【作者】 徐裕钦；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 目的：观察近部取穴、远道取穴和远近配穴法三种取穴方法针刺治疗膝骨关节炎的临床疗效。方法：根据诊断标准和纳入标准,共纳入患者67例,其中脱落6例,实际完成61例。近部取穴20例,远道取穴21例,远近配穴组20例。近部取穴组在病证或病变的局部或临近选取穴位,选取常用穴位犊鼻、膝眼、梁丘、血海。远道取穴组在离病变较远的部位,以膝关节以下的输穴为主选取穴位,选取足三阴三阳经的输穴：陷谷、太白、束骨、太溪、足临泣、太冲。远近配穴组同时选取病变局部及距离病变较远部位的穴位,即同时选取犊鼻、膝眼、梁丘、血海及陷谷、太白、束骨、太溪、足临泣、太冲。常规针刺后,加电针。治疗2疗程及4疗程后对15米行走时间、活动疼痛(VAS记分)、WOMAC评分(包括疼痛、僵硬及功能)指标进行观察,并根据WOMAC评分总分计算临床疗效,所有数据经统计学处理后,比较近部取穴、远道取穴和远近配穴组针刺治疗膝骨关节炎(KOA)的临床疗效差别。结果：通过对纳入研究的病例进行基线比较,三组患者的年龄分布、性别、发病部位、病程分布,以及治疗前病情轻重评分,X光分级,VAS评分,治疗前WOMAC评分比较后,无统计学差异(P>0.05),三者患者的基线及病情皆具有可比性。改善15米行走时间方面近部取穴、远道取穴及远近配穴在治疗2疗程后即可改善患者15米行走时间,远道取穴及远近配穴相比较近部取穴组改善程度更大。而治疗4个疗程后,三组在改善患者15米行走时间上差异不明显(P>0.05)。改善疼痛VAS评分方面近部取穴、远道取穴及远近配穴在治疗2疗程后即可改善。患者VAS评分,且远道取穴及远近配穴相比较近部取穴组改善程度更大。而治疗4个疗程后,三组在进一步改善患者VAS评分上较治疗2疗程后差异不明显(P>0.05)。WOMAC评分疼痛部分近部取穴、远道取穴、远近配穴在治疗2疗程后即可改善患者关节疼痛评分,治疗4疗程后,疼痛症状还可得到进一步改善。关节僵硬部分：近部取穴、远道取穴、远近配穴对患者关节僵硬改善不明显(P>0.05)。功能：治疗2疗程后,近部取穴、远道取穴、远近配穴组患者关节功能改善不明显,在治疗4疗程后近部取穴、远道取穴、远近配穴可明显改善患者关节功能,但组间差异不明显。临床疗效：根据患者WOMAC关节炎指数总分计算临床疗效。治疗2疗程后,近部取穴组总有效率为65%,远道取穴组为61.9%,远近配穴组为95%。治疗4疗程后,近部取穴组总有效率为85%,远道取穴组为95%,远近配穴组为95%。远近配穴组可以在治疗的早期即可达到较为理想的临床疗效,但是治疗4疗程后,近部取穴,远部取穴,远近配穴组疗效相当。结论：三种取穴方法对膝骨关节炎的关节僵硬改善疗效不明显；远道取穴及远近配穴法对患者15米行走时间、疼痛的改善方面起效较快,而对关节功能的改善治疗的时间则需延长至4个疗程,而三种取穴方法在治疗4疗程后,对疼痛,关节功能的改善方面,差异不明显。从临床疗效上来看,远道取穴和远近配穴组在治疗早期(2疗程)即有较好的临床疗效,而当治疗4疗程后,近部取穴、远道取穴及远近配穴法的临床疗效相当,差别不明显。更多还原

【Abstract】 ObjectiveTo observe the clinical efficacy in treating knee osteoarthritis respectively with local acupoints, remote acupoints and the combination of local and remote acupoints.MethodsAccording to the diagnostic criteria and inclusion criteria, a total number of67patients were chosen, with a loss of6cases. The actual number of patients who finished the treatment was61. Those Patients were randomly divided into Local acupoints Group (20cases), Remote apupoints Group(21cases) and Combination of Local and Remote acupoints group (Combination Group for short,20cases). For patients in the Local acupoints Group, acupoints such as Du Bi, Xi Yan, Liang Qiu, Xue Hai adjacent to the lesion knee were choosen. For patients in the Remote acupoints Group, acupoints belong to the Shu Points of Foot Yang Meridians such as Xian Gu, Tai Bai, Shu Gu, Tai Xi, Zu Linqi, Tai Chong were choosen. For Patients in the Combination Group, local and remote acpuoints used in the Local acupoints Group and Remote acupoints Groups were choosen. All acpupoints in this research use electroacupuncture after routine acupuncture. Data of each group including15meter’s walking time, movement pains (reflceted by VAS points) and WOMAC score (including pain, stiffness, and function parts) were collected and given statistical analysis so as to compare clinical effects of treating KOA with three different acupoint selection methods respectively.ResultsBaseline data of each group were compared, the age, sex, invasion site and patient’s condition were comparable.1. After2courses of treatment, the three groups all could increase15meter’s walking time, but the Remote Group and Combined Group were more effective.4courses later, there are no significant difference between the three groups in increasing15meter’s walking time.2.1. After2courses of treatment, the three groups all could decrease the VAS score, but the Remote Group and Combined Group were more effective.4courses later, there are no significant differences between the three groups in increasing VAS.3. Ater2treatment courses, the three groups could reduce the WOMAC (Pain part).4courses later score received further improve. Joint Stiffness part:the three groups have no significant effect on joint stiffness part. Function part:the three groups have no significant effect on joint function until4treatment courses were finished.4. The three goups’Clinical Efficacy comparision were based on the total score of WOMAC. The Remote acupoints Group and Combined acupoints Group have better clinical effect after2treatment courses while4courses later, they had no significant differences.ConelusionThe three groups have no significant influence on the joint stiffness of KOA patients. The Romote acupoints Group and Combined acupoints group has a better and quick effect on the15meters’walking time and pain while4treatment courses were needed in improving the function of knees. After4treatment course, there were no significant differences between the three groups in improving WOMAC.更多还原