中医综合疗法配合关节镜清理术治疗中度膝关节骨关节炎

发布时间：2018-06-18 09:52

本文选题：关节镜清理术 + 玻璃酸钠　；参考：《湖北中医药大学》2015年硕士论文

【摘要】：研究目的:本课题通过回顾性分析研究关节镜清理术加玻璃酸钠注射配合膝关节功能锻炼联合中医中药治疗中度膝关节骨关节炎,探讨综合法综合治疗中度膝关节炎的作用机理,寻求一种治疗中度膝关节骨关节炎的确实有效、经济实用、易于临床应用和推广的方法。研究方法:本研究病例均是选自2012年12月-2014年12月期间湖北省中医院住院部骨伤科陈建锋主任医师收治的中度膝关节炎患者。根据疾病诊断标准、纳入标准以及排除标准,选取其中的90例患者为分析研究对象,根据治疗方法的不同,将其分为对照组A、对照组B和治疗组C三组,每组各30例,病例研究对象为单侧膝关节,若患者为双膝关节炎,则选取临床表现相比较重的一侧。所有病例患者入院均行系统的体格检查和术前检查,行膝关节清理术治疗,术后指导其进行患膝功能锻炼。对照组A的治疗方法是入院单纯应用膝关节镜清理术治疗,术后在医师指导下配合膝关节功能锻炼。对照组B是在对照组A的方法上增加玻璃酸钠关节腔内注射治疗。治疗组C是在对照组B的基础上增加系统的中医中药辨证用药进行治疗。观察三组患者治疗前和治疗后患膝疼痛和关节活动障碍症状的改善情况,应用膝关节Lysholm评分系统对治疗前后的膝关节功能做出评价。研究结果:治疗结束后,根据随访结果,观察、整理数据,使用SPSS16.0软件进行统计学分析。1、三组患者在治疗前(入院时)膝关节Lysholm评分比较:三组相比,P值0.05,无统计学意义,具有可比性。2、三组患者在治疗后(最后一次随访)膝关节Lysholm评分比较(1)A、B两组对比,P=0.0350.05,有显著统计学差异,表明两个对照组的方法治疗中度膝关节骨关节炎效果明显,并且对照组B的治疗效果要优于对照组A;(2)A、C两组对比,P=0.0260.05,有显著统计学差异,表明治疗组的方法治疗中度膝关节骨关节炎效果显著,且其治疗效果优于对照组A;(3)B、C两组对比,P=0.040.05,有显著统计学差异,表明治疗组C治疗效果要优于对照组B。研究结论:上述治疗方法在临床上均可用于中度膝关节骨关节炎的治疗,而以关节镜清理术加玻璃酸钠注射配合中医中药辨证施治三种方法联合的治疗组,对中度膝关节炎临床症状的治疗,其效果明显优于单纯的关节镜清理术和关节镜清理术加玻璃酸钠注射治疗。此三联法治疗中度膝关节骨关节炎,近期疗效确切,相比较于人工膝关节表面置换术具有安全、费用低、疗程短、易于患者接受的优势,值得在临床上推广。在临床工作中可以根据不同的患者病情差异进行应用,三种方法配合治疗,以达到预期的治疗效果。
[Abstract]:Objective: to study retrospectively the treatment of moderate knee osteoarthritis by arthroscopic debridement, sodium hyaluronate injection and knee joint functional exercise combined with traditional Chinese medicine. To explore the mechanism of comprehensive treatment of moderate knee osteoarthritis and to seek a practical and effective method for the treatment of moderate knee osteoarthritis, which is easy to be applied and popularized in clinic. Methods: all cases were selected from the patients with moderate knee arthritis admitted from December 2012 to December 2014 in the Department of Orthopaedics and Trauma, Department of Orthopedics and Trauma, Hubei Provincial Hospital of traditional Chinese Medicine. According to the diagnostic criteria, inclusion criteria and exclusion criteria, 90 patients were selected as the study objects. According to the different treatment methods, the patients were divided into three groups: control group A, control group B and treatment group C, with 30 cases in each group. Case study object is unilateral knee joint, if the patient is bilateral knee arthritis, select the side with more severe clinical manifestation. All the patients underwent systemic physical examination and preoperative examination, knee joint debridement, and postoperative functional exercise of the affected knee. The treatment of control group A was treated by knee arthroscopy only, and combined with knee joint function exercise under the guidance of doctor. Control group B was treated with intraarticular injection of sodium hyaluronate. Treatment group C is based on the control group B to increase the system of traditional Chinese medicine syndrome differentiation drugs for treatment. To observe the improvement of knee pain and dyskinesia before and after treatment in three groups, and evaluate the knee joint function before and after treatment with Lysholm scoring system. Results: at the end of the treatment, according to the follow-up results, the data were analyzed by SPSS 16.0 software. The Lysholm score of knee joint in the three groups was compared before treatment (on admission): the P value of the three groups was 0.05, there was no significant difference between the three groups. The comparison of Lysholm score of knee joint after treatment (the last follow-up) showed that there was significant difference between two groups (P < 0.05), indicating that the treatment of moderate knee osteoarthritis in the two control groups was more effective than that in the control group. The therapeutic effect of the control group B was better than that of the control group (P < 0. 0260.05), indicating that the treatment of moderate knee osteoarthritis in the treatment group was more effective than that in the control group (P < 0. 0260.05). The therapeutic effect of the treatment group was better than that of the control group (P 0.040.05), which indicated that the effect of treatment group C was better than that of the control group (B). Conclusion: the above treatment methods can be used in the treatment of moderate knee osteoarthritis clinically, and the treatment group is treated with arthroscopic debridement and sodium hyaluronate injection combined with traditional Chinese medicine differentiation of symptoms and signs. The clinical symptoms of moderate knee arthritis were significantly better than those of arthroscopic debridement and arthroscopic debridement combined with sodium hyaluronate injection. The treatment of moderate knee osteoarthritis with this triple method is effective in the near future. Compared with artificial knee arthroplasty, it has the advantages of safety, low cost, short course of treatment and easy to be accepted by patients. It is worth popularizing in clinic. In clinical work, according to the different patients' condition, three methods can be used in combination to achieve the expected 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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