针刀镜治疗膝关节内侧滑膜皱襞综合征临床疗效观察

发布时间：2018-05-03 17:23

本文选题：中医微创 + 针刀镜　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:在中医经络经筋理论的指导下,运用微创针刀镜技术对膝关节内侧滑膜皱襞综合征患者进行镜下诊疗,通过比较分析治疗前后膝关节VAS评分和Lysholm评分,评估针刀镜诊疗滑膜皱襞综合征的临床疗效。探讨微创针刀镜治疗膝关节内侧滑膜皱襞综合征的作用机制、安全性及有效性,为临床使用和治疗提供可靠的理论依据和新的方法。方法:所有病例均选自2015年06月至2016年12月广州市中西医结合医院骨伤科收治的膝关节内侧滑膜皱襞综合征患者,将符合诊断、纳入、排除标准的46例患者根据其就诊时间的先后顺序,用随机对照法分成对照组和观察组。对照组口服塞来昔布胶囊(连续服用2周)治疗,观察组在口服药物治疗基础上行微创针刀镜手术治疗。选取治疗前及治疗后第2周、6周作为观察时间点,观察患者治疗前后VAS评分、膝关节功能Lysholm评分变化情况,并对比两组患者治疗前后评分变化;根据《中医病证诊断疗效标准》对疗效进行评价,结果采用自身前后对照及组间对照并进行统计学分析。结果:对照组治疗期间有两例患者因疼痛加重,自行退出研究,余全部完成本次临床观察的治疗。在临床疗效方面,对照组总有效率为52.38%;观察组总有效率为95.65%,有显著性差异(P0.05)。两组患者经治疗2周后VAS评分均较治疗前均下降,具显著性差异(P0.05);观察组VAS评分与对照组对比差异无统计学意义(P0.05)。6周后对照组VAS评分与治疗前经配对T检验无统计学(P0.05);观察组治疗前后对比具显著差异(P0.05),与对照组治疗后比较具有显著统计差异(P0.05)。两组患者经治疗后Lysholm评分均较治疗前均增加;在2周后的时间点上观察组Lysholm评分与治疗前对比具显著差异(P0.05),与对照组对比差异无统计学意义(P0.05);在6周时间点上观察组Lysholm评分与治疗前、对照组对比均具显著差异(P0.05),而对照组治疗前后对比无统计学意义(P0.05)。观察组疗效优良率为91.3%。说明针刀镜联合塞来昔布胶囊治疗滑膜皱襞综合征疗效确切,可明显缓解膝疼痛症状,改善膝关节功能,在提高患者的日常生活能力及远期疗效方面明显优于对照组。结论:应用中医微创针刀镜治疗膝关节内侧滑膜皱襞综合征,能明显提高其的诊断准确率,有效膝关节疼痛、改善关节功能,提高患者生活质量。中医微创针刀镜是一种集安全性,有效性、操作简便、术后功能恢复快等优点的诊疗手段,值得临床进一步推广使用。
[Abstract]:Objective: under the guidance of the theory of meridian and meridian meridians of traditional Chinese medicine, the patients with medial synovial fold syndrome of knee joint were treated with minimally invasive needle knife technique. The VAS score and Lysholm score of knee joint before and after treatment were compared and analyzed. To evaluate the clinical effect of needle knife in diagnosis and treatment of synovial plica syndrome. To explore the mechanism, safety and effectiveness of minimally invasive needle knife in the treatment of medial synovial fold syndrome of knee joint, and to provide a reliable theoretical basis and new method for clinical use and treatment. Methods: all cases were selected from June 2015 to December 2016 in the Department of Orthopedics and Trauma, Guangzhou Integrated Chinese and Western Medicine Hospital. The patients with medial synovial fold syndrome of the knee joint were included in the diagnosis. 46 patients with exclusion criteria were divided into control group and observation group according to the order of visit time. The control group was treated with celecoxib capsule for 2 weeks, while the observation group was treated with minimally invasive needle knife surgery on the basis of oral drug therapy. The VAS score and knee function Lysholm score before and after treatment were observed at 6 weeks before and after treatment, and the scores before and after treatment were compared between the two groups. The curative effect was evaluated according to the criteria of diagnosis and treatment of TCM disease syndrome. Results: two patients in the control group withdrew from the study due to the aggravation of pain. The total effective rate was 52.38 in the control group and 95.65 in the observation group (P 0.05). After 2 weeks of treatment, VAS scores in both groups were lower than those before treatment. There was no significant difference in VAS score between the observation group and the control group (P 0.05). There was no significant difference in the VAS score between the control group and the control group before and after treatment (P 0.05), and there was no significant difference between the observation group and the control group before and after treatment (P 0.05). There was significant statistical difference after treatment (P 0.05). After treatment, the Lysholm scores of the two groups were higher than those before treatment. At the time point after 2 weeks, the Lysholm score of the observation group was significantly different from that of the control group before treatment (P 0.05), but there was no significant difference between the observation group (P 0.05) and the control group (P 0.05), and at the point of 6 weeks, the Lysholm score of the observation group was significantly higher than that of the control group (P < 0.05). There were significant differences between the control group and the control group, but there was no significant difference between the control group and the control group before and after treatment. The excellent and good rate of observation group was 91.3%. The results showed that the treatment of synovial plica syndrome with needle scalpel and celecoxib capsule was effective, which could relieve the pain of knee and improve the function of knee joint. It was superior to the control group in improving the ability of daily living and long-term curative effect. Conclusion: the treatment of medial synovial fold syndrome with traditional Chinese medicine minimally invasive needle knife can obviously improve the accuracy of diagnosis, effective knee pain, improve the function of joint and improve the quality of life of the patients. Traditional Chinese medicine minimally invasive needle knife endoscope is a method of diagnosis and treatment with the advantages of safety, effectiveness, simple operation and quick functional recovery after operation, which is worthy of further clinical application.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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