松解针法与电针治疗膝骨关节炎的临床疗效观察
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摘要
目的:比较软组织松解针法与电针治疗膝骨关节炎(KOA)的临床疗效差异,为临床治疗KOA提供新的治疗方法。方法:将40例KOA患者随机分为电针组和松解组,每组20例。电针组采用电针刺激患者患侧膝关节的内膝眼、外膝眼、鹤顶、血海、膝阳关等穴;松解组采用软组织松解针法治疗,选取患者患侧膝关节的压痛点、条索及结节治疗,均隔日治疗1次,共4次。治疗前后对膝关节视觉模拟量尺(VAS)评分、膝关节屈曲活动度(ROM)、膝骨关节炎严重程度指数(Lequesne指数)及总体疗效进行评定,观察对比两组患者的临床疗效。结果:与治疗前比较,两组治疗后的VAS评分、Lequesne指数均显著降低(P<0.001),ROM均显著升高(P<0.001)。电针组VAS评分、Lequesne指数治疗前后的差值明显小于松解组(P<0.05)。电针组总有效率为80.0%(16/20),松解组总有效率为90.0%(18/20),两组比较差异无统计学意义(P>0.05)。结论:软组织松解针法与电针疗法治疗KOA疗效相当,在减轻KOA患者关节疼痛症状、改善膝关节活动功能方面,软组织松解针法优于电针疗法。
Objective To compare the clinical efficacy of soft-tissue relaxing needling and electroacupuncture(EA)in the treatment of knee osteoarthritis(KOA),so as to explore a new and more effective therapy for KOA.Methods Forty patients with KOA who met our diagnostic criteria were randomly and equally divided into acupuncture group and soft-tissue relaxing needling(relaxing-needling)group.EA(20 Hz,a tolerable strength and duration of 20 min)was applied to the unilateral Neixiyan(EX-LE5)and Waixiyan(EX-LE5),and manual acupuncture stimulation was applied to Heding(EX-LE2),Xuehai(SP10),Xiyangguan(GB33),Liangqiu(ST34),Yanglingquan(GB34)and Yinlingquan(SP9)on the affected side by using uniform reinforcing-reducing technique.In the relaxing-needling group,after identifying the tender point and nodule-like or stiff-strip-muscle spot at the affected limb by palpation,we used filiform needles to insert into them,then,made a longitudinal separation or point-like pricking.The visual analog scale(VAS)pain score,knee flexion activity(range of motion,ROM),and the knee osteoarthritis severity(Lequesne index,composed of daily living,walking distance and pain)were measured before and after the treatment.The therapeutic effect was assessed by consulting the Guiding Principles for Researching New Drugs of Traditional Chinese Medicine(2002)and Criteria for Diagnosis and Assessment of Therapeutic Effect of Syndromes or Illnesses of Traditional Chinese Medicine(1994).Results After the treatment,the VAS score and Lequesne index were significantly decreased in both acupuncture and relaxingneedling groups(P<0.001),and the ROM score was considerably increased in both groups in comparison with their own pretreatment(P<0.001).The difference values of VAS score and Lequesne index between pre-and post-treatment were significantly higher in the relaxing-needling group than in the acupuncture group(P<0.05).Of the two 20 cases in the relaxing-needling and acupuncture groups,8 and 3 experienced a remarkable improvement in their symptoms,10 and 13 were effective,2 and 4 failed,with the effective rate being 90.0% and 80.0%,respectively.No significant difference was found between the two groups in the difference value of ROM score and the effective rate(P>0.05).Conclusion Both relaxing-needling and EA therapies are comparable in the therapeutic effect for KOA,and the former is superior to the latter in reducing the joint pain and improving the knee joint locomotor function,thus being worthy of clinical application.
Objective To compare the clinical efficacy of soft-tissue relaxing needling and electroacupuncture(EA)in the treatment of knee osteoarthritis(KOA),so as to explore a new and more effective therapy for KOA.Methods Forty patients with KOA who met our diagnostic criteria were randomly and equally divided into acupuncture group and soft-tissue relaxing needling(relaxing-needling)group.EA(20 Hz,a tolerable strength and duration of 20 min)was applied to the unilateral Neixiyan(EX-LE5)and Waixiyan(EX-LE5),and manual acupuncture stimulation was applied to Heding(EX-LE2),Xuehai(SP10),Xiyangguan(GB33),Liangqiu(ST34),Yanglingquan(GB34)and Yinlingquan(SP9)on the affected side by using uniform reinforcing-reducing technique.In the relaxing-needling group,after identifying the tender point and nodule-like or stiff-strip-muscle spot at the affected limb by palpation,we used filiform needles to insert into them,then,made a longitudinal separation or point-like pricking.The visual analog scale(VAS)pain score,knee flexion activity(range of motion,ROM),and the knee osteoarthritis severity(Lequesne index,composed of daily living,walking distance and pain)were measured before and after the treatment.The therapeutic effect was assessed by consulting the Guiding Principles for Researching New Drugs of Traditional Chinese Medicine(2002)and Criteria for Diagnosis and Assessment of Therapeutic Effect of Syndromes or Illnesses of Traditional Chinese Medicine(1994).Results After the treatment,the VAS score and Lequesne index were significantly decreased in both acupuncture and relaxingneedling groups(P<0.001),and the ROM score was considerably increased in both groups in comparison with their own pretreatment(P<0.001).The difference values of VAS score and Lequesne index between pre-and post-treatment were significantly higher in the relaxing-needling group than in the acupuncture group(P<0.05).Of the two 20 cases in the relaxing-needling and acupuncture groups,8 and 3 experienced a remarkable improvement in their symptoms,10 and 13 were effective,2 and 4 failed,with the effective rate being 90.0% and 80.0%,respectively.No significant difference was found between the two groups in the difference value of ROM score and the effective rate(P>0.05).Conclusion Both relaxing-needling and EA therapies are comparable in the therapeutic effect for KOA,and the former is superior to the latter in reducing the joint pain and improving the knee joint locomotor function,thus being worthy of clinical application.
引文
[1]张玉森,王子轩.温针配合玻璃酸钠关节内注射治疗膝关节骨性关节炎随机对照观察[J].针刺研究,2011,36(5):373-376.
[2]庄松强,庄开赞,张露敏,等.针刺联合玻璃酸钠关节腔注射治疗膝关节骨性关节炎的临床观察[J].针刺研究,2018,43(5):326-329.
[3]高文香,郝军.筋病理论指导下中医综合疗法治疗膝骨关节炎[J].中医正骨,2014,26(1):60-62.
[4]杨永菊,张江,吕世伟,等.电针透穴治疗膝骨性关节炎随机对照研究[J].针灸临床杂志,2016,32(10):1-4.
[5]马永圆,郭海云,白福海,等.电针治疗膝骨关节炎的基础研究进展[J].上海针灸杂志,2018,37(7):833-840.
[6]马莹.FMS运用于松解针法和电针治疗膝骨关节炎疗效评价的研究[D].北京:北京中医药大学,2018.
[7]李文迅,黄怡然.软组织损伤松解针法的临床应用体会[J].中国中医药现代远程教育,2012,10(20):49-51.
[8]HOCHBERG M C,AlTMAN R D,BRANDT K D,et al.Guidelines for the medical management of osteoarthritis.PartⅡ.Osteoarthritis of the knee[J].Arthritis Rheum,1995,38(11):1541-1546.
[9]田雯,沈林林,黄国付,等.电针改善不同病程膝骨关节炎患者WOMAC和VAS评分的临床研究[J].针灸临床杂志,2015,31(4):26-28.
[10]郭燕梅,瓮长水,陈蔚,等.膝骨关节炎患者下肢动静态位置觉与功能状况和平衡的相关性分析[J].中国康复理论与实践,2013,19(11):1064-1068.
[11]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:349-353.
[12]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994.
[13]刘恩雄,王维敏,吴昌国,等.中药外敷联合盐酸氨基葡萄糖胶囊治疗老年KOA 68例[J].环球中医药,2016,9(11):1357-1359.
[14]邱玲,阚俊微,郑旭,等.温针灸结合康复训练治疗KOA远期疗效观察[J].中国针灸,2013,33(3):199-202.
[15]孙宁,李永婷,林璐璐,等.不同针灸疗法治疗膝骨关节炎的比较与分析[J].中华中医药杂志,2017,32(7):3253-3255.
[16]黄露露,苏友新.国内膝关节骨性关节炎社区康复的研究现状[J].中国康复医学杂志,2018,33(9):1122-1128.
[17]韩超,孙忠人.电针治疗膝骨关节炎的步态特征研究[J].吉林中医药,2018,38(2):217-219.
[18]焦群茹,丁明桥,李熳,等.电针治疗膝骨关节炎的临床疗效及其对血清中IL-10、TNF-α水平影响的研究[J].辽宁中医杂志,2018,45(10):2186-2188.
[19]具紫勇,王颖,陈昌乐,等.电针治疗膝骨关节炎临床研究[J].上海针灸杂志,2017,36(9):1111-1115.
[20]郭艳明,梁永瑛,顾钧青,等.电针围刺治疗早中期膝骨关节炎[J].吉林中医药,2016,36(1):91-93.
[21]车涛,裘敏蕾,孙剑,等.电针治疗膝骨关节炎疗效观察[J].上海针灸杂志,2012,31(8):595-596.
[22]嵇波,郭长青,金燕,等.针刀和电针对膝骨关节炎大鼠痛阈和中枢单胺类神经递质的影响[J].中国病理生理杂志,2010,26(6):1091-1095.
[23]黄怡然,金英利,李娜,等.针刀、电针和圆利针对KOA模型兔股直肌Bcl-2、Bax、Caspase-3蛋白表达的影响[J].针刺研究,2014,39(2):100-105.
[24]卢鼎厚,张志廉.斜刺对骨骼肌损伤的治疗作用[J].中国针灸,1989,9(6):1-4.
[2]庄松强,庄开赞,张露敏,等.针刺联合玻璃酸钠关节腔注射治疗膝关节骨性关节炎的临床观察[J].针刺研究,2018,43(5):326-329.
[3]高文香,郝军.筋病理论指导下中医综合疗法治疗膝骨关节炎[J].中医正骨,2014,26(1):60-62.
[4]杨永菊,张江,吕世伟,等.电针透穴治疗膝骨性关节炎随机对照研究[J].针灸临床杂志,2016,32(10):1-4.
[5]马永圆,郭海云,白福海,等.电针治疗膝骨关节炎的基础研究进展[J].上海针灸杂志,2018,37(7):833-840.
[6]马莹.FMS运用于松解针法和电针治疗膝骨关节炎疗效评价的研究[D].北京:北京中医药大学,2018.
[7]李文迅,黄怡然.软组织损伤松解针法的临床应用体会[J].中国中医药现代远程教育,2012,10(20):49-51.
[8]HOCHBERG M C,AlTMAN R D,BRANDT K D,et al.Guidelines for the medical management of osteoarthritis.PartⅡ.Osteoarthritis of the knee[J].Arthritis Rheum,1995,38(11):1541-1546.
[9]田雯,沈林林,黄国付,等.电针改善不同病程膝骨关节炎患者WOMAC和VAS评分的临床研究[J].针灸临床杂志,2015,31(4):26-28.
[10]郭燕梅,瓮长水,陈蔚,等.膝骨关节炎患者下肢动静态位置觉与功能状况和平衡的相关性分析[J].中国康复理论与实践,2013,19(11):1064-1068.
[11]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:349-353.
[12]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994.
[13]刘恩雄,王维敏,吴昌国,等.中药外敷联合盐酸氨基葡萄糖胶囊治疗老年KOA 68例[J].环球中医药,2016,9(11):1357-1359.
[14]邱玲,阚俊微,郑旭,等.温针灸结合康复训练治疗KOA远期疗效观察[J].中国针灸,2013,33(3):199-202.
[15]孙宁,李永婷,林璐璐,等.不同针灸疗法治疗膝骨关节炎的比较与分析[J].中华中医药杂志,2017,32(7):3253-3255.
[16]黄露露,苏友新.国内膝关节骨性关节炎社区康复的研究现状[J].中国康复医学杂志,2018,33(9):1122-1128.
[17]韩超,孙忠人.电针治疗膝骨关节炎的步态特征研究[J].吉林中医药,2018,38(2):217-219.
[18]焦群茹,丁明桥,李熳,等.电针治疗膝骨关节炎的临床疗效及其对血清中IL-10、TNF-α水平影响的研究[J].辽宁中医杂志,2018,45(10):2186-2188.
[19]具紫勇,王颖,陈昌乐,等.电针治疗膝骨关节炎临床研究[J].上海针灸杂志,2017,36(9):1111-1115.
[20]郭艳明,梁永瑛,顾钧青,等.电针围刺治疗早中期膝骨关节炎[J].吉林中医药,2016,36(1):91-93.
[21]车涛,裘敏蕾,孙剑,等.电针治疗膝骨关节炎疗效观察[J].上海针灸杂志,2012,31(8):595-596.
[22]嵇波,郭长青,金燕,等.针刀和电针对膝骨关节炎大鼠痛阈和中枢单胺类神经递质的影响[J].中国病理生理杂志,2010,26(6):1091-1095.
[23]黄怡然,金英利,李娜,等.针刀、电针和圆利针对KOA模型兔股直肌Bcl-2、Bax、Caspase-3蛋白表达的影响[J].针刺研究,2014,39(2):100-105.
[24]卢鼎厚,张志廉.斜刺对骨骼肌损伤的治疗作用[J].中国针灸,1989,9(6):1-4.