补肾祛瘀针刺法治疗膝骨性关节炎的临床研究

发布时间：2018-07-18 21:48

【摘要】：目的:补肾祛瘀法是全国名老中医李家康教授四十余年针灸临床经验的学术总结。本研究采用补肾祛瘀法治疗膝骨性关节炎并与普通针刺对照,通过针刺前后各项指标的对比,评价其疗效,以进一步总结李家康教授的临床经验和学术思想,以期在针灸临床中推广。方法:选取2014.12-2016.9月就诊于湖北省中医院针灸科门诊与针灸科住院部(花园山病区)的膝骨性关节炎的患者64例,采用随机分组法,将纳入的研究对象随机分为补肾祛瘀针刺组和常规局部针刺组,每组32例。补肾祛瘀针刺组取穴为悬钟、大杼、肾俞、太溪、阴谷、膈俞、足三里、血海、内膝眼、犊鼻和阳陵泉。操作方法:先采用点刺不留针的方法点刺大杼、肾俞及膈俞,大杼与肾俞行捻转补法每穴行手法3次,膈俞斜刺0.8寸行捻转泻法3次。再嘱患者取坐位,针刺其余穴位。太溪、阴谷、足三里、阳陵泉、血海、内膝眼、犊鼻行平补平泻法。出针时直接取出。常规局部针刺组取穴为:内膝眼、犊鼻、血海、梁丘、阳陵泉、膝阳关、足三里、阴陵泉和鹤顶。留针时采用平补平泻针刺方法,出针时直接取出。两组所有患者留针时间为30分钟,每10分钟行手法1次。每周治疗3次,隔日一次,2周为1个疗程,总共治疗2个疗程。治疗结束后第3个月进行随访。记录两组治疗前与治疗后的VAS疼痛视觉评分、WOMAC骨关节炎评分、下肢功能LEFS功能评分,观察对比两种治疗方案的临床疗效。记录治疗结束后3个月末随访的WOMAC骨关节炎评分。结果:1.治疗前,补肾祛瘀针刺组和常规局部针刺组在性别、年龄、病程、中医辨证分型、BMI体质指数、KL-X线关节指数、VAS评分、WOMAC评分、下肢功能LEFS评分方面,经统计均无统计学意义,说明两组组间的临床基线资料具有可比性。2.VAS评分的比较VAS评分结果显示,补肾祛瘀针刺组治疗后与治疗前两两比较,有显著性差异(P0.05);常规局部针刺组治疗后与治疗前两两比较,有显著性差异(P0.05);治疗后,补肾祛瘀针刺组与常规局部针刺组两两比较,有显著性差异(P0.05)。3.WOMAC评分的比较WOMAC评分结果显示,补肾祛瘀针刺组治疗后与治疗前两两比较,有显著性差异(P0.05);常规局部针刺组治疗后与治疗前两两比较,有显著性差异(P0.05);治疗后,补肾祛瘀针刺组与常规局部针刺组两两比较,有显著性差异(P0.05)。4.下肢功能LEFS评分的比较LEFS评分结果显示,补肾祛瘀针刺组治疗后与治疗前两两比较,有显著性差异(P0.05);常规局部针刺组治疗后与治疗前两两比较,有显著性差异(P0.05);治疗后,补肾祛瘀针刺组与常规局部针刺组两两比较,有显著性差异(P0.05)。5.疗效比较补肾祛瘀针刺组有效率为86.67%,局部常规针刺组有效率为80.00%。经秩和检验,P值为0.044,P0.05。两组之间的疗效具有可比性。6.随访在治疗结束3个月后进行随访。补肾祛瘀组与常规局部针刺组在WOMAC评分量表的评分上存在差异(P0.05)。结论:(1)补肾祛瘀针刺组与常规局部针刺组相比,在改善疼痛症状方面,补肾祛瘀针刺组疗效更好。(2)补肾祛瘀针刺组与常规局部针刺组相比,在改善僵硬症状方面,补肾祛瘀针刺组疗效更佳。(3)补肾祛瘀针刺组与常规局部针刺组相比,在改善下肢功能方面,补肾祛瘀针刺组效果更佳。(4)补肾祛瘀针刺组与常规局部针刺组相比,在总有效率方面,补肾祛瘀针刺组效果更明显。(5)补肾祛瘀针刺组与常规局部针刺组相比,补肾祛瘀针刺组远期疗效优于常规局部针刺组。
[Abstract]:Objective: the method of invigorating kidney and removing stasis is an academic summary of Professor Li Jiakang's clinical experience for more than forty years. This study uses the method of Tonifying the kidney and removing stasis to treat osteoarthritis of the knee and compared with the common acupuncture. Through the comparison of various indexes before and after acupuncture, the curative effect is evaluated in order to sum up professor Li Jiakang's clinical experience and academic thought. Methods: 64 patients with osteoarthritis of the knee in the Department of acupuncture and moxibustion Department of Hubei Provincial Traditional Chinese Medical Hospital and the Department of acupuncture and moxibustion Department (Huayuan sick area) were selected for 2014.12-2016.9 months. The subjects were randomly divided into two groups, 32 cases in each group. The operation method: first use the method of punctate needling, the method of punctating the needling, the Shenshu and the phrenic Shu, the 3 times of the twisting and twisting of the Shu and Shenshu 0.8 inches, and the 3 times of the twisting and transpoing method. Position, acupuncture at the rest of the acupoints: Tai Xi, Yin Valley, Zusanli, Yang Mausoleum, blood sea, inner knee, and calf nose, take out the flat purging method. The acupuncture points of the conventional local acupuncture group are taken as: the inner knee, the calf nose, the blood sea, the beam hillock, the Yang mausu spring, the knee Yang Guan, the Zusanli, the Yin mausoleum and the crane. Two The needle retention time of all the patients was 30 minutes, 1 times every 10 minutes. 3 times a week, one day and 2 weeks for 1 courses, and 2 courses were treated in a total. The VAS pain visual score of the two groups before and after treatment, the WOMAC osteoarthritis score, the functional LEFS function score of the lower extremity, and two were observed and two. The results of WOMAC osteoarthritis score were recorded at the end of 3 months after the end of treatment. Results: before 1., the sex, age, course of disease, TCM syndrome differentiation, BMI body mass index, KL- X - ray joint index, VAS score, WOMAC score, and lower extremity function LEFS score before treatment were statistically analyzed. There was no statistical significance. The comparison of the clinical baseline data between the two groups showed that the comparison of the.2.VAS score of the clinical baseline showed that there was a significant difference (P0.05) between the treatment and the 22 before the treatment (P0.05). The routine local acupuncture group had a significant difference (P0.05) after treatment and 22 before treatment. After treatment, the kidney was treated with kidney tonifying. Compared with the conventional local acupuncture group 22, there was significant difference (P0.05).3.WOMAC score compared with the WOMAC score results showed that after treatment and 22 before treatment, there was significant difference (P0.05); the routine local acupuncture group was compared with 22 before treatment (P0.05); after treatment, supplementation Compared with the conventional local acupuncture group 22, there were significant differences (P0.05).4. lower limb function LEFS score compared with the result of LEFS score, there was significant difference (P0.05) compared with the 22 before treatment (P0.05); there were significant differences between the routine local acupuncture group and the 22 before treatment (P0.05). After treatment, there was significant difference (P0.05).5. effect compared with conventional local acupuncture group (22), the effective rate of the acupuncture group was 86.67%, the effective rate of the local conventional acupuncture group was 80.00%. through the rank sum test, the P value was 0.044, the therapeutic effect between the P0.05. two groups was comparable with.6. after 3 months of treatment after the end of the treatment. The score of the WOMAC score was different (P0.05). Conclusion: (1) the effect of Tonifying the kidney and removing blood stasis acupuncture group is better than the conventional local acupuncture group. (2) the group of Tonifying the kidney and removing stasis acupuncture group and the routine local acupuncture group are compared with the conventional local acupuncture group, and improve the stiffness symptoms. The effect of invigorating kidney and removing stasis acupuncture group was better. (3) compared with conventional local acupuncture group, the effect of tonifying kidney and removing blood stasis in acupuncture group was better than that of conventional local acupuncture group. (4) the effect of tonifying kidney and removing blood stasis acupuncture group with conventional local acupuncture group was more obvious in total effective efficiency. (5) the group of tonifying kidney and removing blood stasis acupuncture group and Compared with routine local acupuncture group, the long-term effect of Bushen Qu Yu acupuncture group was better than that of routine local acupuncture group.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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