清宫正骨手法治疗膝痹病（膝关节骨性关节炎）临床研究

发布时间：2018-06-28 08:25

本文选题：清宫正骨手法 + 膝关节骨性关节炎　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:通过对膝痹病(膝关节骨性关节炎)的流行病学、发病机制、临床特点、中西医诊疗现状等方面的理论研究,总结得出膝关节骨性关节炎为中老年人常见病、多发病,其患病率呈逐年升高趋势,本病导致的膝关节肿痛、变形及活动障碍,使患者生活质量明显下降,由于病因尚未明了,目前尚无特异性疗法,且多数疗法存在各类缺欠和不足,探求一种疗效确切、低毒副作用、经济实惠的治疗方法,是当前本病研究的焦点与难点。本课题研究的主要目的在于探讨清宫正骨手法对膝痹病(膝关节骨性关节炎)的关节疼痛、关节僵硬、日常活动等方面的影响作用,进一步观察和评价其治疗效果,为本研究的治疗方法在临床上的推广应用提供科学依据。方法:选取符合入组标准的患者作为研究对象共80例,按照随机数字表法随机分成清宫正骨手法(研究组)和双氯芬酸钠缓释片联合关节腔注射玻璃酸钠(对照组)2组,其中研究组为40人,对照组为40人。两组均采用视觉模拟评分(VAS)、WOMAC骨关节炎指数评分及疗效评价标准,在治疗开始前及疗程结束后1周对患者膝关节症状、体征、活动功能等进行评分及记录,统计分析其临床疗效。每个患者在治疗开始前和治疗结束后1周都进行安全性项目监测,详细记录研究过程中出现的不良事件,以评估治疗方法的安全性。结果:临床研究结果显示:(1)研究组治疗40例患者中临床控制3例,2例无效,观察时间窗内总效率为95.00%;对照组治疗40例患者中临床控制1例,6例无效,观察时间窗内有效率为85.00%;两组在临床治疗效果比较上,研究组优于对照组,且差异有统计学意义(P0.05)。(2)经过治疗后两组患者VAS评分、WOMAC评分中疼痛积分、僵硬积分、日常活动积分及总积分均较治疗前有明显下降,且差异有统计学意义(P0.05);两组患者VAS评分改善程度对比,差异无统计学意义(P0.05);两组患者WOMAC积分改善程度比较,研究组优于对照组,且差异有统计学意义(P0.05);两组患者WOMAC积分中疼痛、僵硬的改善程度对比,差异无统计学意义(P0.05);两组患者WOMAC积分中日常活动的改善程度比较,研究组显著优于对照组,且差异有统计学意义(P0.05)。(3)经两种不同方法治疗的患者不良事件发生率比较方面,清宫正骨手法组仅有2位患者对中药过敏,出现轻度的皮肤红疹;而在西药治疗的对照组有8位患者出现嗜睡、胃痛、恶心呕吐或关节穿刺点红肿等不良反应,经停药后症状可消失。两组患者在研究治疗过程中不良反应发生率比较,研究组低于对照组,且差异有统计学意义(p0.05)。结论:综上所述,通过本课题的临床研究可以得出清宫正骨手法治疗膝痹病(膝关节骨性关节炎)比西药对照组显示出更好的疗效,且能更显著地改善患者膝关节日常活动功能,提升患者的生活质量。清宫正骨手法治疗膝痹病(膝关节骨性关节炎)的临床治疗效果显著、确切,无毒副作用,是膝痹病的一种有效治疗方法,值得临床进一步推广应用。
[Abstract]:Objective: to conclude that osteoarthritis of the knee is a common disease of the middle aged and old people, and the prevalence rate is increasing year by year, and the knee joint swelling and pain, deformability and activity disorder caused by this disease, through the theoretical study of the epidemiology, pathogenesis, clinical characteristics and the diagnosis and treatment of Chinese and Western medicine. The quality of life of the patients is obviously reduced, because the cause of the disease is not yet clear, there is no specific therapy at present, and there are many kinds of deficiency and deficiency in most therapies. It is the focus and difficulty of the current research of the disease. The main purpose of this study is to explore the bone manipulation of the palace. To further observe and evaluate the therapeutic effect of knee arthralgia (knee osteoarthritis) on joint pain, joint stiffness and daily activity, and to provide scientific basis for the application of this study in clinical application. Methods: 80 patients were selected according to the standard of entry group, according to the random number. The method was randomly divided into 2 groups: the study group and the Diclofenac Sodium Sustained Release Tablets joint cavity injection of sodium hyaluronate (control group). The study group was 40 and the control group was 40. The two groups were treated with visual analogue score (VAS), WOMAC bone arthritis index score and evaluation criteria, before the treatment began and 1 weeks after the end of the course of treatment. Scores and records of the patients' knee symptoms, signs and activity functions were recorded and recorded, and their clinical efficacy was statistically analyzed. Each patient monitored the safety items before the treatment and 1 weeks after the end of the treatment. The adverse events were recorded in detail to assess the safety of the treatment. Results: the results of clinical studies showed: (1) In the study group, there were 3 cases of clinical control in 40 patients, 2 cases ineffective, the total efficiency was 95% in the observation time window, 1 in the control group, 6 ineffective, and 85% in the observation time window. In the two group, the study group was superior to the control group in comparison with the control group, and the difference was statistically significant (P0.05). (2) after treatment (2) After the treatment, the scores of pain in the two groups of the two groups, the score of pain in the WOMAC score, the stiffness integral, the score of daily activity and the total score were significantly lower than before the treatment (P0.05), and the difference in the degree of improvement of the two groups was not statistically significant (P0.05), and the improvement of the WOMAC integral in the two groups was better than that of the control group. Group, and the difference was statistically significant (P0.05); there was no significant difference in pain and stiffness improvement in the two groups of WOMAC scores (P0.05); the improvement of daily activities in the two groups was significantly better than that in the control group, and the difference was statistically significant (P0.05). (3) patients treated with two different methods. In comparison with the incidence of adverse events, only 2 patients were allergic to traditional Chinese medicine and had mild skin rash, while 8 patients in the control group treated with western medicine had adverse reactions such as somnolence, stomach pain, nausea and vomiting, or red and swelling joint punctures, and the symptoms disappeared after withdrawal. The two groups were not treated in the course of the treatment. Compared with the control group, the study group was lower than the control group, and the difference was statistically significant (P0.05). Conclusion: in summary, the clinical study of this subject can be used to show that the treatment of knee arthralgia (osteoarthritis of knee joint) is better than the western medicine control group, and it can improve the daily life of the knee joint more significantly. The clinical effect of the treatment of knee arthralgia (knee osteoarthritis) is significant, accurate, nontoxic side effect, and it is an effective treatment for knee arthralgia, 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】：R274.9

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