退行性骨关节炎中医健康管理模式的构建与应用研究
|
摘要
研究背景
现代研究表明,随着人均寿命的延长,以退行性骨关节炎为主的骨关节病的发病率呈迅速上升趋势,引起了医学界的广泛重视,以Lorig KR教授为核心的科研团队在上世纪七十年代针对骨关节炎进行了一系列健康管理方面的研究,最终形成一整套关节炎健康管理项目,也证明了骨关节炎的健康管理能够有效缓解疼痛,减少就医次数,降低治疗和康复的费用。但在中国,由于医疗体系建设的不完善,普通群众的知识层次的限制,健康管理在中国十年间的发展并不是一帆风顺。而中医体质学说在疾病的预防及治疗方面,发挥着重要作用,尤其是在慢性病的健康管理方面有突出作用,但目前无论是退行性骨关节炎的体质学研究,还是健康管理研究,都进行的较少,也不够深入。
目的
用综述的方式了解中医体质与疾病相关性的研究进展以及退行性骨关节炎流行病学的研究进展,对退行性骨关节炎中医健康管理模式的构建与应用进行理论探讨和临床研究,通过调查表的形式调查退行性骨关节炎的常见影响因素和体质,探讨中老年退行性骨关节炎与常见影响因素的相关性、与中医体质的相关性,在三级预防理论的基础上对中老年退行性骨关节炎中医健康管理模式的构建进行初步探讨,建立以中医体质学说为基础的中医健康管理模式,并应用这一模式对中老年退行性骨关节炎患者进行健康干预,观察干预效果,同时优化方案。
方法
1.文献回顾与理论研究：通过查阅文献的形式了解国内外慢性病健康管理的研究现状,重点回顾骨关节炎健康管理的研究现状；通过传统综述的形式回顾中医体质学的研究现状,重点回顾中医体质与疾病相关性的研究现状；通过传统综述的形式回顾退行性骨关节炎中西医治疗研究进展,在当前治疗现状的基础上探讨中医健康管理与疾病治疗整合的办法。
2.临床研究一：中老年退行性骨关节炎影响因素及中医体质相关性研究：选择广东省第二中医院骨科门诊确诊的124例骨性关节炎中老年患者为病例组,124例非骨性关节炎中老年志愿者为对照组,实施横断面现场调查。由研究者用统一的调查表(中医体质量表和骨关节炎影响因素调查问卷)收集影响因素资料和体质分布资料,对统计出的影响因素进行单因素分析,单因素分析筛选出的影响因素采用多因素Logistic回归分析的方法分析退行性骨关节炎的危险因素与保护因素；对于骨关节炎的体质分布资料,用平和质做对照,采用多因素Logistic回归分析的方法对体质调查数据进行分析,分析退行性骨关节炎的危险体质。
3.临床研究二：中医健康管理干预肝肾亏虚型膝骨关节炎的临床研究：选择就诊于我院许学猛教授门诊的肝肾亏虚型膝骨关节炎患者共72例,应用随机数字号码表,通过随机对照的方法,将患者随机分为试验组和对照组。两组均接受“骨筋肉”并重特色疗法治疗,试验组治疗同时给予中医健康管理干预。“骨筋肉”并重特色疗法具体包括穴位注射、中药口服、五籽散外熨和功能锻炼；肝肾亏虚型膝骨关节炎中医健康管理方案参照临床研究一的结果制订。
结果
1.临床研究一
(1)临床调查：我院门诊中老年人退行性骨关节炎患者的患病比率最高的是膝关节,占所有患者的45.97%,其余依次为腰椎、颈椎、髋关节、踝关节的39.52%、8.87%、4.03%、1.61%。不同影响因素对退行性骨关节炎的影响不尽相同,应用卡方检验进行单因素分析,分析结果得出包括年龄、性别、体质量指数(BMI)、工作姿势、劳动类型、家族史、关节外伤史、蹲坑排便习惯、饮酒、失眠和焦虑、居住楼梯房、食用水果、体育锻炼、运动形式、健康知识获得15个影响因素与骨关节炎的发病有相关性,将单因素分析筛选出的相关因素进行多因素Logistic回归分析(变量筛选方法：Forward:LR,变量入选标准α=0.05,剔除标准为0.1),筛选骨关节炎的相关危险因素。结果显示,性别、体重指数(BMI)、蹲坑排便习惯、运动形式、健康知识获得方式是退行性骨关节炎的相关因素。具体表现为：男性相对于女性骨关节炎的发病风险更低(OR=0.955,95%CI：0.920-0.991,P=0.014)；体重指数越大(越肥胖)者骨关节炎的发病风险更高(OR=-1.252,95%CI：1.080-1.452,P=-0.004)；有蹲坑排便习惯者相对于无蹲坑排便习惯者骨关节炎的发病风险更高(OR=-1.525,95%CI：1.357～1.713,P=0.001)；运动形式为负重运动者相对于运动形式为伸展力量运动者骨关节炎的发病风险更高(OR=0.549,95%CI：0.325～0.928,P=-0.025)；主动获取健康知识相对于被动获取知识者骨关节炎的发病风险更低(OR=-0.047,95%CI：0.006～0.363,P=0.005)。通过多因素Logistic回归分析结果显示：与平和质相比,阳虚体质(P=0.002)人群患骨关节炎病的危险度显著增高(OR值为1.329,95%CI：1.109～1.593)；与平和质相比,血瘀体质(P=0.029)人群患骨关节炎的危险度显著增高(OR值为2.755,95%CI：1.110～6.836)。
(2)制订退行性骨关节炎中医健康管理方案：通过退行性骨关节炎与体质、影响因素二者关系的研究,基于三级预防理论,制订了退行性骨关节炎的中医健康管理方案。该方案包括体质调护方案和退行性骨关节炎专病健康管理方案两部分。根据退行性骨关节炎的危险体质,制订了阳虚质和血瘀质的体质调护方案,具体内容包括环境起居、形体运动、精神调适、膳食调理、药物调养、音乐及其他调摄六个方面；退行性骨关节炎的专病健康管理方案的具体内容包括饮食管理、运动管理、起居管理、疾病管理和体重管理五个部分。根据三级预防理论,一级预防主要在于生活方式管理,目的在于调整偏颇体质,监测疾病的发生,适用体质调护方案；二级预防主要针对危险体质和危险因素,通过对危险体质的干预希望能改变为平和体质,通过规避危险因素减少患病风险,适用体质调护方案+OA专病健康管理方案的联合方案；三级预防为临床辅助,主要是根据患者的病情采取积极的治疗措施防止病情的发展和传变,适用临床治疗+体质调护方案+OA专病健康管理方案的联合方案。
2.临床研究二
肝肾亏虚型骨关节炎的体质分类中,阳虚质占了较大比例,试验组和对照组分别为25例、27例,总的体质分布无显著性差异(X2=1.021,P=0.796),试验组和对照组主要危险因素——性别、是否使用蹲坑排便、体质量指数未见明显差异。两组均于治疗三个月后行疗效评价,两组病例均未出现脱落,没有出现中止临床试验的情况。试验组疗效评价的结果为：临床控制6例,显效21例,有效7例,无效2例,总有效率为94.4%；对照组疗效评价结果为：临床控制3例,显效13例,有效13例,无效7例,总有效率为80.6%；两组结果经Ridit分析,结果有统计学意义(卡方值=7.460P=0.009<0.05),试验组的秩均值为30.47,对照组的秩均值为42.53,提示试验组治疗3个月后疗效优于对照组。
结论
1.在退行性骨关节炎与体质、影响因素的相关性研究中得出了骨关节炎的危险体质为阳虚质、血瘀质,危险因素为性别、BMI、蹲坑排便习惯,保护因素为伸展力量运动和主动获取健康知识的结论。丰富了退行性骨关节炎的发病理论,为“体病相关”的论点提供了新的理论依据。
2.在理论探讨和调查研究的基础上,成功构建了退行性骨关节炎的中医健康管理模式,能够有效对健康人群,高危人群和患病人群进行健康管理,满足临床预防、治疗、康复三方面的需要。
3.建立了中医体质调护方案与专病健康管理方案相结合的慢性病健康管理模式,可按实际情况进行搭配、调整,能满足个体化需要,简便易行。
Background
Nowadays more and more studies have shown an increasing incidence rate of osteoarthritis with the extension of average life expectancy, which consequently has caused wide attention within the medical field. The scientific research team of Professor Lorig KR did a series of management researches in1970s, which indicated that osteoarthritis health management can effectively relieve pain, reduce the number of medical treatment and save the cost of treatment and rehabilitation. In China, due to the imperfect construction of the medical system and the masses of ordinary knowledge level constraints, the development of health management in China in ten years is not good. The Constitution Theory of Traditional Chinese Medicine (TCM) plays an important role in the prevention and treatment of diseases and has a prominent role in the chronic health management aspects, but neither the studies of degenerative osteoarthritis nor the health management studies are seldom carried out and not deep enough.
Objective
To review the related TCM constitution and disease research progress, degenerative osteoarthritis epidemiological research on degenerative osteoarthritis and to construct the application research on theory and application of degenerative osteoarthritis of TCM health management mode. With questionnaire survey common factors and physicals of degenerative osteoarthritis, the correlation between common factors and degenerative osteoarthritis and the degenerative osteoarthritis and TCM physical were explored. By Discussing the TCM Health Management System based on tertiary prevention, the system based on physique theory of TCM was established. For intervene degenerative osteoarthritis patients, the TCM Health Management System of degenerative osteoarthritis were used and the intervention effects were observed while optimizing the systems.
Methods
1literature review and theoretical study:By reviewing the papers of domestic and foreign research progress, it was focused on research status of osteoarthritis health management. By understanding research situation about the relationship between physique and disease, it was focused on research status the relationship between physique and disease. By understanding research progress of TCM and western medicine treatment of degenerative osteoarthritis, it was explored the integrative method about disease and health management of TCM based on the current treatment situation.
2Clinical Research Ⅰ
The correlation study about degenerative osteoarthritis influence factors and physique. In the disease group were the124osteoarthritis senile patients selected from Guangdong Second Provincial TCM Hospital and diagnosed as degenerative osteoarthritis. In the control group were the124volunteers with senile osteoarthritis that were not in the bone joints. A cross-sectional on-the-spot investigation was taken to all these patients with the " Traditional Chinese Medicine Physical Scale " and " Degenerative Osteoarthritis Influencing Factors Questionnaires". By collecting physical factors and affecting the physique distribution data, the questionnaires were applied and the influence factors by statistics were assessed by single factor analysis, then based on single factor analysis, the risk factors and protect factors of the degenerative osteoarthritis infection were analyzed by multi-factorial logistic regression. For the physical distribution data of osteoarthritis, normal type as control, the physical distribution data of the degenerative osteoarthritis infection were analyzed by multi-factorial logistic regression.
3Clinical research Ⅱ
Clinical research on liver and kidney deficiency type knee osteoarthritis Chinese medicine health management mode:the choice of treatment in our hospital outpatient Professor Xu Xuemeng syndrome of deficiency of liver and kidney.in patients with knee osteoarthritis in72cases, using random number table, through random control method, the patients were divided into test group and control group. The two groups were received "bone muscle" and characteristic treatment, while giving the Chinese medicine health management intervention trial group."Bone muscle" and characteristic therapy including oral medicine, acupuncture point injection, five seeds scattered outside the ironing and functional exercise; according to deficiency of the liver and kidney the knee osteoarthritis Chinese medicine health management program clinical study results for.
Results
1Clinical Research I
Clinical investigation:In our hospital, elderly patients with degenerative osteoarthritis of knee joint prevalence rate is the highest, accounting for45.97%of all patients, followed by the rest of the lumbar, cervical vertebra, hip joint, ankle is39.52%,8.87%,4.03%,1.61%. Effect of different factors on degenerative osteoarthritis, chi-square test was used for univariate analysis, the analysis results found that age, sex, body mass index (BMI), work posture, labor type, family history, joint trauma history, squatting defecation habit, alcohol drinking, insomnia and anxiety, living storey, edible fruit, physical exercise, sport form, health knowledge obtained form, they are all factors that influence the degenerative osteoarthritis. The Logistic regression multivariate analysis of factors associated with screening out single factor analysis (screening method:variable Forward:LR, variable selection criteria=0.05, excluding standard is0.1), related risk factors of bone and joint inflammation. The related factors of degenerative osteoarthritis include sex, body mass index (BMI), squatting defecation habit, sport form and health knowledge acquisition. Concrete manifestation:men to lower the risk of female osteoarthritis (OR=0.955,95%CI:0.920-0.991, P=0.014); a higher BMI (more obesity risk of osteoarthritis) were higher (0R=1.252,95%CI:1.080-1.452, P=0.004); a squatting defecation habits are higher than the risk of not squatting defecation habit bone arthritis (OR=1.525,95%CI:1.357-1.713, P=0.001); weight-bearing exercise is higher risk than stretching and strength exercises(OR=0.549,95%CI:0.325-0.928, P=0.025) active access health knowledge to lower risk than passively acquired knowledge of osteoarthritis (OR=0.047,95%CI:0.006-0.363, P=0.005). By multiple factor Logistic regression analysis:compared with the mild physical, deficiency of Yang (P=0.002) risk groups of patients with osteoarthritis were significantly higher (OR=1.329,95%CI:1.109～1.593); compared with the mild physical, blood stasis constitution (P=0.029) risk of people suffering from osteoarthritis was significantly increased (OR value2.755,95%CI:1.1106.836).
(2) Construction degenerative osteoarthritis of the TCM system of degenerative osteoarthritis:through the research of degenerative osteoarthritis and physique, influence factors of the relationship between the two, three levels of prevention based on the theory of traditional Chinese medicine health management plan, formulated the degenerative osteoarthritis. The scheme includes physical nursing plan and degenerative osteoarthritis disease health management program in two parts. According to the risk constitution of degenerative osteoarthritis of Yang deficiency and blood stasis, formulate the constitution adjustment scheme, the concrete content includes six aspects of environmental living, physical movement, mental adjustment, diet, drug therapy, music and other measures; the specific content of degenerative osteoarthritis disease health management program includes five a part of food management, sports management, personal management, disease management and weight management. According to the three levels of prevention theory, primary prevention is the main way of life management, the purpose is to adjust biased physique, monitoring disease, suitable physical nursing program; two levels of prevention mainly for physical and dangerous risk factors, the risk of physical intervention to change into peace constitution, by avoiding risk factors to reduce risk, joint program of health management for physical adjustment scheme of+0A special diseases health management scheme; three levels of prevention for clinical assistant, mainly take active treatment according to the condition of patients to prevent disease development and transfer, joint plan of health management for clinical treatment of health nursing program+0A special diseases health management scheme.
2Clinical research Ⅱ
Constitution of deficiency liver and kidney knee osteoarthritis, Yang deficiency accounted for the larger proportion, the test group and the control group were25cases,27cases, no significant difference in total physical distribution (X2=1.021,P=0.796), the test group and the control group, the main risk factors-gender, whether to use squatting defecation, body mass index, no significant difference. The patients in the two groups three months after curative effect evaluation, two cases were no shedding, no suspension of clinical test situation. Clinical evaluation of test results for:6cases of clinical control,21cases markedly effective, effective7cases, invalid2cases, the total efficiency of94.4%; control group curative effect evaluation result is:3cases of clinical control,13cases markedly effective, effective13cases, invalid7cases, the total efficiency of80.6%; the results of two groups Ridit analysis, the results were statistically significant (chi-square=7.460P=0.009<0.05), rank mean test group was30.47, control rank mean group was42.53, suggesting the test group3months after treatment the curative effect is better than that of the control group.
Conclusion
1.The correlation study about degenerative osteoarthritis influencing factors and constitution, we found that yang deficiency and blood stasis were dangerous constitutions, gender、BMI、squat-defecation habits were dangerous factors, protect factors were stretching and strength exercises、active healthy information acquisition. Enrich the pathogenesis theory of degenerative osteoarthritis, provides new theoretical for "correlation of constitution and disease" argument.
2. Based on discussion and investigation on the theory and research, construct the degenerative osteoarthritis of TCM health management mode, can management the healthy people、high-risk people and patients, to satisfy the need of clinical prevention, treatment, rehabilitation of three aspects.
3. Construct chronic disease health management mode use constitution of TCM regulating scheme and special diseases health management scheme. Can be adjusted according to the actual situation, to meet the individual needs, simple and easy.
现代研究表明,随着人均寿命的延长,以退行性骨关节炎为主的骨关节病的发病率呈迅速上升趋势,引起了医学界的广泛重视,以Lorig KR教授为核心的科研团队在上世纪七十年代针对骨关节炎进行了一系列健康管理方面的研究,最终形成一整套关节炎健康管理项目,也证明了骨关节炎的健康管理能够有效缓解疼痛,减少就医次数,降低治疗和康复的费用。但在中国,由于医疗体系建设的不完善,普通群众的知识层次的限制,健康管理在中国十年间的发展并不是一帆风顺。而中医体质学说在疾病的预防及治疗方面,发挥着重要作用,尤其是在慢性病的健康管理方面有突出作用,但目前无论是退行性骨关节炎的体质学研究,还是健康管理研究,都进行的较少,也不够深入。
目的
用综述的方式了解中医体质与疾病相关性的研究进展以及退行性骨关节炎流行病学的研究进展,对退行性骨关节炎中医健康管理模式的构建与应用进行理论探讨和临床研究,通过调查表的形式调查退行性骨关节炎的常见影响因素和体质,探讨中老年退行性骨关节炎与常见影响因素的相关性、与中医体质的相关性,在三级预防理论的基础上对中老年退行性骨关节炎中医健康管理模式的构建进行初步探讨,建立以中医体质学说为基础的中医健康管理模式,并应用这一模式对中老年退行性骨关节炎患者进行健康干预,观察干预效果,同时优化方案。
方法
1.文献回顾与理论研究：通过查阅文献的形式了解国内外慢性病健康管理的研究现状,重点回顾骨关节炎健康管理的研究现状；通过传统综述的形式回顾中医体质学的研究现状,重点回顾中医体质与疾病相关性的研究现状；通过传统综述的形式回顾退行性骨关节炎中西医治疗研究进展,在当前治疗现状的基础上探讨中医健康管理与疾病治疗整合的办法。
2.临床研究一：中老年退行性骨关节炎影响因素及中医体质相关性研究：选择广东省第二中医院骨科门诊确诊的124例骨性关节炎中老年患者为病例组,124例非骨性关节炎中老年志愿者为对照组,实施横断面现场调查。由研究者用统一的调查表(中医体质量表和骨关节炎影响因素调查问卷)收集影响因素资料和体质分布资料,对统计出的影响因素进行单因素分析,单因素分析筛选出的影响因素采用多因素Logistic回归分析的方法分析退行性骨关节炎的危险因素与保护因素；对于骨关节炎的体质分布资料,用平和质做对照,采用多因素Logistic回归分析的方法对体质调查数据进行分析,分析退行性骨关节炎的危险体质。
3.临床研究二：中医健康管理干预肝肾亏虚型膝骨关节炎的临床研究：选择就诊于我院许学猛教授门诊的肝肾亏虚型膝骨关节炎患者共72例,应用随机数字号码表,通过随机对照的方法,将患者随机分为试验组和对照组。两组均接受“骨筋肉”并重特色疗法治疗,试验组治疗同时给予中医健康管理干预。“骨筋肉”并重特色疗法具体包括穴位注射、中药口服、五籽散外熨和功能锻炼；肝肾亏虚型膝骨关节炎中医健康管理方案参照临床研究一的结果制订。
结果
1.临床研究一
(1)临床调查：我院门诊中老年人退行性骨关节炎患者的患病比率最高的是膝关节,占所有患者的45.97%,其余依次为腰椎、颈椎、髋关节、踝关节的39.52%、8.87%、4.03%、1.61%。不同影响因素对退行性骨关节炎的影响不尽相同,应用卡方检验进行单因素分析,分析结果得出包括年龄、性别、体质量指数(BMI)、工作姿势、劳动类型、家族史、关节外伤史、蹲坑排便习惯、饮酒、失眠和焦虑、居住楼梯房、食用水果、体育锻炼、运动形式、健康知识获得15个影响因素与骨关节炎的发病有相关性,将单因素分析筛选出的相关因素进行多因素Logistic回归分析(变量筛选方法：Forward:LR,变量入选标准α=0.05,剔除标准为0.1),筛选骨关节炎的相关危险因素。结果显示,性别、体重指数(BMI)、蹲坑排便习惯、运动形式、健康知识获得方式是退行性骨关节炎的相关因素。具体表现为：男性相对于女性骨关节炎的发病风险更低(OR=0.955,95%CI：0.920-0.991,P=0.014)；体重指数越大(越肥胖)者骨关节炎的发病风险更高(OR=-1.252,95%CI：1.080-1.452,P=-0.004)；有蹲坑排便习惯者相对于无蹲坑排便习惯者骨关节炎的发病风险更高(OR=-1.525,95%CI：1.357～1.713,P=0.001)；运动形式为负重运动者相对于运动形式为伸展力量运动者骨关节炎的发病风险更高(OR=0.549,95%CI：0.325～0.928,P=-0.025)；主动获取健康知识相对于被动获取知识者骨关节炎的发病风险更低(OR=-0.047,95%CI：0.006～0.363,P=0.005)。通过多因素Logistic回归分析结果显示：与平和质相比,阳虚体质(P=0.002)人群患骨关节炎病的危险度显著增高(OR值为1.329,95%CI：1.109～1.593)；与平和质相比,血瘀体质(P=0.029)人群患骨关节炎的危险度显著增高(OR值为2.755,95%CI：1.110～6.836)。
(2)制订退行性骨关节炎中医健康管理方案：通过退行性骨关节炎与体质、影响因素二者关系的研究,基于三级预防理论,制订了退行性骨关节炎的中医健康管理方案。该方案包括体质调护方案和退行性骨关节炎专病健康管理方案两部分。根据退行性骨关节炎的危险体质,制订了阳虚质和血瘀质的体质调护方案,具体内容包括环境起居、形体运动、精神调适、膳食调理、药物调养、音乐及其他调摄六个方面；退行性骨关节炎的专病健康管理方案的具体内容包括饮食管理、运动管理、起居管理、疾病管理和体重管理五个部分。根据三级预防理论,一级预防主要在于生活方式管理,目的在于调整偏颇体质,监测疾病的发生,适用体质调护方案；二级预防主要针对危险体质和危险因素,通过对危险体质的干预希望能改变为平和体质,通过规避危险因素减少患病风险,适用体质调护方案+OA专病健康管理方案的联合方案；三级预防为临床辅助,主要是根据患者的病情采取积极的治疗措施防止病情的发展和传变,适用临床治疗+体质调护方案+OA专病健康管理方案的联合方案。
2.临床研究二
肝肾亏虚型骨关节炎的体质分类中,阳虚质占了较大比例,试验组和对照组分别为25例、27例,总的体质分布无显著性差异(X2=1.021,P=0.796),试验组和对照组主要危险因素——性别、是否使用蹲坑排便、体质量指数未见明显差异。两组均于治疗三个月后行疗效评价,两组病例均未出现脱落,没有出现中止临床试验的情况。试验组疗效评价的结果为：临床控制6例,显效21例,有效7例,无效2例,总有效率为94.4%；对照组疗效评价结果为：临床控制3例,显效13例,有效13例,无效7例,总有效率为80.6%；两组结果经Ridit分析,结果有统计学意义(卡方值=7.460P=0.009<0.05),试验组的秩均值为30.47,对照组的秩均值为42.53,提示试验组治疗3个月后疗效优于对照组。
结论
1.在退行性骨关节炎与体质、影响因素的相关性研究中得出了骨关节炎的危险体质为阳虚质、血瘀质,危险因素为性别、BMI、蹲坑排便习惯,保护因素为伸展力量运动和主动获取健康知识的结论。丰富了退行性骨关节炎的发病理论,为“体病相关”的论点提供了新的理论依据。
2.在理论探讨和调查研究的基础上,成功构建了退行性骨关节炎的中医健康管理模式,能够有效对健康人群,高危人群和患病人群进行健康管理,满足临床预防、治疗、康复三方面的需要。
3.建立了中医体质调护方案与专病健康管理方案相结合的慢性病健康管理模式,可按实际情况进行搭配、调整,能满足个体化需要,简便易行。
Background
Nowadays more and more studies have shown an increasing incidence rate of osteoarthritis with the extension of average life expectancy, which consequently has caused wide attention within the medical field. The scientific research team of Professor Lorig KR did a series of management researches in1970s, which indicated that osteoarthritis health management can effectively relieve pain, reduce the number of medical treatment and save the cost of treatment and rehabilitation. In China, due to the imperfect construction of the medical system and the masses of ordinary knowledge level constraints, the development of health management in China in ten years is not good. The Constitution Theory of Traditional Chinese Medicine (TCM) plays an important role in the prevention and treatment of diseases and has a prominent role in the chronic health management aspects, but neither the studies of degenerative osteoarthritis nor the health management studies are seldom carried out and not deep enough.
Objective
To review the related TCM constitution and disease research progress, degenerative osteoarthritis epidemiological research on degenerative osteoarthritis and to construct the application research on theory and application of degenerative osteoarthritis of TCM health management mode. With questionnaire survey common factors and physicals of degenerative osteoarthritis, the correlation between common factors and degenerative osteoarthritis and the degenerative osteoarthritis and TCM physical were explored. By Discussing the TCM Health Management System based on tertiary prevention, the system based on physique theory of TCM was established. For intervene degenerative osteoarthritis patients, the TCM Health Management System of degenerative osteoarthritis were used and the intervention effects were observed while optimizing the systems.
Methods
1literature review and theoretical study:By reviewing the papers of domestic and foreign research progress, it was focused on research status of osteoarthritis health management. By understanding research situation about the relationship between physique and disease, it was focused on research status the relationship between physique and disease. By understanding research progress of TCM and western medicine treatment of degenerative osteoarthritis, it was explored the integrative method about disease and health management of TCM based on the current treatment situation.
2Clinical Research Ⅰ
The correlation study about degenerative osteoarthritis influence factors and physique. In the disease group were the124osteoarthritis senile patients selected from Guangdong Second Provincial TCM Hospital and diagnosed as degenerative osteoarthritis. In the control group were the124volunteers with senile osteoarthritis that were not in the bone joints. A cross-sectional on-the-spot investigation was taken to all these patients with the " Traditional Chinese Medicine Physical Scale " and " Degenerative Osteoarthritis Influencing Factors Questionnaires". By collecting physical factors and affecting the physique distribution data, the questionnaires were applied and the influence factors by statistics were assessed by single factor analysis, then based on single factor analysis, the risk factors and protect factors of the degenerative osteoarthritis infection were analyzed by multi-factorial logistic regression. For the physical distribution data of osteoarthritis, normal type as control, the physical distribution data of the degenerative osteoarthritis infection were analyzed by multi-factorial logistic regression.
3Clinical research Ⅱ
Clinical research on liver and kidney deficiency type knee osteoarthritis Chinese medicine health management mode:the choice of treatment in our hospital outpatient Professor Xu Xuemeng syndrome of deficiency of liver and kidney.in patients with knee osteoarthritis in72cases, using random number table, through random control method, the patients were divided into test group and control group. The two groups were received "bone muscle" and characteristic treatment, while giving the Chinese medicine health management intervention trial group."Bone muscle" and characteristic therapy including oral medicine, acupuncture point injection, five seeds scattered outside the ironing and functional exercise; according to deficiency of the liver and kidney the knee osteoarthritis Chinese medicine health management program clinical study results for.
Results
1Clinical Research I
Clinical investigation:In our hospital, elderly patients with degenerative osteoarthritis of knee joint prevalence rate is the highest, accounting for45.97%of all patients, followed by the rest of the lumbar, cervical vertebra, hip joint, ankle is39.52%,8.87%,4.03%,1.61%. Effect of different factors on degenerative osteoarthritis, chi-square test was used for univariate analysis, the analysis results found that age, sex, body mass index (BMI), work posture, labor type, family history, joint trauma history, squatting defecation habit, alcohol drinking, insomnia and anxiety, living storey, edible fruit, physical exercise, sport form, health knowledge obtained form, they are all factors that influence the degenerative osteoarthritis. The Logistic regression multivariate analysis of factors associated with screening out single factor analysis (screening method:variable Forward:LR, variable selection criteria=0.05, excluding standard is0.1), related risk factors of bone and joint inflammation. The related factors of degenerative osteoarthritis include sex, body mass index (BMI), squatting defecation habit, sport form and health knowledge acquisition. Concrete manifestation:men to lower the risk of female osteoarthritis (OR=0.955,95%CI:0.920-0.991, P=0.014); a higher BMI (more obesity risk of osteoarthritis) were higher (0R=1.252,95%CI:1.080-1.452, P=0.004); a squatting defecation habits are higher than the risk of not squatting defecation habit bone arthritis (OR=1.525,95%CI:1.357-1.713, P=0.001); weight-bearing exercise is higher risk than stretching and strength exercises(OR=0.549,95%CI:0.325-0.928, P=0.025) active access health knowledge to lower risk than passively acquired knowledge of osteoarthritis (OR=0.047,95%CI:0.006-0.363, P=0.005). By multiple factor Logistic regression analysis:compared with the mild physical, deficiency of Yang (P=0.002) risk groups of patients with osteoarthritis were significantly higher (OR=1.329,95%CI:1.109～1.593); compared with the mild physical, blood stasis constitution (P=0.029) risk of people suffering from osteoarthritis was significantly increased (OR value2.755,95%CI:1.1106.836).
(2) Construction degenerative osteoarthritis of the TCM system of degenerative osteoarthritis:through the research of degenerative osteoarthritis and physique, influence factors of the relationship between the two, three levels of prevention based on the theory of traditional Chinese medicine health management plan, formulated the degenerative osteoarthritis. The scheme includes physical nursing plan and degenerative osteoarthritis disease health management program in two parts. According to the risk constitution of degenerative osteoarthritis of Yang deficiency and blood stasis, formulate the constitution adjustment scheme, the concrete content includes six aspects of environmental living, physical movement, mental adjustment, diet, drug therapy, music and other measures; the specific content of degenerative osteoarthritis disease health management program includes five a part of food management, sports management, personal management, disease management and weight management. According to the three levels of prevention theory, primary prevention is the main way of life management, the purpose is to adjust biased physique, monitoring disease, suitable physical nursing program; two levels of prevention mainly for physical and dangerous risk factors, the risk of physical intervention to change into peace constitution, by avoiding risk factors to reduce risk, joint program of health management for physical adjustment scheme of+0A special diseases health management scheme; three levels of prevention for clinical assistant, mainly take active treatment according to the condition of patients to prevent disease development and transfer, joint plan of health management for clinical treatment of health nursing program+0A special diseases health management scheme.
2Clinical research Ⅱ
Constitution of deficiency liver and kidney knee osteoarthritis, Yang deficiency accounted for the larger proportion, the test group and the control group were25cases,27cases, no significant difference in total physical distribution (X2=1.021,P=0.796), the test group and the control group, the main risk factors-gender, whether to use squatting defecation, body mass index, no significant difference. The patients in the two groups three months after curative effect evaluation, two cases were no shedding, no suspension of clinical test situation. Clinical evaluation of test results for:6cases of clinical control,21cases markedly effective, effective7cases, invalid2cases, the total efficiency of94.4%; control group curative effect evaluation result is:3cases of clinical control,13cases markedly effective, effective13cases, invalid7cases, the total efficiency of80.6%; the results of two groups Ridit analysis, the results were statistically significant (chi-square=7.460P=0.009<0.05), rank mean test group was30.47, control rank mean group was42.53, suggesting the test group3months after treatment the curative effect is better than that of the control group.
Conclusion
1.The correlation study about degenerative osteoarthritis influencing factors and constitution, we found that yang deficiency and blood stasis were dangerous constitutions, gender、BMI、squat-defecation habits were dangerous factors, protect factors were stretching and strength exercises、active healthy information acquisition. Enrich the pathogenesis theory of degenerative osteoarthritis, provides new theoretical for "correlation of constitution and disease" argument.
2. Based on discussion and investigation on the theory and research, construct the degenerative osteoarthritis of TCM health management mode, can management the healthy people、high-risk people and patients, to satisfy the need of clinical prevention, treatment, rehabilitation of three aspects.
3. Construct chronic disease health management mode use constitution of TCM regulating scheme and special diseases health management scheme. Can be adjusted according to the actual situation, to meet the individual needs, simple and easy.
引文
[1]Cooper C, Campbell L, Byng P, et al. Occupational activity and the risk of hip osteoarthritis. [J]. Ann Rheum Dis,1996,55:680-682
[2]李宁华,薛庆云,张毅等.中国六城市中老年人群X线膝骨关节炎流行病学分析[J].实用医学杂志,2008,24(16)：2887-2888.
[3]Roland W, Roy D, Mare C, et al. Osteoarthritis. [M]. Lippincott Williams & Wilkins, 2006,4
[4]陈君石等.《健康管理在健康保险中的应用》与趋势.[J].《健康管理与健康保险高层论坛》论文集.2003.
[5]黄建始.美国的健康管理：源自无法遏制的医疗费用增长[J].中华医学杂志,2006,86(15)：1011-1013.
[6]李莉.英国国家卫生制度及对中国的借鉴[J].改革与战略.2006,9：21-24
[7]魏炜,赵亮.现代健康管理模式浅析[J].卫生经济研究.2006,5：19-21
[8]卫生部公布第四次国家卫生服务调查主要结果[EB]. http://www.Gov.Cn/gzdt/ 2009-02/27/content_1245006.htm
[9]中华医学会健康管理学分会,中华健康管理学杂志编委会.健康管理概念与学科体系的中国专家初步共识[J].中华健康管理学杂志,2009,3：141-147
[10]卫生部疾病控制司.《慢性非传染性疾病预防医学诊疗规范》.2002.
[11]赵润栓,高楠楠,谢燕,体质调养在健康管理实践中的应用体会.中国疗养医学,2011,20(4)：297-299
[12]孟春英,郭颖,曹爽,等.“知己”健康管理模式在社区慢性病管理中的应用[J]护理学杂志,2008,(8)：59-61.
[13]朱俊峰。46例慢性病病人健康管理疗效的观察[J].中国医药导,2009,(11)：330-331.
[14]张宏伟,李晓莹.某银行105名职工慢性病健康管理[J].中华健康管理学杂志,2008,2(1)：36-38.
[15]周军,李详成.慢性病健康管理非药物干预模式的研究初探[J].中国公共卫生管理,2008,24(3)：289-290.
[16]冯超,吴琴琴,马继红,等.健康管理中心的慢性病管理[J].现代预防医学2008,35(8)：1517-1518.
[17]李星明,黄建始.健康管理和社区卫生整合对慢性病防治的意义与服务模式探讨[J].疾病控制杂志,2008,12(1)：53-57.。
[18]中华中医药学会.中医体质分类与判定[M].中国中医药出版社,2009
[19]黄绮丹,熊晓红等.中医体质学说与现代健康管理.中国中医药医药现代远程教育.2007,5(7)：5-7
[20]Stanford Patient Education Research Center. Arthritis Self-Management (Self-Help) Program. [EB/OL]. [2009-05-19]. http://patienteducation. stanford.edu/programs/asmp.html
[21]Warsi A, La Valley MP, Wang PS, ey al. Arthritis self-management education programs: ameta-analysis of the effect on pain and disability[J]. Arthritis Rheum,2003,48(8): 2207-2213.
[22]Chodosh J, Morton SC, Mojica W, et al. Meta-analysis:chronic disease self-management programs for older adults[J]. Ann Intern Med,2005,143(6):427-438.
[23]Jordan JL, Holden MA, Mason EEJ, et al. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults [J]. Cochrane Database Svst Rev, 2010, (1):CD005956.
[24]Smith C, Kumar S, Pelling N. The effectiveness of self-management educational interventions for osteoarthritis of the knee [J]. JBI Library Syst Rev,2009,7C25):1089-1116.
[25]Devos-Comby L, Cronan T, Roesch SC. Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review [J]. J Rheumatol, 2006,33(4)
[26]Walsh NE, Mitchell HL, Reeves BC, et al. Integrated exercise andself-management programmes in osteoarthritis of the hip and knee:a systematic review of effectiveness[J]. Phys Ther Rev,2006,11(4):289-298.
[27]May S. Self-management of chronic low back pain and osteoarthritis[J]. Nat Rev Rheumatol,2010,64:199-209.
[28]孙丽媛,刘素珍,成翼娟.社区居民关节炎白我健康管理干预效果研究[J].现代预防医学：2010,37(13)：2447-2450
[29]王琦,朱燕波.中国一般人群中医体质流行病学调查——基于全国9省市21948例流行病学调查数据[J].中华中医药杂志,2009,24(1)：7-12
[30]王琦.中医体质三论[J].北京中医药大学学报,2008,31(10)：653-655.
[31]王琦.论中医体质研究的3个关键问题(下)[J].中医杂志,2006,47(5)：329-332
[32]王琦,朱燕波,吴玉娥.肥胖、超重与正常体质量高血压患者的中医体质类型分布特点比较研究[J].中华中医药杂志.2011,26(8)：1676-1679
[33]蔡亮,江静华,杨健松.骨量减少及骨质疏松症中医体质分类与辨证分型相关性研究[J].新中医.2011,43(7)：51-52
[34]余敏英,黄李平,梁莉等,广西地区335例原发性血脂异常者中医体质调查研究[J].湖南中医杂志.2011,27(6)：87-89
[35]韦芳宁,王莉.414例慢性肾脏病患者中医体质特征研究[J].国际医药卫生导报,2009,15(1)：5-8.
[36]周晓燕,刘晓虹,卢玉蕾,等.糖耐量低减中医体质分型与胰岛素水平的关系[J].湖南中医杂志,2010,26(1)：53-54.
[37]孙理军,崔刚,王震.咸阳地区糖尿病中医体质的临床调查研究[J].陕西中医学院学报,2010,33(4)：35-36.
[38]孟萍,邓棋,卫王静等.中医体质因素与非酒精性脂肪肝的发病相关性研究[J].光明中医,2008,23(9)：1245-1247.
[39]张向农,王欣,王梅,等.355例肿瘤患者中医体质类型流行病学调查研究[J].中国中医药信息杂志,2010,17(5)：13-16.
[40]姜峰.季节性过敏性鼻炎患者中医体质特点研究[J].中国中医基础医学杂志,2007,13(9)：705-706.
[41]夏仲元,王琦,郭琪.甲亢和甲减中医体质类型调查分析[J].北京中医药大学学报,33(4)：280-282.
[42]胡学军,龙顺钦,杨小兵等.原发性肝癌的中医体质调查分析[J].时珍国医国药.2010,21(4)：995-997.
[43]司纪广,石传科,张强,等.106例下肢静脉曲张患者中医体质辨证调查分析[J].辽宁中医杂志.2005,32(10)：1032-1033.
[44]李斌,张成会,刘红霞.583例寻常型银屑病患者中医体质特征研究[J].四川中医.2010(10)：62-64.
[45]苟运浩,刘长灵,过建春等.中医体质和HBV感染结局的相关性研究.中国中医药科技.2010,17(6)：473-474
[46]王玉霞,任翠梅,李润杰等.中医体质辨识融入社区健康管理对代谢综合征的防治效果分析[J].中国全科医学.2012.15(2A),459-461
[47]王长海,栗平,马志新,等.老年髋部骨折患者中医体质类型与骨密度关系的病例对照研究[J].中国骨质疏松杂志,2010,16,(9)：655-658.
[48]刘培中,李创鹏,刘志龙等.600例高血压病患者危险因素与中医体质分类的相关性研究[J].新中医.2011,43(60)：19-21
[49]刘璠,刘莲,陈新林.600例慢性高原病患者中医体质特点研究[J].中医研究.2010,23(2)：38-40
[50]韩丽蓓,崔红霞,刘金凤等.2型糖尿病合并高脂血症患者中医体质类型及与血脂指标的相关性研究[J].北京中医药大学学报.2011,18(3),4-7
[51]潘朝锌,王庆高,何新兵,等.冠脉血栓形成的中医体质特点临床研究[J].新中医,2010,
[52]张云云,张海梅,郭德莹,等.168例缺血性脑卒中患者体质特点研究[J].上海中医药杂志,2008,42(2)：31-34
[53]罗广波,唐爱华,周燕,等.不同体质的糖调节受损患者与胰岛素抵抗相关性研究[J].新中医,2008,40(9)：44-45.
[54]赵文霞,段荣章,刘君颖.1163例非酒精性脂肪肝患者与气虚质痰湿质相关性研究[J].辽宁中医杂志,2010,37(8)：1543-1544.
[55]王文锐,倪海祥,魏佳平等.2型糖尿病患者非糖尿病一级亲属中医体质调查研究[J].中华中医药学刊.2011,29(10),2261-2263
[56]厚磊李洪娟许俊琴.兼夹体质与上热下寒的相关性研究[J].中医杂志.2011,52(16)：1396-1397
[57]杨萌,杨毅玲.临床中常见“隐症”与体质关系研究[J].云南中医学院学报.2010,33(5)：4-7
[58]Kuettner KE, Goldberg VM. Introduction. In:Kuettneer KE, Goldberg VM, editors. Osteoarthritic disorders[M]. Rosemont:American Academy of Orthopaedic Surgeons; 1995, pp ⅹⅹⅰ-ⅹⅹⅴ.
[59]Arden N, NevittMC. Osteoarthritis:Ep idemiology[J]. Arthritis Rheum,2006,20 (1):3-25
[60]Global Economic and Health Care Burden of Musculoskeletal Disease[DB].2001, World Health Organization, www.boneandjointdecade.org
[61]Kellgren JH, Lawrence J S. Radiological assessment of osteoarthrotis[J]. Ann Rheum Dis,1957,16:494-499
[62]Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States [J]. Arthritis Rheum 41:778-799
[63]汤敏生,彭伟雄,江笑娥等,广州市荔湾区社区居民症状性骨关节炎患病情况调查[J].广东医学.2007,28(9),1506-1509
[64]史方,顾凯,卢伟,等.上海市关节炎患病率抽样调查及相关因素分析[J].江苏医药杂志,2000,12(26)：967-969
[65]钱颐,孙凌云,王祝新,等.南京郊区农民症状性骨关节炎的流行病学调[J].中华流行病学杂志,2003,12(24)：136-139
[66]叶志中,谭艳红,卢华,等.深圳市风湿病流行病学调查[J].中华风湿病学杂志,2003,5(9)：45-48
[67]曾庆徐,黄少弼,陈韧,等.汕头地区风湿病流行病学调查10年小结[J].中华内科杂志,1997,3(36)：133-135
[68]曾庆徐,黄少弼,肖征宇,等.症状性骨关节炎的临床及流行病学探讨[J].中华内科杂志,1995,2(34)：88-90
[69]李宁华.中老年分群骨关节炎的流行病学特征[J].中国临床康复,2005,(38)：133-135
[70]李宁华,张耀南,张毅等.国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较.[J].中国组织工程研究与临床康复.2007,11(39)：7758-7760
[71]Schnitzer TJ, Non-NSAID pharmacologic treatment options for the management of chronic pain[J]. Am J Med,1994,105:45S-52S
[72]Lin J, Zhang W, Jones A, et al. Efficacy of topical non-steroidal antiinflammatory drugs in the treatment of osteoarthritis:meta-analysis of randomised controlled trials[J].BMJ,2004,329(7461):324-327
[73]王小磊,孙洪云,谭举朋等.糖皮质激素联合玻璃酸钠治疗膝骨关节炎的疗效观察[J].中华临床医师杂志(电子版),2011,5(6)：1808-1810
[74]Bannuru R R,Natov N S, Obadan I E, et al. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis:a systematic review and meta-analysis[J]. Arthritis Rheum,2009,61(12):1704-1711
[75]Bradley JA, Brandt KD, Katz BP, et al. Treatment of knee osteoarthritis:relationship of clinical features of joint inflammation to the response to the nonsteroidal antiinflammatory drug or pure analgesic[J]. J Rheumatol.1992 19:1950-1954
[76]Bradley JA, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee[J]. N Engl J Med.19911 325:87-91
[77]Towheed TE, Maxwell L, Judd MG, et al. Acetaminophen for osteoarthritis [J]. Cochrane Database Syst Rev,2006(1):CD004257.
[78]Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee[J]. Arthritis Care Res (Hoboken),2012,64(4): 465-474.
[79]Pelletier JP, Martel-Pelletier J. Therapeutic targets in osteoarthritis:from today to tomorrow with new imaging technology[J]. Ann Rheum Dis,2003,62(Suppl 2):1179-1182.
[80]郑晓辉,马邦兴,白曼莫.骨炎定方治疗肝肾不足气虚血瘀型膝骨关节炎54例疗效观察[J].广州中医药大学学报.2010,27(5)：449-456
[81]梁吴.痹祺胶囊治疗膝关节骨性关节炎150例临床疗效观察.[J].中华中医药杂志.2009,24(6)：819-820
[82]边新群.痹祺胶囊治疗膝骨性关节炎临床疗效观察.[J].中华中医药杂志.2006,21(10)：636-638
[83]痹祺胶囊治疗膝骨关节炎临床观察.[J].辽宁中医杂志.2011,38(7)：1254-1255
[84]刘向前,姚共和,杨少锋.以NSAIDs为对照中药治疗膝关节骨关节炎文献的系统评价[J].中医药学刊,2005,23(6)：1008-1012
[85]张胜,彭志华,关俊辉.复方息痛膜穴位贴敷治疗阳虚寒凝证膝关节骨性关节炎30例临床观察[J].新中医.2011,43(10)：88-89
[86]张旺琼,钟志年,周首邦.中药熏洗和中医护理配合治疗膝骨性关节炎的临床研究[J].中医临床研究.2012,4(24)：106-109
[87]唐欣荣,中艳慧,杨景科.中药热熨方治疗膝骨性关节炎60例.河南中医.2011,31(11)：1272-1274
[88]林国华,李万瑶,苏国龙等.温针治疗膝骨关节炎40例疗效观察[J].新中医,2004,36(10)：48-49
[89]裘敏蕾,戴琪萍,车涛等.电针膝眼穴治疗膝骨性关节炎的临床研究[J].中医正骨,2006,18(3)：15-17
[90]许学猛,刘文刚,赵传喜等.骨筋肉并重特色三联疗法治疗退行性膝关节病临床研究[J].中医正骨.2006,18(7)：15-16
[91]中华医学会风湿病学会.骨关节炎诊治指南(草案)[J].中华风湿病学杂志,2003,11(7)702-704.
[92]胡立胜,周强.中医临床研究设计与SAS编程统计分析[M].学苑出社,2005,41-42
[93]周兆凡.我国成人体重指数和腰围对有关疾病危险因素异常的预测价值：适宜体重指数和腰围切点的研究仁[J].中华流行病学杂志,2002,23,(1)：5-10
[94]汤敏生,彭伟雄,江笑娥等,广州市荔湾区社区居民症状性骨关节炎患病情况调查[J].广东医学.2007,28(9)：1506-1509
[95]臧长海,曾庆馀,李小峰.太原市膝骨关节炎的流行病学研究.[J].中华内科杂志,2006,45(7)：533-536
[96]李宁华,张耀南,张毅等.国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较.[J].中国组织工程研究与临床康复.2007,11(39)：7758-7760
[97]何春红,谭妃英,谢小鸣.广州市越秀区126例老年人膝关节骨性关节炎患病危险因素：与121例老年组的病例-对照分析.中国组织工程研究与临床康复.2009,13(33)：6581-6584
[98]Wluka AE, Davis SR, etal. Users of oestrogen replaeement therapy have more knee cartilage than non-users[J]. Ann-Rheum-Dis,2001,60(4):332-336
[99]Nevitt MC Felson DT, etal. The effect of estrogen plus progestin on knee cartilage than non-users[J]. Ann-rheum-DIS,2001,60(4):332-336.
[100]Ham KD, Loeser RF etal. Effects of long-term estrogen replacement therapy on osteoarthritis severity in cynomolgus monkeys[J]. Arthritis-Rheum,2002,46(7): 1956-1964.
[101]Mcalindon TE, Jacques P, Zhang Y, et al. Do antioxidant mi2 cronutrients protect against the development and progression of knee osteoarthritis[J] Arthritis Rheum, 1996,39:648-656.
[102]Jensen LK, Eenberg W. Oeeupationa sariskfa Ctorfor knee disorders. [J]. Seand J Work Environ Health.1996:22(3):165-169
[103]刘春梅,徐荃.北京地区1858名老年人下蹲与膝关节骨性关节炎患病率的回顾性调查[J].中华流行病学杂志,2007,28(2)：177-179.
[104]张建新,王和鸣,吴超英.泉州市中老年人退行性膝骨性关节炎的流行病学调查[J].中国中医骨伤科杂志,2007,15(2)：4-5.
[105]Hiroyuki Shiozaki Y K, Go Omori. Epidemiology of osteoarthritis of the knee in a rural Japanese population [J]. knee,1999,6:183-188.
[106]Fuller2Thomson E, StefanykM, Brennenstuhl S. The RobustAsso2 ciation Between Chi ldhood Physical Abuse and Osteoarthritis in Adulthood:Findings From a Rep resentative Community Samp le [J]. Arthritis Rheum,2009,61 (11):1554-1562.
[107]Knut J, Rasmus G, Olav R. Acetabular dysp lasia as an aetiologi2 cal factor in development of hip osteoarthritis[J]. International Orthopaedics,2009,33:653-657.
[108]Doherty M, Lanyon P. Epidemiology of peripheral joint osteoarthritis.Ann Rheum Dis 1996:55(9):585-587
[109]Biestad BE, Engebretsen L, Storheim K, et al. Knee osteoarthritis After Anterior Cruciate Ligament Injury[J]. Am J Sports Med,2009,37 (7):1434-1443.
[110]Garstang SV, Stitik TP. Osteoarthritis:Ep idemiology, Risk Fac2tors, and Pathophysiology[J]. Am J PhysMed Rehabil,2006,85(Supp 1):2-11.
[111]Oliveria S A, Felson D T, Reed J I, et al. Incidence of symptom atichand, hip, and knee osteoarthritis among patients in a health maintenance organization [J]. Arthritis Rheum,1995,38(8):1134-1141.
[112]史方,顾凯,卢伟等.上海市关节炎患病率抽样调查及相关因素分析[J].中华流行病学杂志.2003,24(12)：1136-1140
[113]梁雄勇,周明旺,李盛华.骨性关节炎遗传易感性研究进展[J].中国中医骨伤科杂志.2012,20(3)：70-72
[114]Mac Gregor AJ, Li Q, Spector TD, et al. The genetic influence on radiographic osteoarthritis is site specific at the hand, hip and knee[J]. Rheumatology,2009,48'. 277-280.
[115]Kellgren JH and Lawrence JS. Osteo-arthrosis and disk degeneration in an urban population [J]. Ann Rheum Dis,1958,17(4):388-97.
[116]Fuller2Thomson E, StefanykM, Brennenstuhl S. The RobustAsso2 ciation Between Childhood Physical Abuse and Osteoarthritis in Adulthood:Findings From a Rep resentative Community Samp le [J]. Arthritis Rheum,2009,61 (11):1554-1562.
[117]Gellber AC, Hochberg MC, Mead LA, et al. Joint injury in young adults and risk for subsequent knee and hi osteoarthritis. Ann Int Med.133:321-328
[118]Graney M J. The reciprocal relationship between disability and depression [J]. J Am Geriatr Soc,2000,48(4):452-453.
[119]Creamer P, Lethbridge-Cejku M, Costa P, et al. The relationship of anxiety and depression with self-reported knee pain in the community:data from the Baltimore Longitudinal Study of Aging [J]. Arthritis Care Res,1999,12(1):3-7.
[120]刘淑刚,王金榜.健康教育在膝骨关节炎治疗中的疗效评价[J].临床研究.2013,6(3)：127-128
[121]陈雅琴,蒲卉明.电话回访式健康教育对类风湿关节炎患者出院后遵医行为的影响[J].齐鲁护理杂志.2011,17(34)：114-115
[122]He J, Whelton PK, Appel LJ, et al longterm effeets of weight loss and dietary sodium reduction on incidence of hypertension[J]. Hypertension,2000,35(2):544-549.,
[123]李智斐,张家立,钟远鸣.颈部肌肉四方抗阻静力功能锻炼预防CSM初步观察[J].中国中医骨伤科杂志.2011,19(7)：30-32
[124]刘敏,吴淮,刘文刚.骨筋肉运动康复操用于腰椎间盘突出症患者的疗效观察[J].护理学杂志.2009,24(22)：84-85
[125]袁胜男,韩晓燕,高丽娟.社区超重和肥胖居民健康管理及效果评价[J].中国慢性病预防与控制.2012,20,(2)：124-127
[126]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,1994：30-31.
[127]邓晋丰,许学猛.中医骨伤证治[M].广东人民出版社.2000：12-16
[128]钟杰琴,谢国平,李扬眉.五籽散药熨加腰椎电动牵引治疗腰椎间盘突出症疗效观察[J].实用医学杂志,2005,21(9),987-988
[129]Winzenberg T, Oldenburg B, Frendin S, ct al. The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women:a randomized controlled trisl[J]. BMC Public Health,2006,6: 12-24.
[2]李宁华,薛庆云,张毅等.中国六城市中老年人群X线膝骨关节炎流行病学分析[J].实用医学杂志,2008,24(16)：2887-2888.
[3]Roland W, Roy D, Mare C, et al. Osteoarthritis. [M]. Lippincott Williams & Wilkins, 2006,4
[4]陈君石等.《健康管理在健康保险中的应用》与趋势.[J].《健康管理与健康保险高层论坛》论文集.2003.
[5]黄建始.美国的健康管理：源自无法遏制的医疗费用增长[J].中华医学杂志,2006,86(15)：1011-1013.
[6]李莉.英国国家卫生制度及对中国的借鉴[J].改革与战略.2006,9：21-24
[7]魏炜,赵亮.现代健康管理模式浅析[J].卫生经济研究.2006,5：19-21
[8]卫生部公布第四次国家卫生服务调查主要结果[EB]. http://www.Gov.Cn/gzdt/ 2009-02/27/content_1245006.htm
[9]中华医学会健康管理学分会,中华健康管理学杂志编委会.健康管理概念与学科体系的中国专家初步共识[J].中华健康管理学杂志,2009,3：141-147
[10]卫生部疾病控制司.《慢性非传染性疾病预防医学诊疗规范》.2002.
[11]赵润栓,高楠楠,谢燕,体质调养在健康管理实践中的应用体会.中国疗养医学,2011,20(4)：297-299
[12]孟春英,郭颖,曹爽,等.“知己”健康管理模式在社区慢性病管理中的应用[J]护理学杂志,2008,(8)：59-61.
[13]朱俊峰。46例慢性病病人健康管理疗效的观察[J].中国医药导,2009,(11)：330-331.
[14]张宏伟,李晓莹.某银行105名职工慢性病健康管理[J].中华健康管理学杂志,2008,2(1)：36-38.
[15]周军,李详成.慢性病健康管理非药物干预模式的研究初探[J].中国公共卫生管理,2008,24(3)：289-290.
[16]冯超,吴琴琴,马继红,等.健康管理中心的慢性病管理[J].现代预防医学2008,35(8)：1517-1518.
[17]李星明,黄建始.健康管理和社区卫生整合对慢性病防治的意义与服务模式探讨[J].疾病控制杂志,2008,12(1)：53-57.。
[18]中华中医药学会.中医体质分类与判定[M].中国中医药出版社,2009
[19]黄绮丹,熊晓红等.中医体质学说与现代健康管理.中国中医药医药现代远程教育.2007,5(7)：5-7
[20]Stanford Patient Education Research Center. Arthritis Self-Management (Self-Help) Program. [EB/OL]. [2009-05-19]. http://patienteducation. stanford.edu/programs/asmp.html
[21]Warsi A, La Valley MP, Wang PS, ey al. Arthritis self-management education programs: ameta-analysis of the effect on pain and disability[J]. Arthritis Rheum,2003,48(8): 2207-2213.
[22]Chodosh J, Morton SC, Mojica W, et al. Meta-analysis:chronic disease self-management programs for older adults[J]. Ann Intern Med,2005,143(6):427-438.
[23]Jordan JL, Holden MA, Mason EEJ, et al. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults [J]. Cochrane Database Svst Rev, 2010, (1):CD005956.
[24]Smith C, Kumar S, Pelling N. The effectiveness of self-management educational interventions for osteoarthritis of the knee [J]. JBI Library Syst Rev,2009,7C25):1089-1116.
[25]Devos-Comby L, Cronan T, Roesch SC. Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review [J]. J Rheumatol, 2006,33(4)
[26]Walsh NE, Mitchell HL, Reeves BC, et al. Integrated exercise andself-management programmes in osteoarthritis of the hip and knee:a systematic review of effectiveness[J]. Phys Ther Rev,2006,11(4):289-298.
[27]May S. Self-management of chronic low back pain and osteoarthritis[J]. Nat Rev Rheumatol,2010,64:199-209.
[28]孙丽媛,刘素珍,成翼娟.社区居民关节炎白我健康管理干预效果研究[J].现代预防医学：2010,37(13)：2447-2450
[29]王琦,朱燕波.中国一般人群中医体质流行病学调查——基于全国9省市21948例流行病学调查数据[J].中华中医药杂志,2009,24(1)：7-12
[30]王琦.中医体质三论[J].北京中医药大学学报,2008,31(10)：653-655.
[31]王琦.论中医体质研究的3个关键问题(下)[J].中医杂志,2006,47(5)：329-332
[32]王琦,朱燕波,吴玉娥.肥胖、超重与正常体质量高血压患者的中医体质类型分布特点比较研究[J].中华中医药杂志.2011,26(8)：1676-1679
[33]蔡亮,江静华,杨健松.骨量减少及骨质疏松症中医体质分类与辨证分型相关性研究[J].新中医.2011,43(7)：51-52
[34]余敏英,黄李平,梁莉等,广西地区335例原发性血脂异常者中医体质调查研究[J].湖南中医杂志.2011,27(6)：87-89
[35]韦芳宁,王莉.414例慢性肾脏病患者中医体质特征研究[J].国际医药卫生导报,2009,15(1)：5-8.
[36]周晓燕,刘晓虹,卢玉蕾,等.糖耐量低减中医体质分型与胰岛素水平的关系[J].湖南中医杂志,2010,26(1)：53-54.
[37]孙理军,崔刚,王震.咸阳地区糖尿病中医体质的临床调查研究[J].陕西中医学院学报,2010,33(4)：35-36.
[38]孟萍,邓棋,卫王静等.中医体质因素与非酒精性脂肪肝的发病相关性研究[J].光明中医,2008,23(9)：1245-1247.
[39]张向农,王欣,王梅,等.355例肿瘤患者中医体质类型流行病学调查研究[J].中国中医药信息杂志,2010,17(5)：13-16.
[40]姜峰.季节性过敏性鼻炎患者中医体质特点研究[J].中国中医基础医学杂志,2007,13(9)：705-706.
[41]夏仲元,王琦,郭琪.甲亢和甲减中医体质类型调查分析[J].北京中医药大学学报,33(4)：280-282.
[42]胡学军,龙顺钦,杨小兵等.原发性肝癌的中医体质调查分析[J].时珍国医国药.2010,21(4)：995-997.
[43]司纪广,石传科,张强,等.106例下肢静脉曲张患者中医体质辨证调查分析[J].辽宁中医杂志.2005,32(10)：1032-1033.
[44]李斌,张成会,刘红霞.583例寻常型银屑病患者中医体质特征研究[J].四川中医.2010(10)：62-64.
[45]苟运浩,刘长灵,过建春等.中医体质和HBV感染结局的相关性研究.中国中医药科技.2010,17(6)：473-474
[46]王玉霞,任翠梅,李润杰等.中医体质辨识融入社区健康管理对代谢综合征的防治效果分析[J].中国全科医学.2012.15(2A),459-461
[47]王长海,栗平,马志新,等.老年髋部骨折患者中医体质类型与骨密度关系的病例对照研究[J].中国骨质疏松杂志,2010,16,(9)：655-658.
[48]刘培中,李创鹏,刘志龙等.600例高血压病患者危险因素与中医体质分类的相关性研究[J].新中医.2011,43(60)：19-21
[49]刘璠,刘莲,陈新林.600例慢性高原病患者中医体质特点研究[J].中医研究.2010,23(2)：38-40
[50]韩丽蓓,崔红霞,刘金凤等.2型糖尿病合并高脂血症患者中医体质类型及与血脂指标的相关性研究[J].北京中医药大学学报.2011,18(3),4-7
[51]潘朝锌,王庆高,何新兵,等.冠脉血栓形成的中医体质特点临床研究[J].新中医,2010,
[52]张云云,张海梅,郭德莹,等.168例缺血性脑卒中患者体质特点研究[J].上海中医药杂志,2008,42(2)：31-34
[53]罗广波,唐爱华,周燕,等.不同体质的糖调节受损患者与胰岛素抵抗相关性研究[J].新中医,2008,40(9)：44-45.
[54]赵文霞,段荣章,刘君颖.1163例非酒精性脂肪肝患者与气虚质痰湿质相关性研究[J].辽宁中医杂志,2010,37(8)：1543-1544.
[55]王文锐,倪海祥,魏佳平等.2型糖尿病患者非糖尿病一级亲属中医体质调查研究[J].中华中医药学刊.2011,29(10),2261-2263
[56]厚磊李洪娟许俊琴.兼夹体质与上热下寒的相关性研究[J].中医杂志.2011,52(16)：1396-1397
[57]杨萌,杨毅玲.临床中常见“隐症”与体质关系研究[J].云南中医学院学报.2010,33(5)：4-7
[58]Kuettner KE, Goldberg VM. Introduction. In:Kuettneer KE, Goldberg VM, editors. Osteoarthritic disorders[M]. Rosemont:American Academy of Orthopaedic Surgeons; 1995, pp ⅹⅹⅰ-ⅹⅹⅴ.
[59]Arden N, NevittMC. Osteoarthritis:Ep idemiology[J]. Arthritis Rheum,2006,20 (1):3-25
[60]Global Economic and Health Care Burden of Musculoskeletal Disease[DB].2001, World Health Organization, www.boneandjointdecade.org
[61]Kellgren JH, Lawrence J S. Radiological assessment of osteoarthrotis[J]. Ann Rheum Dis,1957,16:494-499
[62]Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States [J]. Arthritis Rheum 41:778-799
[63]汤敏生,彭伟雄,江笑娥等,广州市荔湾区社区居民症状性骨关节炎患病情况调查[J].广东医学.2007,28(9),1506-1509
[64]史方,顾凯,卢伟,等.上海市关节炎患病率抽样调查及相关因素分析[J].江苏医药杂志,2000,12(26)：967-969
[65]钱颐,孙凌云,王祝新,等.南京郊区农民症状性骨关节炎的流行病学调[J].中华流行病学杂志,2003,12(24)：136-139
[66]叶志中,谭艳红,卢华,等.深圳市风湿病流行病学调查[J].中华风湿病学杂志,2003,5(9)：45-48
[67]曾庆徐,黄少弼,陈韧,等.汕头地区风湿病流行病学调查10年小结[J].中华内科杂志,1997,3(36)：133-135
[68]曾庆徐,黄少弼,肖征宇,等.症状性骨关节炎的临床及流行病学探讨[J].中华内科杂志,1995,2(34)：88-90
[69]李宁华.中老年分群骨关节炎的流行病学特征[J].中国临床康复,2005,(38)：133-135
[70]李宁华,张耀南,张毅等.国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较.[J].中国组织工程研究与临床康复.2007,11(39)：7758-7760
[71]Schnitzer TJ, Non-NSAID pharmacologic treatment options for the management of chronic pain[J]. Am J Med,1994,105:45S-52S
[72]Lin J, Zhang W, Jones A, et al. Efficacy of topical non-steroidal antiinflammatory drugs in the treatment of osteoarthritis:meta-analysis of randomised controlled trials[J].BMJ,2004,329(7461):324-327
[73]王小磊,孙洪云,谭举朋等.糖皮质激素联合玻璃酸钠治疗膝骨关节炎的疗效观察[J].中华临床医师杂志(电子版),2011,5(6)：1808-1810
[74]Bannuru R R,Natov N S, Obadan I E, et al. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis:a systematic review and meta-analysis[J]. Arthritis Rheum,2009,61(12):1704-1711
[75]Bradley JA, Brandt KD, Katz BP, et al. Treatment of knee osteoarthritis:relationship of clinical features of joint inflammation to the response to the nonsteroidal antiinflammatory drug or pure analgesic[J]. J Rheumatol.1992 19:1950-1954
[76]Bradley JA, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee[J]. N Engl J Med.19911 325:87-91
[77]Towheed TE, Maxwell L, Judd MG, et al. Acetaminophen for osteoarthritis [J]. Cochrane Database Syst Rev,2006(1):CD004257.
[78]Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee[J]. Arthritis Care Res (Hoboken),2012,64(4): 465-474.
[79]Pelletier JP, Martel-Pelletier J. Therapeutic targets in osteoarthritis:from today to tomorrow with new imaging technology[J]. Ann Rheum Dis,2003,62(Suppl 2):1179-1182.
[80]郑晓辉,马邦兴,白曼莫.骨炎定方治疗肝肾不足气虚血瘀型膝骨关节炎54例疗效观察[J].广州中医药大学学报.2010,27(5)：449-456
[81]梁吴.痹祺胶囊治疗膝关节骨性关节炎150例临床疗效观察.[J].中华中医药杂志.2009,24(6)：819-820
[82]边新群.痹祺胶囊治疗膝骨性关节炎临床疗效观察.[J].中华中医药杂志.2006,21(10)：636-638
[83]痹祺胶囊治疗膝骨关节炎临床观察.[J].辽宁中医杂志.2011,38(7)：1254-1255
[84]刘向前,姚共和,杨少锋.以NSAIDs为对照中药治疗膝关节骨关节炎文献的系统评价[J].中医药学刊,2005,23(6)：1008-1012
[85]张胜,彭志华,关俊辉.复方息痛膜穴位贴敷治疗阳虚寒凝证膝关节骨性关节炎30例临床观察[J].新中医.2011,43(10)：88-89
[86]张旺琼,钟志年,周首邦.中药熏洗和中医护理配合治疗膝骨性关节炎的临床研究[J].中医临床研究.2012,4(24)：106-109
[87]唐欣荣,中艳慧,杨景科.中药热熨方治疗膝骨性关节炎60例.河南中医.2011,31(11)：1272-1274
[88]林国华,李万瑶,苏国龙等.温针治疗膝骨关节炎40例疗效观察[J].新中医,2004,36(10)：48-49
[89]裘敏蕾,戴琪萍,车涛等.电针膝眼穴治疗膝骨性关节炎的临床研究[J].中医正骨,2006,18(3)：15-17
[90]许学猛,刘文刚,赵传喜等.骨筋肉并重特色三联疗法治疗退行性膝关节病临床研究[J].中医正骨.2006,18(7)：15-16
[91]中华医学会风湿病学会.骨关节炎诊治指南(草案)[J].中华风湿病学杂志,2003,11(7)702-704.
[92]胡立胜,周强.中医临床研究设计与SAS编程统计分析[M].学苑出社,2005,41-42
[93]周兆凡.我国成人体重指数和腰围对有关疾病危险因素异常的预测价值：适宜体重指数和腰围切点的研究仁[J].中华流行病学杂志,2002,23,(1)：5-10
[94]汤敏生,彭伟雄,江笑娥等,广州市荔湾区社区居民症状性骨关节炎患病情况调查[J].广东医学.2007,28(9)：1506-1509
[95]臧长海,曾庆馀,李小峰.太原市膝骨关节炎的流行病学研究.[J].中华内科杂志,2006,45(7)：533-536
[96]李宁华,张耀南,张毅等.国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较.[J].中国组织工程研究与临床康复.2007,11(39)：7758-7760
[97]何春红,谭妃英,谢小鸣.广州市越秀区126例老年人膝关节骨性关节炎患病危险因素：与121例老年组的病例-对照分析.中国组织工程研究与临床康复.2009,13(33)：6581-6584
[98]Wluka AE, Davis SR, etal. Users of oestrogen replaeement therapy have more knee cartilage than non-users[J]. Ann-Rheum-Dis,2001,60(4):332-336
[99]Nevitt MC Felson DT, etal. The effect of estrogen plus progestin on knee cartilage than non-users[J]. Ann-rheum-DIS,2001,60(4):332-336.
[100]Ham KD, Loeser RF etal. Effects of long-term estrogen replacement therapy on osteoarthritis severity in cynomolgus monkeys[J]. Arthritis-Rheum,2002,46(7): 1956-1964.
[101]Mcalindon TE, Jacques P, Zhang Y, et al. Do antioxidant mi2 cronutrients protect against the development and progression of knee osteoarthritis[J] Arthritis Rheum, 1996,39:648-656.
[102]Jensen LK, Eenberg W. Oeeupationa sariskfa Ctorfor knee disorders. [J]. Seand J Work Environ Health.1996:22(3):165-169
[103]刘春梅,徐荃.北京地区1858名老年人下蹲与膝关节骨性关节炎患病率的回顾性调查[J].中华流行病学杂志,2007,28(2)：177-179.
[104]张建新,王和鸣,吴超英.泉州市中老年人退行性膝骨性关节炎的流行病学调查[J].中国中医骨伤科杂志,2007,15(2)：4-5.
[105]Hiroyuki Shiozaki Y K, Go Omori. Epidemiology of osteoarthritis of the knee in a rural Japanese population [J]. knee,1999,6:183-188.
[106]Fuller2Thomson E, StefanykM, Brennenstuhl S. The RobustAsso2 ciation Between Chi ldhood Physical Abuse and Osteoarthritis in Adulthood:Findings From a Rep resentative Community Samp le [J]. Arthritis Rheum,2009,61 (11):1554-1562.
[107]Knut J, Rasmus G, Olav R. Acetabular dysp lasia as an aetiologi2 cal factor in development of hip osteoarthritis[J]. International Orthopaedics,2009,33:653-657.
[108]Doherty M, Lanyon P. Epidemiology of peripheral joint osteoarthritis.Ann Rheum Dis 1996:55(9):585-587
[109]Biestad BE, Engebretsen L, Storheim K, et al. Knee osteoarthritis After Anterior Cruciate Ligament Injury[J]. Am J Sports Med,2009,37 (7):1434-1443.
[110]Garstang SV, Stitik TP. Osteoarthritis:Ep idemiology, Risk Fac2tors, and Pathophysiology[J]. Am J PhysMed Rehabil,2006,85(Supp 1):2-11.
[111]Oliveria S A, Felson D T, Reed J I, et al. Incidence of symptom atichand, hip, and knee osteoarthritis among patients in a health maintenance organization [J]. Arthritis Rheum,1995,38(8):1134-1141.
[112]史方,顾凯,卢伟等.上海市关节炎患病率抽样调查及相关因素分析[J].中华流行病学杂志.2003,24(12)：1136-1140
[113]梁雄勇,周明旺,李盛华.骨性关节炎遗传易感性研究进展[J].中国中医骨伤科杂志.2012,20(3)：70-72
[114]Mac Gregor AJ, Li Q, Spector TD, et al. The genetic influence on radiographic osteoarthritis is site specific at the hand, hip and knee[J]. Rheumatology,2009,48'. 277-280.
[115]Kellgren JH and Lawrence JS. Osteo-arthrosis and disk degeneration in an urban population [J]. Ann Rheum Dis,1958,17(4):388-97.
[116]Fuller2Thomson E, StefanykM, Brennenstuhl S. The RobustAsso2 ciation Between Childhood Physical Abuse and Osteoarthritis in Adulthood:Findings From a Rep resentative Community Samp le [J]. Arthritis Rheum,2009,61 (11):1554-1562.
[117]Gellber AC, Hochberg MC, Mead LA, et al. Joint injury in young adults and risk for subsequent knee and hi osteoarthritis. Ann Int Med.133:321-328
[118]Graney M J. The reciprocal relationship between disability and depression [J]. J Am Geriatr Soc,2000,48(4):452-453.
[119]Creamer P, Lethbridge-Cejku M, Costa P, et al. The relationship of anxiety and depression with self-reported knee pain in the community:data from the Baltimore Longitudinal Study of Aging [J]. Arthritis Care Res,1999,12(1):3-7.
[120]刘淑刚,王金榜.健康教育在膝骨关节炎治疗中的疗效评价[J].临床研究.2013,6(3)：127-128
[121]陈雅琴,蒲卉明.电话回访式健康教育对类风湿关节炎患者出院后遵医行为的影响[J].齐鲁护理杂志.2011,17(34)：114-115
[122]He J, Whelton PK, Appel LJ, et al longterm effeets of weight loss and dietary sodium reduction on incidence of hypertension[J]. Hypertension,2000,35(2):544-549.,
[123]李智斐,张家立,钟远鸣.颈部肌肉四方抗阻静力功能锻炼预防CSM初步观察[J].中国中医骨伤科杂志.2011,19(7)：30-32
[124]刘敏,吴淮,刘文刚.骨筋肉运动康复操用于腰椎间盘突出症患者的疗效观察[J].护理学杂志.2009,24(22)：84-85
[125]袁胜男,韩晓燕,高丽娟.社区超重和肥胖居民健康管理及效果评价[J].中国慢性病预防与控制.2012,20,(2)：124-127
[126]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,1994：30-31.
[127]邓晋丰,许学猛.中医骨伤证治[M].广东人民出版社.2000：12-16
[128]钟杰琴,谢国平,李扬眉.五籽散药熨加腰椎电动牵引治疗腰椎间盘突出症疗效观察[J].实用医学杂志,2005,21(9),987-988
[129]Winzenberg T, Oldenburg B, Frendin S, ct al. The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women:a randomized controlled trisl[J]. BMC Public Health,2006,6: 12-24.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |