“固本通经”针刺法结合三步推拿法治疗膝骨性关节炎的临床研究

发布时间：2018-03-25 02:23

  本文选题：膝骨性关节炎　切入点：固本通经　出处：《湖北中医药大学》2017年硕士论文

【摘要】：目的观察“固本通经”针刺法结合三步推拿法治疗膝骨性关节炎的临床疗效,探究其有效性,为临床治疗膝骨性关节炎提供有效的方法。方法对湖北中医药大学附属门诊国医堂2014年12月至2016年11月就诊的78例膝骨性关节炎患者,按照就诊的先后顺序随机分为治疗组和对照组,每组各39例。治疗组采用“固本通经”针刺法结合三步推拿法治疗,针刺选穴为:内膝眼、犊鼻、鹤顶、梁丘、血海、阴陵泉、阳陵泉、关元、三阴交、悬钟。各穴位行提插捻转补泻手法,以患者得气为度。三步推拿法主要参考中国中医科学院张涛研究员的手法治疗,由松解、调整、整理三步组成。针刺治疗留针20min,推拿治疗10min。对照组采用常规针刺结合三步推拿法治疗,针刺选穴膝眼、梁丘、阳陵泉、血海、阿是穴、大杼,寒湿证配腰阳关,瘀血证配膈俞,肝肾亏虚配肝俞、肾俞、气海。针刺留针20min,推拿治疗10min。嘱患者每日于家中行股四头肌锻炼方法。以上治疗每周3次,4周为1个疗程,1个疗程后评定疗效。治疗组和对照组患者治疗前后均进行VAS、JOA、WOMAC评分,比较两组治疗前后评分差异,并采用统计软件SPSS19.0进行数据分析。结果1.比较治疗组和对照组的性别、年龄、病程以及治疗前的VAS评分、JOA评分、W0MAC评分,经统计学分析,差异均无统计学意义(p0.05),具有可比性。2.临床疗效:经过1个疗程的治疗,治疗组36例患者临床治愈7例(19.4%),有效18例(50%),好转9例(25%),无效2例(5.6%),总有效率为94.4%;对照组38例患者临床治愈3例(7.9%),有效12例(31.6%),好转14例(36.8%),无效9例(23.7%),总有效率为76.3%。两组临床疗效比较,经卡方检验,差异具有统计学意义(p0.05),提示治疗组疗效优于对照组。3.两组治疗前后的VAS评分比较:治疗组治疗前VAS评分为4.27±1.45,治疗后为1.33±1.01;对照组治疗前VAS评分为4.45±1.01,治疗后为1.14±0.72。两组治疗前后VAS评分进行比较,均有显著性差异(p0.05),说明“固本通经”针刺法结合三步推拿法以及常规针刺结合三步推拿法均能在一定程度上改善膝骨性关节炎的疼痛症状,但两组的疗效差异没有统计学意义(p0.05)。4.两组治疗前后的JOA评分比较:治疗组治疗前JOA评分为60.28±5.73,治疗后为88.06±5.25;对照组治疗前JOA评分为59.47±8.69,治疗后为72.37±4.89。两组治疗前后JOA评分进行比较,均有显著性差异(p0.05),说明两组均能一定程度地改善膝骨性关节炎的临床症状,但治疗组效果优于对照组(p0.05)。说明“固本通经”针刺法结合三步推拿法在改善患者步行、爬楼梯、屈曲角度等综合方面较常规针刺结合三步推拿法对膝骨性关节炎的效果更好。5.两组治疗前后的W0MAC评分比较,治疗组治疗前W0MAC评分为48.50±3.74,治疗后为17.41±3.56;对照组治疗前W0MAC评分为47.61±4.03,治疗后为29.59士3.67。两组治疗前后W0MAC评分进行比较,均有显著性差异(p0.05),说明两组均能一定程度地改善膝骨性关节炎的疼痛和功能指数,但治疗组在改善患者僵硬、生理功能等综合方面较对照组疗效好。结论本研究表明,治疗组和对照组均能有效治疗膝骨性关节炎,两种疗法均能有效缓解患者膝关节的疼痛,但本研究并没有显示哪种疗法止痛效果更好,在改善患者步行、爬楼梯、屈曲角度、活动时的疼痛感、僵硬、生理功能等综合方面,治疗组疗效优于对照组。
[Abstract]:Objective To observe the effect of "the path" acupuncture method combined with the clinical curative effect of three step massage in the treatment of knee osteoarthritis, to explore its effectiveness, to provide effective methods for clinical treatment of knee osteoarthritis. Methods 78 cases of patients with arthritis of Hubei University of TCM affiliated outpatient from December 2014 to November 2016 Guoyitang in accordance with the treatment of knee osteoarthritis. The order were randomly divided into treatment group and control group, 39 cases in each group. The treatment group was treated by "three step massage therapy combined with the pressure of acupuncture, acupuncture point selection: in the eye of the knee, calf nose, crane, Liangqiu, sea of blood, Yin Ling Quan, Yanglingquan, Guanyuan and Sanyinjiao, hang a bell. Each acupoint for lifting thrusting twirling reinforcing and reducing, to patients with gas for degrees. Three step massage main reference China Zhang Tao Academy of traditional Chinese medicine, massage therapy, by loosening, adjustment, finishing three steps. Acupuncture needle 20min, massage therapy 10mi N. control group with routine acupuncture treatment combined with three step massage, acupuncture point selection and eye of the knee, Yanglingquan, Xuehai, Liangqiu, Ashi, Dazhu, Yaoyangguan with cold dampness syndrome, blood stasis syndrome with Geshu, liver and kidney deficiency with liver Yu, Shenshu, Qihai. Acupuncture massage therapy for 20min, 10min. Huanzhe daily in a bank stock four myo exercise method. More than 3 times a week, 4 weeks for 1 courses, 1 courses of treatment. The curative effect was evaluated after treatment group and control group before and after treatment were VAS, JOA, WOMAC score, the difference score before and after treatment between the two groups, and the use of statistical software SPSS19.0 data analysis results 1.. Comparison of treatment group and control group in gender, age, course of disease and treatment before the VAS score, JOA score, W0MAC score, the statistical analysis, there were no significant differences (P0.05), with comparable clinical efficacy of.2.: after 1 courses of treatment, the treatment group of 36 cases of patients with clinical 娌绘剤7渚，

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