOMAC score A, B, C three groups were significantly lower than before treatment, B group and C group was higher than the number of group A, group, the difference was significant (P<0.01);2. A, B, C three groups before treatment, pain score, stiffness score, activity score and total score of difficulty, after analysis of variance, P>0.05, no significant differences, comparable. A, B, C three groups after treatment, pain score, activity score and total score of difficulty, after analysis of variance, P<0.01, suggest a significant difference; stiffness score score after treatment comparison, P>0.05, suggest no difference.3. Stomach Meridian widespread patellar tendons around the knee, we found clinically that many patients with early manifestations of KOA to the main patellofemoral lesions, mainly around the knee in front of the patella and the medial painConclusion:This study investigated 90 cases of polio KOA Meridian tendon meridians sticking patients with therapy, the following conclusions:1. Patients with knee osteoarthritis Meridian bar, full sun by the tendons, Foot Shaoyang meridians, the four feet of Yin Meridian tendon tendon syndrome after single and multiple complex syndrome, in all these meridians lesions, tendon lesions Meridian most extensive, so we were focusing on the meridians of clinical observation and treatment;2. In clinical practice, we guide the use of dialectical meridians of Chinese medicine Babu posted outside the rule of knee osteoarthritis, In addition under the’pain as the Meridian’line topical pain points, Also changed according to the law by the tendon transfer, changes in its transmission line through parts of paste through the tendons of one or two creams to prevent the trans-mission change. Under this approach, we have made in the clinical use of a good time effect. According to pain compared to a single point of topical therapy has its advantages, effects more clearly, especially in the relief of knee pain and functional activities. 3. Given the number of cases in this study is limited, and the long course, the condition of heavy knees after a few more bars for the joint disease, analysis of them is very complex, in order to simplify the problem and improve the feasibility study, so select this syndrome The most common tendon lesions Meridian clinical observation, the initial induction Meridian tendon lesions of knee pain and lesions mainly around the front of the patella and medial-based, but still require long-term clinical observation and scientific multi-center clinical trials research, to systematically build a complete system of mer-idians syndrome.更多还原