毫火针配合运动疗法治疗膝骨关节炎的疗效观察

发布时间：2018-05-10 23:05

本文选题：膝骨性关节炎 + 毫火针疗法　；参考：《广州中医药大学》2017年硕士论文

【摘要】：本文从文献研究、理论探讨和临床试验三个方面对膝骨关节炎的中西医结合治疗进行了较为系统和深入的研究。论文的第一部分为前言。首先介绍其病理、临床表现、对患者的影响和发病率的增加,指出膝骨关节炎的治疗及预防保健的重要性。其次介绍了膝骨关节炎的早中后期的西医治疗办法及其不足以及针灸治疗膝骨关节炎的优点。然后介绍了针对膝骨关节炎的病因,采用火针疗法对膝骨关节炎患者有良好的止痛作用但对关节活动度的改善欠佳,并对能改善关节活动功能的运动疗法进行简要介绍,从而引出本文对火针与火针配合运动疗法对膝骨关节炎的疗效差异的研究目的和临床意义。论文的第二部分为文献研究和理论探讨。本文从祖国医学对膝骨关节炎的认识、病因病机和治疗方法及现代医学对膝骨关节炎的认识、流行病学特点、发病机制和治疗方法等进行了一系列探讨。从在祖国医学认为,膝骨性关节炎属于痹症的范畴,古代医学文献对痹症的论述颇多。指出病因涉及各个方面,包括外感和内伤;其病位在膝关节,病变则多数涉及肝、肾、脾脏;病属本虚标实;肝肾亏虚、气血虚弱是该病的病理基础,风寒湿邪是常见诱发因素,瘀血阻络是发病关键;根据其病机特点,治疗以补虚泻实为治则,温阳散寒、活血通络为治法。具体治疗方法又有中药、针刺疗法、电针、温针灸、针药结合、小针刀疗法、穴位注射法、火针疗法。在现代医学方面,先论述了膝骨关节炎的病理和临床表现、流行病学特点,指出病因与多种因素有关,可能的致病因素和发病机制有关节应力平衡失调、自由基的作用、免疫反应的作用和骨质疏松。治疗方法包括非药物治疗、药物治疗。运动疗法属于非药物疗法之一,包括肌肉锻炼、关节活动度锻炼、水中运动疗法等,是改善膝骨关节炎患者临床症状及关节功能的有效治疗方法。膝骨关节炎的疗法多样,其中火针疗法能有效减轻患者疼痛,运动疗法可以改善关节活动度,有效延缓膝骨关节炎的发作。论文第三部分通过运用火针疗法配合运动疗法来治疗膝骨关节炎,探讨其临床意义。目的:研究毫火针和运动疗法治疗膝骨关节炎的效果和安全性,并对比毫火针结合运动疗法对照单纯毫火针治疗是否可以更好的改善膝骨关节炎患者的临床症状和日常功能及活动能力,是否能更有效缓解患者疼痛,从而为临床上治疗膝骨关节炎提供一种更为有效、简便的治疗方案。方法:从根据研究方案,入选本研究的对象共60人,随机分为2组,对照组30人,观察组30人。对照组进行毫火针疗法,观察组进行毫火针配合运动疗法。两组患者取相同的主穴,即阿是穴、膝眼、梁丘、阳陵泉。根据不同证型加用相应穴位,即肾虚髓亏患者加用悬钟,瘀血阻络患者加用血海,阳虚寒凝患者加用足三里。观察组选取主穴和相应证型的配穴后实施火针疗法,点刺过程时间控制在0.5秒内,深约为0.2～0.5cm,点刺结束后快速以万花油外涂针孔,每星期治疗3次,每隔天治疗1次,4周治疗为一疗程。观察组每次火针疗法(与对照组同)完成后进行运动疗法,即先仰卧位直腿牵伸乆绳肌训练后俯卧位牵伸股四头肌训练,用药时间与对照组相同。1疗程结束后评定疗效。根据膝关节骨性关节炎治疗效果的判定标准JOA和直观模拟量表VAS对治疗前和治疗后情况进行分析,采用尼莫地平法作为疗效评定,并且通过统计学进行分析。结果:临床观察和统计学分析结果显示,二组患者治疗前后JOA和VAS评分比较,P0.01,说明两种治疗方法均有效;治疗后观察组临床改善率为0.76±0.24,明显高于对照组的0.62±0.17;安全性方面,观察组未见不良反应。结论:毫火针疗法和火针配合运动疗法对膝骨关节炎的治疗均有较好的疗效。相比之下,火针配合运动疗法疗效优于单纯的火针疗法。毫火针配合运动疗法在膝骨关节炎的治疗中能发挥其独特、综合、全面的优势,是一种安全微创、行之有效、值得推广的绿色健康疗法。
[Abstract]:This paper makes a systematic and in-depth study on the combination of traditional Chinese and Western medicine for knee osteoarthritis from three aspects of literature, theory and clinical trials. The first part of this paper is preface. First, it introduces its pathology, clinical manifestation, the effect of the patients and the increase of the incidence, and points out the treatment and preventive health care of the knee osteoarthritis. Secondly, it introduces the treatment of knee osteoarthritis in the early and middle and late stages of Western medicine and its shortcomings as well as the advantages of acupuncture and moxibustion for the treatment of knee osteoarthritis. Then it introduces the cause of the knee osteoarthritis, with a good analgesic effect on the patients with knee osteoarthritis with the use of fire needle therapy, but it is not better to improve the activity of the knee joint and to improve the effect. The movement therapy of the function of the joint activity is briefly introduced, which leads to the purpose and clinical significance of the study on the difference of the curative effect between the fire needle and the fire needle in combination with the motion therapy of the knee osteoarthritis. The second part of the paper is the literature study and the theoretical discussion. Modern medicine has made a series of discussions on the understanding, epidemiological characteristics, pathogenesis and treatment methods of knee osteoarthritis. From the Chinese medicine, the knee osteoarthritis belongs to the category of arthralgia, and the ancient medical literature deals with arthralgia. It points out that the etiology involves various aspects, including external and internal injuries; the disease is in the knee joint, Most of the diseases involve the liver, kidney and spleen; the disease belongs to the virtual standard, the deficiency of the liver and kidney, the weakness of Qi and blood is the pathological basis of the disease, the wind cold and damp evil is the common inducing factor, the blood stasis obstructing the collaterals is the key to the disease. Electroacupuncture, warm acupuncture, acupuncture and medicine combination, small needle knife therapy, acupoint injection, and fire needle therapy. In modern medicine, the pathological and clinical manifestations and epidemiological characteristics of knee osteoarthritis are discussed first. The etiology is related to a variety of factors, possible pathogenic factors and the pathogenesis of joint stress imbalance, free radical effect and immune response. The effects and osteoporosis. The treatment includes non drug therapy and drug therapy. Exercise therapy belongs to one of the non drug therapies, including muscle exercise, joint activity exercise, and water exercise therapy. It is an effective treatment method to improve the clinical symptoms and joint function of patients with knee osteoarthritis. The treatment can effectively relieve the pain of the patients. Exercise therapy can improve the degree of joint activity and effectively delay the attack of knee osteoarthritis. In the third part, the clinical significance of the treatment of knee osteoarthritis is discussed by using fire needle therapy and exercise therapy. Objective: To study the effect and safety of the millefire needle and the transport therapy for the treatment of knee osteoarthritis. Compared with the milli needle combined with exercise therapy, it can better improve the clinical symptoms, daily function and activity ability of the patients with knee osteoarthritis and whether it can more effectively relieve the pain of the patients, thus providing a more effective and simple treatment for the clinical treatment of knee osteoarthritis. A total of 60 subjects were selected and divided into 2 groups randomly, 30 in the control group and 30 in the observation group. The control group was treated with the milli fire needle therapy and the observation group was treated with the milli fire needle and exercise therapy. The same main points were taken in the two groups, that is, the acupoints, the knee, the beam hillock, and the Yang Ling spring. The root of the different syndrome types was added to the corresponding acupoints, that is, the kidney deficiency pulp loss patients plus suspension. The patients with blood stasis and collaterals were added to the blood sea, the patients with Yang deficiency and cold coagulation were added with Zusanli. The observation group selected the main points and the corresponding syndromes to carry out the fire needle therapy. The time of the pricking process was controlled in 0.5 seconds, about 0.2 to 0.5cm. After the prick, 3 times a week, 1 times a week, and 4 weeks for one treatment. In the observation group, the exercise therapy was carried out each time after the treatment was completed (with the control group), that is, the four head muscle training in the prone position after the supine straight leg was drafted by the straight leg, and the medication time was evaluated after the same.1 course of treatment with the control group. According to the criterion JOA of the treatment effect of osteoarthritis of the knee joint and the visual analogue scale VAS Analysis of the conditions before and after treatment, using nimodipine as the evaluation of curative effect, and through statistics analysis. Results: the results of clinical observation and statistical analysis showed that the scores of JOA and VAS before and after treatment in the two groups were compared, P0.01, indicating that the two treatments were all effective, and the clinical improvement rate of the observation group was 0.76 + 0.24 after treatment. It was significantly higher than that of the control group of 0.62 + 0.17, and the safety of the observation group had no adverse reaction. Conclusion: the treatment of knee osteoarthritis with the combination of fire needle therapy and fire needle combined with sports therapy has better effect on the treatment of knee osteoarthritis. By comparison, the effect of the fire needle combined with exercise therapy is better than the simple fire needle therapy. It is a safe, minimally invasive, effective, and green health therapy that is worthy of promotion.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684.3

【参考文献】