通络治痹汤加味辨证治疗膝骨关节炎疗效观察

发布时间：2018-02-20 06:25

本文关键词： 膝骨关节炎中西医结合通络治痹汤步态分析　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:跟随社会不断进步,人口老龄化问题的不断加深,膝骨关节炎(Kneeosteoarthritis,KOA)已有迅速增加趋势,随着患者年龄的增长以及病情的不断进展,患者多出现关节畸形,功能障碍,本病晚期致残率高,严重影响患者日常生活,对患者个体以致整个社会带来一定的压力。根据前期临床研究的结论,早期积极有效的治疗对于本病的干预有着着实可观的收获。因此,运用汤药对疾病进行早期安全灵活的干预,对治疗本病有着非常重要的意义。本研究旨在明确通络治痹汤加味联合局部注射玻璃酸钠治疗KOA的临床观察,进而探讨此一临床治疗方法,有望为病患提供更加安全有效的治疗措施。目的:通过对步态分析数据以及VAS疼痛视觉模拟评分和Lequesne指数评分的收集整理,临床观察经辨证后使用通络治痹汤加味治疗KOA的能效,通过真实客观的临床与实验评价体系,证实应用中医辨证论治体系治疗KOA的优势。方法:临床收集共120例符合条件病例,随机分为治疗组和对照组,两组数量各为60例。治疗组通过对患者辨证论治,予口服通络治痹汤加减方结合注射玻璃酸钠;对照组予藤黄健骨丸口服结合注射玻璃酸钠;治疗时间为5周。所有病例于治疗前后进行疼痛视觉模拟评分(VAS评分)、Lequesne膝关节骨性关节炎严重指数评分及步态分析,由此观察通络治痹汤加味辨证治疗KOA的临床疗效。结果:1.VAS评分显示,两组治疗后此项评分降低,P值0.01;且治疗组治疗后评分较对照组更低,P值0.01。说明治疗组所接受的治疗措施能够更为有效地缓解患者主观疼痛感。2.Lequesne评分显示,两组治疗后此项评分降低,P值0.01;且治疗组治疗后评分较对照组更低,P值0.01。说明治疗组能更加显著改善患者患膝功能,提高生活能力。3.步态参数结果显示,与治疗前比较,所检参数均有好转,P值0.01;且治疗组的步行能力、平衡能力的改善程度均较对照组高,P值0.05。因此治疗组更能够显著改善患者步行能力,间接表达出显著的治疗效果。结论:1.加味通络治痹汤结合玻璃酸钠治疗膝骨关节炎能明显改善病患膝骨关节炎局部的主观症状,并且能改善患者步行姿态。2.基于同时接受玻璃酸钠治疗的基础上,治疗组运用辨证施治后口服加味通络治痹汤的方法优于对照组诊断明确后单纯服用中成药藤黄健骨丸的治疗方法。
[Abstract]:Background: with the development of society and the aging of population, Kneeosteoarthritis (KOAA) of knee osteoarthritis has been increasing rapidly. With the age of patients and the progress of disease, patients often have joint deformity and dysfunction. The high rate of disability in the late stage of the disease seriously affects the daily life of the patients, exerts certain pressure on the individual patients and the whole society. According to the conclusion of the previous clinical research, Early active and effective treatment has had a substantial gain in the intervention of the disease. Therefore, early safe and flexible intervention on the disease with decoction and medicine, The purpose of this study was to make clear the clinical observation of Tongluo Zhibi decoction combined with local injection of sodium hyaluronate in the treatment of KOA. Objective: to collect gait analysis data, VAS pain visual analogue score and Lequesne index score. After clinical observation, the energy efficiency of treating KOA with Tongluo decoction was observed, and the advantages of treating KOA with TCM syndrome differentiation system were confirmed through real and objective clinical and experimental evaluation system. Methods: 120 cases of KOA were collected clinically. Treatment group and control group were randomly divided into two groups, 60 cases in each group. The treatment group was treated by syndrome differentiation, the treatment group was treated by oral Tongluo Zhibi decoction combined with injection of sodium hyaluronate, the control group was treated with Fuhuangjianggu pills and injection of sodium hyaluronate; The duration of treatment was 5 weeks. All the patients were evaluated with visual analogue pain score and VAS score, and Lequesne knee osteoarthritis severity index score and gait analysis before and after treatment. Therefore, the clinical effect of Tongluo treating Bi decoction on syndrome differentiation was observed. Results: 1. The score of VAS showed that. After treatment, the scores of the two groups decreased by 0.01, and the scores of the treatment group after treatment were lower than those of the control group. The results showed that the therapeutic measures accepted in the treatment group were more effective in alleviating the subjective pain of the patients. 2. The Lequesne score showed that the patients' subjective pain was alleviated more effectively in the treatment group than in the control group. After treatment, the score of the treatment group was lower than that of the control group, and the score of the treatment group was lower than that of the control group. The results showed that the treatment group could significantly improve the knee function and improve the living ability of the patients. The gait parameters showed that compared with before treatment, the gait parameters showed that the patients in the treatment group were significantly better than those in the control group. The parameters were improved by 0.01, and the improvement degree of walking ability and balance ability of the treatment group were higher than that of the control group. Therefore, the treatment group could significantly improve the walking ability of the patients, and the improvement degree of the balance ability of the treatment group was higher than that of the control group. Conclusion Jiawei Tongluo Zhibi decoction combined with sodium hyaluronate can obviously improve the local subjective symptoms of knee osteoarthritis. And can improve the patient's walking posture. 2. Based on the treatment of sodium hyaluronate at the same time, The treatment group was superior to the control group in taking the traditional Chinese patent medicine Fuhuang Jiangu pill only after the treatment of syndrome differentiation and treatment by oral administration of Jiawei Tongluo Zhibi decoction.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

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