关节镜手术结合针刺治疗膝关节骨性关节炎的临床观察

发布时间：2018-06-05 16:14

本文选题：膝关节骨性关节炎(KOA) + 关节镜清理手术　；参考：《湖北中医药大学》2015年硕士论文

【摘要】：背景:膝关节骨性关节炎(knee osteoarthritis,KOA)是在世界上最常见的一种关节相关的疾病,是非常常见的关节炎方式和引发慢性关节残疾病变的第一重要的因素。又被称为退行性关节炎,肥大或者增生性关节炎,退行性骨关节疾病。临床特征是为关节软骨的被破坏,变性和骨质增生,而最主要的临床特点是关节的变形、疼痛、活动度降低和关节功能受到一定限制。在当今世界范围内,KOA对于我们人类的威胁正在与日俱增,有效的防治该疾病正在成为临床上各个学者和专家研究和重视的课题。在当前的临床治疗中,还没有发现对此症的特效治疗手段和方法,因此,进行试验和研究,使用中西医结合治疗的方法治疗该病,开拓一种治疗的新思路就有了尤为重要的临床意义。目的:经过试验的临床观察来相互比较单纯的膝关节镜清理手术(对照组)和中医针灸刺法结合膝关节镜清理术(治疗组)治疗KOA,评价和观察膝关节镜清理手术结合中医针灸刺法对于临床治疗KOA的疗效[1],从而延伸出对于治疗该病过程中使用中西医结合治疗的疗效肯定,也有利于继续推广中西医结合治疗在临床上的应用。方法:选取宜昌市一医院2013年8月一2014年2月骨科的门诊和住院患者,其中诊断为膝关节退化性骨性关节炎,符合实验病历纳入标准并且入选为实验对象的患者120例,其中男64例,女56例,年龄为38—76岁,平均59.42岁。病程最短10月,最长10年,平均4.50年,单膝发病48例,双膝发病72例。严格地按照收入和排除的具体相关标准,使用照随机的分组方法,分为2个组,一个组为治疗组,一个组为对照组,治疗组60例病人,对照组60例,治疗组为手术结合针灸针刺治疗,对照组为单纯手术治疗。经过相同疗程治疗后,进行随访和复查,并且记录观察指标,每组患者的评价标准都以JOA评分和VAS视觉评分为准。结果:1.在VAS视觉评分方面[2],治疗组治疗前后互相比较,有了明显的好转,对照组也有了明显的改善(两组p值都0.05),而治疗组的效果优于对照组的治疗效果(p0.05)。2.在JOA评分方面[3],两组治疗前后组内对比也都有了改善和好转,而治疗组的效果明显要好于对照组的治疗效果(p0.05)。结论:具体试验组比对照组的疼痛VAS评分上和膝关节功能分级上都有了显著的好转,这就一定程度上说明了关节镜清理手术后配合中医针灸治疗方法确实能够有效地减轻患者手术后的关节疼痛和肿胀,也能够使得患者在术后的恢复速度更快,表明了中医针灸疗法不仅可以巩固关节镜清理术的治疗效果,更可以和现代手术相辅相成,达到一加一大于二的加成效果,事半功倍。该临床实验把现代西方医学的手术治疗手段和祖国传统的特色治疗方法有效而充分的结合,使两个本风马牛不相及的治疗思想共同地发挥出作用,取二者之精华,双效共现,从而起到更加良好的的治疗效果。
[Abstract]:Background: knee osteoarthritis (KOA) is the most common joint related disease in the world. It is a very common form of arthritis and the first important factor in the cause of chronic joint disability. It is also known as degenerative arthritis, hypertrophic or proliferative arthritis, and degenerative osteoarthrosis. The main clinical features of articular cartilage are deformability, degeneration and hyperosteogeny, and the most important clinical features are joint deformation, pain, reduction of activity and joint function. In today's world, the threat of KOA to our human being is increasing, and effective prevention and control of the disease is becoming a clinical scholar and expert. In the current clinical treatment, no special therapeutic means and methods have been found in the current clinical treatment. Therefore, it is very important to use the method of combining traditional Chinese and Western medicine to treat the disease and to develop a new idea of treatment. Compared with pure knee arthroscopy (control group) and traditional Chinese medicine acupuncture and acupuncture combined with knee arthroscopy (treatment group) treatment of KOA, the curative effect of knee arthroscopy cleaning operation combined with traditional Chinese medicine acupuncture method for clinical treatment of KOA was evaluated and observed, and the curative effect of combination of traditional Chinese and Western medicine in the treatment of the disease was affirmed, and the curative effect was affirmed for the treatment of the disease during the treatment of the disease. It is also beneficial to continue to promote the clinical application of integrated traditional Chinese and Western medicine. Methods: the outpatient and hospitalized patients in Department of orthopedics, Yichang, August 2013 1, February 2014, were diagnosed as degenerative osteoarthritis of the knee joint. 120 patients were eligible for the experimental medical records and were selected as the subjects, including 64 males and 56 females. The age ranged from 38 to 76 years, with an average of 59.42 years. The shortest course of disease was October, the longest 10 years, an average of 4.50 years, 48 cases of single knee and 72 cases of double knee. According to the specific standards of income and exclusion, the treatment group was divided into 2 groups, one group was the treatment group, the other was the control group, the treatment group 60 patients, and the control group 60 cases, the treatment was treated. The group was treated with acupuncture and moxibustion with acupuncture, and the control group was treated with simple operation. After the same course of treatment, follow up and review, and record the observation index, the evaluation criteria of each group were based on JOA and VAS visual score. Results: 1. in the VAS visual score [2], the treatment group compared with each other before and after treatment. The control group also had a significant improvement (two groups of P values were 0.05), and the effect of the treatment group was better than that of the control group (P0.05).2. in the JOA score [3], the two groups before and after treatment were also improved and improved, and the treatment group was better than the treatment group (P0.05). Conclusion: the specific test group was compared with the control group. The pain VAS score of the group and the classification of the knee joint function have improved significantly. To a certain extent, it can be explained that the acupuncture treatment with traditional Chinese medicine after arthroscopy can effectively reduce the pain and swelling of the joint after the operation, and can also make the patient recover faster after the operation, indicating the traditional Chinese medicine needle. The moxibustion therapy can not only consolidate the therapeutic effect of arthroscopic debridement, but also complement the modern operation to achieve one plus one greater than two addition effect. The therapeutic ideas together play a role in taking the essence of the two, and achieving a better therapeutic effect.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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