体外冲击波疗法配合展筋活血膝痹方外敷治疗膝关节骨性关节炎的临床研究
发布时间：2019-05-18 12:25
【摘要】：目的:观察体外冲击波疗法配合展筋活血膝痹方外敷治疗膝关节骨性关节炎的临床疗效,并初步探讨展筋活血膝痹方外敷在治疗膝关节骨性关节炎中的作用机理。方法:将符合《中华人民共和国中医药行业标准·中医病症诊断疗效标准·膝关节骨性关节炎》的80例门诊及住院病人通过随机数字表法分为两组,每组40例,分别为治疗组:体外冲击波疗法配合展筋活血膝痹方外敷治疗组;对照组:玻璃酸钠配合展筋活血膝痹方外敷治疗组,治疗组,男性13例,女性27例,58膝,平均年龄(?x±s下同)67.0±5.1岁;对照组,男性16例,女性24例,49膝。平均年龄66.0±4.8岁。两组患者的一般情况无统计学差别。两组患者均先对疼痛的膝关节进行外敷展筋活血膝痹方:伸筋草30g透骨草30g土鳖虫15g红花10g鸡血藤60g生麻黄15g急性子9g威灵仙60g汉防己15g续断20g木瓜20g独活9g桂枝10g艾叶15g路路通15g白芷15g青风藤25g海桐皮30g络石藤15g川芎30g,以上中药研粉,并用黄酒、陈醋按1:3调敷于患处,用TDP治疗仪照射30分钟,外敷治疗治疗结束后30分钟,治疗组患者在膝关节周围痛点进行定位,并在痛点及周围予以冲击波治疗;对照组患者予以患膝玻璃酸钠注射液灌注治疗。展筋活血膝痹方外敷每日1次,20天为一疗程;冲击波治疗每间隔3天1次,5次为一疗程;玻璃酸钠注射液灌注治疗,每关节1支(2ml),1周灌注1次,5次为1疗程,严格无菌操作。观察指标包括反映患者疼痛程度的VAS评分,反映患者疗效持续的时间t(单位:周),反映患者膝关节骨性关节炎症状的体征积分。以症状、体征积分表为依据将两组患者治疗前进行分级:轻度患者积分小于10分;中度患者积分大于等于10分小于20分;重度患者积分在20分及以上。分别统计两组患者治疗前后的VAS评分、症状体征积分及疗效持续时间,将两组患者所得数据进行统计学分析,VAS评分、症状体征积分按轻重等级进行组间和组内比较,疗效持续时间按轻重等级进行组间比较。结果:1两组患者治疗前VAS评分无明显差异,无统计学意义(P0.05);治疗组:组内轻、中度患者治疗前、后比较,VAS评分明显下降,数据变化有统计学意义(P0.05),重度患者治疗前、后比较,VAS评分下降,数据变化无统计学意义(P0.05);对照组:组内轻、中度患者治疗前、后比较,VAS评分下降,数据变化有统计学意义(P0.05),重度患者治疗前、后比较,VAS评分无明显变化,数据变化无统计学意义(P0.05);两组患者中的轻、中度患者治疗后的VAS评分比较具有显著差异,有统计学意义(P0.05),两组患者中的重度患者治疗后的VAS评分比较无显著差异,无统计学意义(P0.05)。2两组患者治疗前症状、体征积分无明显差异,无统计学意义(P0.05);治疗组:组内轻、中度患者治疗前、后比较,症状、体征积分明显下降,数据变化有统计学意义(P0.05),重度患者治疗前、后比较,症状、体征积分下降,数据变化有统计学意义(P0.05);对照组:组内轻、中度患者治疗前、后比较,症状、体征积分下降,数据变化有统计学意义(P0.05),重度患者治疗前、后比较,症状、体征积分有变化,数据变化有统计学意义(P0.05);两组患者中的轻、中度患者治疗后的症状、体征积分比较具有显著差异,有统计学意义(P0.05),两组患者中的重度患者治疗后的症状、体征积分比较无显著差异,无统计学意义(P0.05)。3对两组患者进行最长为期52周的随访,结果治疗组中轻、中、重度患者的疗效持续时间较对照组中的轻、中、重度患者有明显差异,数据有统计学意义(P0.05)。结论:1从缓解患者疼痛方面,体外冲击波疗法配合展筋活血膝痹方外敷对于轻、中度患者的疗效明显优于关节腔玻璃酸钠灌注配合展筋活血膝痹方外敷疗法,且前者在缓解疼痛速度方面明显快于后者。2从缓解患者症状、体征方面,体外冲击波疗法配合展筋活血膝痹方外敷对于轻、中度患者的疗效明显优于关节腔玻璃酸钠灌注配合展筋活血膝痹方外敷疗法,且体外冲击波疗法配合展筋活血膝痹方外敷对症状、体征的缓解更为彻底。3体外冲击波疗法配合展筋活血膝痹方外敷在疗效持续时间上明显优于玻璃酸钠灌注配合展筋活血膝痹方外敷疗法。4两种方法对重度膝关节骨性关节炎患者疗效不佳。
[Abstract]:Objective: To observe the clinical effect of external application on the treatment of knee osteoarthritis with the combination of extracorporeal shock wave therapy and the external application of Huoxue Huoxue, and to explore the mechanism of the external application in the treatment of knee osteoarthritis. Methods:80 out-patient and in-patient patients, which meet the criteria of the Chinese medicine industry standard of the People's Republic of China, in the diagnosis and treatment of knee osteoarthritis, were divided into two groups by a random digital method, and 40 cases in each group were treated as treatment group: In-vitro shock wave therapy combined with the external application treatment group of Huoxue Huoxue, the control group: the treatment group, the treatment group, the male 13 cases, the female 27 cases, the 58 knee, the average age (?) in the treatment group, the treatment group, the male 13 cases, the female 27 cases, the 58 knees and the average age (? X (s) 67.0-5.1 years; control group, male 16 cases, female 24 cases,49 knee. The mean age was 66.0 to 4.8 years. There was no statistical difference between the two groups. In the two groups, the knee joint of the pain is externally applied with the external application and the blood-activating and blood-promoting knee joint is applied to the knee joint. 15 g of Chinese ephedra,15 g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of radix angelicae pubescentis, 15g of radix angelicae pubescentis, 15g of radix angelicae pubescentis, 15g of argyi leaf, 15g of argyi leaf, 15g of radix angelicae pubescentis, 15g of argyi leaf, 15g of Chinese angelica root, 15g of Chinese medicine powder and 15g of Chinese medicinal powder, and is mixed with yellow wine, Chen Vinegar was applied to the affected part according to 1:3. The treatment group was treated with TDP treatment instrument for 30 minutes. The treatment group was treated with the pain point around the knee joint for 30 minutes after the treatment. The patients in the treatment group were treated with shock wave at the pain point and around the knee. The control group was treated with sodium hyaluronate injection. The external application of the Huoxue Huoxue Geng Decoction was once daily and 20 days as a course of treatment. The shock wave was treated for 3 days every 3 days and 5 times as a course of treatment. The sodium hyaluronate injection was treated with 1 branch (2 ml) for 1 week,5 times as a course of treatment and strict aseptic operation. The observations included a VAS score that reflects the degree of pain in the patient, a time t (unit: week) that reflects the duration of the patient's efficacy, and a sign integral that reflects the patient's knee osteoarthritis symptoms. The two groups of patients were graded according to the symptoms and the sign integral table: the score of mild patients was less than 10; the integral of the moderate patients was greater than or equal to 10, and the score was less than 20; and the integral of the severe patients was 20 minutes and above. The VAS scores, the symptoms and sign points and the duration of the treatment before and after the treatment of the two groups of patients were respectively counted, and the data obtained in the two groups were statistically analyzed, the VAS score and the symptom and sign points were compared between the groups and the group according to the severity grade, The duration of the efficacy was compared between groups according to the severity level. Results: There was no significant difference between the two groups before and after the treatment (P0.05); the treatment group: before and after the treatment of mild and moderate patients, the VAS score decreased significantly, the data change was statistically significant (P0.05), and the VAS score decreased after the treatment before and after the treatment of severe patients. There was no statistical significance in the data change (P0.05); the control group: before and after the treatment of mild and moderate patients in the group, the VAS score decreased, the data change was statistically significant (P0.05), and the change of the VAS score was not significantly changed before and after the treatment of the severe patients (P0.05); The VAS scores in the two groups were significantly different from those of the two groups (P0.05). There was no significant difference in the sign integral (P0.05); the treatment group: the group was mild in group, the group was mild in group, the score of the symptom and the sign of the group was significantly decreased, the data change was statistically significant (P0.05), and the scores of the patients before, after and after the treatment of the severe patients were lower, and the integral of the signs decreased. There was a significant difference in data change (P0.05); the control group: before and after the treatment of mild and moderate patients in the group, the scores of the symptoms, the signs and the change of the data were statistically significant (P0.05). There was a significant difference in the data of the two groups (P0.05). There was no significant difference in the symptoms and signs of the patients with severe and moderate in the two groups (P0.05). There was no significant difference between the two groups (P0.05). Conclusion:1 From the aspect of relieving the pain of the patient, the external application of the extracorporeal shock wave therapy combined with the expansion of the tendon and the blood-activating knee is better than that of the joint-cavity sodium hyaluronate infusion and the blood-activating and blood-activating-knee-type external application therapy for the patients with mild and moderate. in addition, in that aspect of relieve the symptom and the sign of the patient, the external application of the in-vitro shock wave therapy in combination with the expansion of the tendon and the blood-activating geniculate is obviously superior to the external application therapy of the joint-cavity sodium hyaluronate infusion and the blood-activating and blood-activating, in addition, in-vitro shock wave therapy is matched with that external application of the tendon-promoting blood-activating and blood-promoting geniculate to treat 3. In-vitro shock wave therapy combined with the external application of Huoxue Huoxue and Huoxue Huoxue Decoction is better than that of sodium hyaluronate in the duration of the treatment, and the effect of two methods on the patients with severe knee osteoarthritis is not good.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684.3
[Abstract]:Objective: To observe the clinical effect of external application on the treatment of knee osteoarthritis with the combination of extracorporeal shock wave therapy and the external application of Huoxue Huoxue, and to explore the mechanism of the external application in the treatment of knee osteoarthritis. Methods:80 out-patient and in-patient patients, which meet the criteria of the Chinese medicine industry standard of the People's Republic of China, in the diagnosis and treatment of knee osteoarthritis, were divided into two groups by a random digital method, and 40 cases in each group were treated as treatment group: In-vitro shock wave therapy combined with the external application treatment group of Huoxue Huoxue, the control group: the treatment group, the treatment group, the male 13 cases, the female 27 cases, the 58 knee, the average age (?) in the treatment group, the treatment group, the male 13 cases, the female 27 cases, the 58 knees and the average age (? X (s) 67.0-5.1 years; control group, male 16 cases, female 24 cases,49 knee. The mean age was 66.0 to 4.8 years. There was no statistical difference between the two groups. In the two groups, the knee joint of the pain is externally applied with the external application and the blood-activating and blood-promoting knee joint is applied to the knee joint. 15 g of Chinese ephedra,15 g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of Chinese ephedra, 15g of radix angelicae pubescentis, 15g of radix angelicae pubescentis, 15g of radix angelicae pubescentis, 15g of argyi leaf, 15g of argyi leaf, 15g of radix angelicae pubescentis, 15g of argyi leaf, 15g of Chinese angelica root, 15g of Chinese medicine powder and 15g of Chinese medicinal powder, and is mixed with yellow wine, Chen Vinegar was applied to the affected part according to 1:3. The treatment group was treated with TDP treatment instrument for 30 minutes. The treatment group was treated with the pain point around the knee joint for 30 minutes after the treatment. The patients in the treatment group were treated with shock wave at the pain point and around the knee. The control group was treated with sodium hyaluronate injection. The external application of the Huoxue Huoxue Geng Decoction was once daily and 20 days as a course of treatment. The shock wave was treated for 3 days every 3 days and 5 times as a course of treatment. The sodium hyaluronate injection was treated with 1 branch (2 ml) for 1 week,5 times as a course of treatment and strict aseptic operation. The observations included a VAS score that reflects the degree of pain in the patient, a time t (unit: week) that reflects the duration of the patient's efficacy, and a sign integral that reflects the patient's knee osteoarthritis symptoms. The two groups of patients were graded according to the symptoms and the sign integral table: the score of mild patients was less than 10; the integral of the moderate patients was greater than or equal to 10, and the score was less than 20; and the integral of the severe patients was 20 minutes and above. The VAS scores, the symptoms and sign points and the duration of the treatment before and after the treatment of the two groups of patients were respectively counted, and the data obtained in the two groups were statistically analyzed, the VAS score and the symptom and sign points were compared between the groups and the group according to the severity grade, The duration of the efficacy was compared between groups according to the severity level. Results: There was no significant difference between the two groups before and after the treatment (P0.05); the treatment group: before and after the treatment of mild and moderate patients, the VAS score decreased significantly, the data change was statistically significant (P0.05), and the VAS score decreased after the treatment before and after the treatment of severe patients. There was no statistical significance in the data change (P0.05); the control group: before and after the treatment of mild and moderate patients in the group, the VAS score decreased, the data change was statistically significant (P0.05), and the change of the VAS score was not significantly changed before and after the treatment of the severe patients (P0.05); The VAS scores in the two groups were significantly different from those of the two groups (P0.05). There was no significant difference in the sign integral (P0.05); the treatment group: the group was mild in group, the group was mild in group, the score of the symptom and the sign of the group was significantly decreased, the data change was statistically significant (P0.05), and the scores of the patients before, after and after the treatment of the severe patients were lower, and the integral of the signs decreased. There was a significant difference in data change (P0.05); the control group: before and after the treatment of mild and moderate patients in the group, the scores of the symptoms, the signs and the change of the data were statistically significant (P0.05). There was a significant difference in the data of the two groups (P0.05). There was no significant difference in the symptoms and signs of the patients with severe and moderate in the two groups (P0.05). There was no significant difference between the two groups (P0.05). Conclusion:1 From the aspect of relieving the pain of the patient, the external application of the extracorporeal shock wave therapy combined with the expansion of the tendon and the blood-activating knee is better than that of the joint-cavity sodium hyaluronate infusion and the blood-activating and blood-activating-knee-type external application therapy for the patients with mild and moderate. in addition, in that aspect of relieve the symptom and the sign of the patient, the external application of the in-vitro shock wave therapy in combination with the expansion of the tendon and the blood-activating geniculate is obviously superior to the external application therapy of the joint-cavity sodium hyaluronate infusion and the blood-activating and blood-activating, in addition, in-vitro shock wave therapy is matched with that external application of the tendon-promoting blood-activating and blood-promoting geniculate to treat 3. In-vitro shock wave therapy combined with the external application of Huoxue Huoxue and Huoxue Huoxue Decoction is better than that of sodium hyaluronate in the duration of the treatment, and the effect of two methods on the patients with severe knee osteoarthritis is not good.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684.3
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