推拿治疗膝关节骨性关节炎研究述评
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摘要
推拿是中医治疗膝骨关节炎(Knee osteoarthritis,KOA)的主要方法之一,分步推拿法、点穴推髌法、按揉法、理筋整复手法、拔伸法等局部推拿法可起到疏通经络气血、放松局部肌肉、改善关节活动度的作用。中医整体观的多部位推拿可调节全身气血经脉通畅,与西医整体调节膝关节的力学平衡有相通之处,辨证论治的选穴、施行手法可针对性地起到补益肝肾,祛湿除痹,行气化瘀的作用。但缺少单纯推拿手法治疗KOA的高质量临床随机对照研究及作用机理的临床研究,开辟推拿治疗KOA的新思路、规范治疗KOA的推拿手法、深入研究推拿作用于KOA的机制等是今后的主要临床研究方向。
Massage is one of the main methods of TCM in the treatment of knee osteoarthritis( KOA). Local massage methods such as step-by-step massage,patella-pushing at acupoints,pressing and kneading,tendon-tightening manipulation,traction and counter-traction method,etc. can play the role of dredging meridians and collaterals,relaxing local muscles and improving joint activity. The multi-position massage of TCM holistic view can regulate the unblocked channels of qi and blood in the whole body,which has something in common with the mechanical balance of the knee joint in Western medicine. The selection of acupoints based on syndrome differentiation and treatment and the implementation of manipulation can play a targeted role in tonifying liver and kidney,dispelling dampness and removing arthralgia,and promoting qi and removing blood stasis. However,there is a lack of high-quality clinical randomized controlled study and clinical research on the mechanism of massage therapy for KOA. Therefore,the main clinical research directions in the future are to open up new ideas for massage therapy for KOA,standardize massage therapy for KOA,and further study the mechanism of massage on KOA.
Massage is one of the main methods of TCM in the treatment of knee osteoarthritis( KOA). Local massage methods such as step-by-step massage,patella-pushing at acupoints,pressing and kneading,tendon-tightening manipulation,traction and counter-traction method,etc. can play the role of dredging meridians and collaterals,relaxing local muscles and improving joint activity. The multi-position massage of TCM holistic view can regulate the unblocked channels of qi and blood in the whole body,which has something in common with the mechanical balance of the knee joint in Western medicine. The selection of acupoints based on syndrome differentiation and treatment and the implementation of manipulation can play a targeted role in tonifying liver and kidney,dispelling dampness and removing arthralgia,and promoting qi and removing blood stasis. However,there is a lack of high-quality clinical randomized controlled study and clinical research on the mechanism of massage therapy for KOA. Therefore,the main clinical research directions in the future are to open up new ideas for massage therapy for KOA,standardize massage therapy for KOA,and further study the mechanism of massage on KOA.
引文
[1]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[2]吴启富,范永中,叶志中.常见风湿病中西医结合诊疗指南(草案)骨关节炎中西医结合诊疗指南[J].中药药理与临床,2013,29(6):150-155.
[3] TANG X,WANG S,ZHAN S,et al. The Prevalence of SymptomaticKnee Osteoar-thritis in China:Results From the China Health andRetirement Longitudinal Study[J]. Arthritis Rheumatol,2016,68(3):648-653.
[4]艾金伟,李德胜,刘羽,等.中医辨证治疗膝骨性关节炎的网状Meta分析[J].中国循证医学杂志,2016,16(5):532-542.
[5]李永明,孙超,王晶.推拿对膝关节骨性关节炎髌韧带关节软骨作用效应的动物实验研究[J].武汉体育学院学报,2008,42(8):71.
[6]朱鸿飞,刘益杰,冯伟.模拟按压手法对兔膝骨关节炎治疗作用的实验研究[J].上海中医药杂志,2012,46(9):72.
[7]周强,程英武.推拿局部镇痛机制探讨[J].辽宁中医杂志,2012,39(7):1376-1378.
[8]吴佳航,张弛,董思佳,等.“舒筋”手法对膝关节骨性关节炎家兔关节液白介素1β和5-羟色胺的影响研究[J].中国全科医学,2018,21(6):688-693.
[9]王济纬,史炜镔,杜宁,等.手法治疗实验性膝骨关节炎的血流动力学研究[J].中国骨伤,1997,10(6):13.
[10]韩崑,熊昌源.三联疗法对膝关节骨关节炎氧自由基代谢的影响[J].湖北中医杂志,2006,28(3):9.
[11]赵长伟,梁运海,闻辉,等.手法治疗膝关节骨性关节炎疗效观察[J].长春中医药大学学报,2012,28(6):1086.
[12]查海东,周阿高,徐春巍,等.“五步”手法治疗膝骨关节炎30例[J].中国中医骨伤科杂志,2014,22(11):37-38.
[13]丁海涛,唐学章,陈剑.七步推拿法治疗膝骨性关节炎的临床研究[J].中华中医药杂志,2014,29(9):3025-3027.
[14]王宏南.七步推拿法与传统推拿治疗膝骨性关节炎的临床疗效对比研究[J].中华中医药学刊,2016,34(8):2045-2048.
[15]王锡友,高雁冰,李洋,等.孙氏九步八分推拿法治疗膝关节骨性关节炎30例临床观察[J].北京中医药,2014,33(7):522-525.
[16]王立军,丁全茂,包银兰.点穴分筋推拿手法治疗膝关节炎的临床研究[J].浙江中医药大学学报,2014,38(9):1111-1114.
[17]李琳琳,黎丹东,张旭辉,等.髌骨内推治疗膝骨关节炎疗效观察[J].河北中医,2017,39(4):516-520.
[18]叶蕻芝,李西海,吴明霞,等.揉膝推髌点穴法对膝骨性关节炎的疗效[J].中国老年学杂志,2012,32(4):707-709.
[19]张永泉.屈膝点按扣揉法治疗膝关节骨性关节炎49例[J].天津中医药,2013,30(4):209-211.
[20]李忠龙,王建军,刘康.深部揉压按摩法治疗老年膝关节骨性关节炎的短期疗效观察[J].中国康复医学杂志,2015,30(6):580-584.
[21]赵强,王一洲.伸筋易骨法治疗膝关节骨性关节炎临床观察[J].天津中医药,2014,31(5):275-277.
[22]张传东.疏经整复手法调整膝关节肌力平衡治疗膝关节骨性关节炎临床疗效观察[J].亚太传统医药,2016,12(21):109-111.
[23]杨智杰,陈剑峰,张亚峰.经筋推拿治疗膝骨关节炎的疗效[J].江苏医药,2014,40(21):2590-2592.
[24]赵明宇,刘益兵,王凯,等.动态拔伸手法松解股四头肌治疗膝骨关节炎的临床研究[J].中医学报,2012,27(11):1417-1418.
[25]马高亮,黄竹妹.多角度拔伸微调推拿手法治疗骨性膝关节炎的疗效观察[J].中医临床研究,2015,7(7):27-28.
[26]庞坚,曹月龙,郭朝卿,等.“石氏手法”治疗膝骨关节炎的临床疗效回顾性分析[J].时珍国医国药,2013,24(8):1936-1937.
[27]汪利合,李慧英,赵鹏飞,等.六指六穴点压及旋转屈伸手法治疗膝骨性关节炎的多中心临床研究[J].中医学报,2012,27(6):772-774.
[28]李华南,马菲,吴颖,等.“松筋易骨”膏摩法配合腹部推拿治疗膝骨性关节炎临床随机对照研究[J].中华中医药杂志,2016,31(10):4142-4145.
[29]林远方,朱其广,郑晓斌,等.膝、盆、腰三位一体推拿疗法治疗膝关节骨性关节炎临床观察[J].新中医,2012,44(5):88-90.
[30]田强,赵家友,郭汝松,等.腰部脊柱推拿治疗膝关节骨性关节炎30例[J].实用医学杂志,2016,32(6):1010-1012.
[31]麦穗,陈一鑫,陈小莉.揉髌手法结合臀部点按手法治疗膝关节骨性关节炎临床研究[J].河北中医,2016,38(6):906-909.
[32]赵明宇,鲍铁周,赵启,等.基于平乐正骨“筋滞骨错”理论推拿治疗膝关节骨性关节炎疗效评价[J].中华中医药杂志,2017,32(3):1372-1374.
[33]李振朝.中医辨证推拿治疗58例膝骨性关节炎的临床疗效观察[J].内蒙古中医药,2017,36(9):117-118.
[34]张树勇,石瑛,黄品贤.推髌按膝手法治疗肝肾亏虚型膝骨关节炎临床观察[J].辽宁中医杂志,2014,41(5):1004-1007.
[2]吴启富,范永中,叶志中.常见风湿病中西医结合诊疗指南(草案)骨关节炎中西医结合诊疗指南[J].中药药理与临床,2013,29(6):150-155.
[3] TANG X,WANG S,ZHAN S,et al. The Prevalence of SymptomaticKnee Osteoar-thritis in China:Results From the China Health andRetirement Longitudinal Study[J]. Arthritis Rheumatol,2016,68(3):648-653.
[4]艾金伟,李德胜,刘羽,等.中医辨证治疗膝骨性关节炎的网状Meta分析[J].中国循证医学杂志,2016,16(5):532-542.
[5]李永明,孙超,王晶.推拿对膝关节骨性关节炎髌韧带关节软骨作用效应的动物实验研究[J].武汉体育学院学报,2008,42(8):71.
[6]朱鸿飞,刘益杰,冯伟.模拟按压手法对兔膝骨关节炎治疗作用的实验研究[J].上海中医药杂志,2012,46(9):72.
[7]周强,程英武.推拿局部镇痛机制探讨[J].辽宁中医杂志,2012,39(7):1376-1378.
[8]吴佳航,张弛,董思佳,等.“舒筋”手法对膝关节骨性关节炎家兔关节液白介素1β和5-羟色胺的影响研究[J].中国全科医学,2018,21(6):688-693.
[9]王济纬,史炜镔,杜宁,等.手法治疗实验性膝骨关节炎的血流动力学研究[J].中国骨伤,1997,10(6):13.
[10]韩崑,熊昌源.三联疗法对膝关节骨关节炎氧自由基代谢的影响[J].湖北中医杂志,2006,28(3):9.
[11]赵长伟,梁运海,闻辉,等.手法治疗膝关节骨性关节炎疗效观察[J].长春中医药大学学报,2012,28(6):1086.
[12]查海东,周阿高,徐春巍,等.“五步”手法治疗膝骨关节炎30例[J].中国中医骨伤科杂志,2014,22(11):37-38.
[13]丁海涛,唐学章,陈剑.七步推拿法治疗膝骨性关节炎的临床研究[J].中华中医药杂志,2014,29(9):3025-3027.
[14]王宏南.七步推拿法与传统推拿治疗膝骨性关节炎的临床疗效对比研究[J].中华中医药学刊,2016,34(8):2045-2048.
[15]王锡友,高雁冰,李洋,等.孙氏九步八分推拿法治疗膝关节骨性关节炎30例临床观察[J].北京中医药,2014,33(7):522-525.
[16]王立军,丁全茂,包银兰.点穴分筋推拿手法治疗膝关节炎的临床研究[J].浙江中医药大学学报,2014,38(9):1111-1114.
[17]李琳琳,黎丹东,张旭辉,等.髌骨内推治疗膝骨关节炎疗效观察[J].河北中医,2017,39(4):516-520.
[18]叶蕻芝,李西海,吴明霞,等.揉膝推髌点穴法对膝骨性关节炎的疗效[J].中国老年学杂志,2012,32(4):707-709.
[19]张永泉.屈膝点按扣揉法治疗膝关节骨性关节炎49例[J].天津中医药,2013,30(4):209-211.
[20]李忠龙,王建军,刘康.深部揉压按摩法治疗老年膝关节骨性关节炎的短期疗效观察[J].中国康复医学杂志,2015,30(6):580-584.
[21]赵强,王一洲.伸筋易骨法治疗膝关节骨性关节炎临床观察[J].天津中医药,2014,31(5):275-277.
[22]张传东.疏经整复手法调整膝关节肌力平衡治疗膝关节骨性关节炎临床疗效观察[J].亚太传统医药,2016,12(21):109-111.
[23]杨智杰,陈剑峰,张亚峰.经筋推拿治疗膝骨关节炎的疗效[J].江苏医药,2014,40(21):2590-2592.
[24]赵明宇,刘益兵,王凯,等.动态拔伸手法松解股四头肌治疗膝骨关节炎的临床研究[J].中医学报,2012,27(11):1417-1418.
[25]马高亮,黄竹妹.多角度拔伸微调推拿手法治疗骨性膝关节炎的疗效观察[J].中医临床研究,2015,7(7):27-28.
[26]庞坚,曹月龙,郭朝卿,等.“石氏手法”治疗膝骨关节炎的临床疗效回顾性分析[J].时珍国医国药,2013,24(8):1936-1937.
[27]汪利合,李慧英,赵鹏飞,等.六指六穴点压及旋转屈伸手法治疗膝骨性关节炎的多中心临床研究[J].中医学报,2012,27(6):772-774.
[28]李华南,马菲,吴颖,等.“松筋易骨”膏摩法配合腹部推拿治疗膝骨性关节炎临床随机对照研究[J].中华中医药杂志,2016,31(10):4142-4145.
[29]林远方,朱其广,郑晓斌,等.膝、盆、腰三位一体推拿疗法治疗膝关节骨性关节炎临床观察[J].新中医,2012,44(5):88-90.
[30]田强,赵家友,郭汝松,等.腰部脊柱推拿治疗膝关节骨性关节炎30例[J].实用医学杂志,2016,32(6):1010-1012.
[31]麦穗,陈一鑫,陈小莉.揉髌手法结合臀部点按手法治疗膝关节骨性关节炎临床研究[J].河北中医,2016,38(6):906-909.
[32]赵明宇,鲍铁周,赵启,等.基于平乐正骨“筋滞骨错”理论推拿治疗膝关节骨性关节炎疗效评价[J].中华中医药杂志,2017,32(3):1372-1374.
[33]李振朝.中医辨证推拿治疗58例膝骨性关节炎的临床疗效观察[J].内蒙古中医药,2017,36(9):117-118.
[34]张树勇,石瑛,黄品贤.推髌按膝手法治疗肝肾亏虚型膝骨关节炎临床观察[J].辽宁中医杂志,2014,41(5):1004-1007.