基于经筋理论推拿治疗膝骨性关节炎的疗效评价研究

发布时间：2018-03-24 00:36

  本文选题：膝骨性关节炎　切入点：经筋　出处：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:通过观察比较传统推拿疗法与经筋推拿疗法在膝骨性关节炎(KOA)患者治疗前后的VAS评分、WOMAC评分、红外热成像温度变化以及疗效评价差异,探讨经筋推拿手法在KOA治疗中的优势。材料与方法:将2016年1月~2017年3月期间辽宁中医药大学各附属医院和沈阳军区总医院北方医院收入的150名符合试验标准的住院患者,随机分为传统推拿组和经筋推拿组,每组各有患者75名。传统推拿组治疗取穴参照《推拿治疗学》,重点穴位为膝关节局部的血海、梁丘、内外膝眼、鹤顶、阳陵泉、阿是穴及远端的伏兔、足三里穴等。经筋推拿组诊疗方法选点参照薛立功著《中国经筋学》,医者自上而下对患者足阳明、太阳、少阳和三阴经筋在腹部、腰背部、膝踝部等循行部位运用揉按、弹拨、点滑的手法进行整体理筋,消除肌肉、筋膜的痉挛和紧张,然后着重对膝外前侧、膝外中侧、膝外后侧以及膝内侧的结筋病灶点进行点按、横向滑拨等手法进行逐一消灶。两组患者治疗时间均为25min/次,日1次,1周7次,疗程之间间隔1日,共治疗4周。疗程结束后,观察记录两组患者治疗前、后的(1)膝关节疼痛程度(VAS分值);(2)WOMAC评分;(3)以红外热成像技术观测患者膝关节外前侧、外中侧、外后侧、内侧体表温度观察点的温度(℃);(4)疗效评价:采用VAS指数和WOMAC评分的改善值百分率进行临床症状测定评分,即改善值/治疗前值×100%(改善值为治疗前值-治疗后值),将各指标的改善值百分率计算平均百分率后进行疗效评价,分四个等级。治愈:改善百分率为≥90%;显效:改善百分率为90%~50%;好转:改善百分率为50%~30%;未愈:改善百分率为≤30%。结果:1.两组患者治疗后VAS评分较治疗前明显降低(P0.05);治疗后经筋推拿组和传统推拿组VAS评分比较,经筋推拿组明显低于传统推拿组(P0.05)。2.两组患者治疗后WOMAC评分较治疗前明显降低(P0.05);治疗后经筋推拿组和传统推拿组WOMAC评分比较,经筋推拿组明显低于传统推拿组(P0.05)。3.两组患者治疗后膝关节外前侧、外中侧、外后侧、膝内侧共22个体表温度观察点的温度值较治疗前明显降低(P0.05);治疗后经筋推拿组和传统推拿组体表观察点温度值比较,经筋推拿组明显低于传统推拿组(P0.05)。4.经筋推拿组治愈18例,显效46例,好转8例,未愈3例,总有效率为96%;传统推拿组治愈15例,显效20例,好转34例,未愈6例,总有效率为92%。经卡方检验有统计学差异(P0.05),经筋推拿组的疗效明显优于传统推拿组。结论:1.在减轻KOA患者疼痛方面,经筋推拿疗法优于传统推拿疗法。2.在改善KOA患者功能障碍方面,经筋推拿疗法优于传统推拿疗法。3.在红外热成像体表温度观察点温度改变方面,经筋推拿疗法优于传统推拿疗法。4.在KOA患者疗效方面,经筋推拿疗法优于传统推拿疗法。
[Abstract]:Objective: to observe and compare the VAS score, the temperature change of infrared thermal imaging and the difference of curative effect between traditional massage therapy and meridian massage therapy in patients with osteoarthritis of knee before and after treatment. To explore the advantage of meridian massage in the treatment of KOA. Materials and methods: from January 2016 to March 2017, 150 inpatients who met the test standard were collected from the affiliated hospitals of Liaoning University of traditional Chinese Medicine and the North Hospital of Shenyang military region General Hospital. They are randomly divided into the traditional massage group and the meridian massage group, with 75 patients in each group. The traditional massage group takes points for reference to massage therapy. The key points are the local blood sea of the knee joint, Liang Qiu, the inner and outer knee eyes, the crane roof, and the Yangling spring. Ashi acupoint and distal Fu rabbit, Zusanli acupoint, etc. Selected points for diagnosis and treatment in the meridian and massage group refer to Xue Ligong's "Chinese Meridian Science". The doctor from the top down to the foot Yangming, Sun, Shaoyang and Sanyin meridians are in the abdomen and back of the waist. The knee ankle and so on along the line place uses the kneading press, the bouncing, the point slippery hand to carry on the whole to regulate the tendon, eliminates the muscle, the fascia spasm and the tension, then emphatically carries on the click to the outside knee anterior side, the knee outside the middle side, the knee outside the posterior side and the knee medial side and the knee medial side nodal fascia focal point carries on the click to press, The treatment time of the two groups was 25min/ times, 7 times a day, the interval between the courses of treatment was 1 day, the total treatment was 4 weeks. After the course of treatment, the patients in the two groups were observed and recorded before the treatment. The pain degree of the knee joint was evaluated by VAS score and WOMAC score. The anterior, middle and posterior sides of the knee joint were observed by infrared thermal imaging technique, and the results were as follows: (1) the anterior side, the middle side and the posterior side of the knee joint were measured by infrared thermal imaging. Evaluation of Therapeutic effect of the observation Point of medial body Surface temperature: the clinical symptom score was measured by VAS index and the percentage of improvement value of WOMAC score. That is, the improvement value / pre-treatment value 脳 100 value (the improvement value is pre-treatment value-after treatment value), after calculating the average percentage of the improvement value of each index, the curative effect was evaluated. There are four grades: cure: improvement percentage is 鈮，

本文编号：1655946