短刺法配合电针肌肉起止点治疗膝骨关节炎的临床观察
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摘要
目的观察短刺法配合电针肌肉起止点治疗膝骨关节炎的临床疗效。方法将60例膝骨关节炎患者随机分为治疗组和对照组,每组30例。治疗组予短刺法配合电针肌肉起止点治疗,对照组予塞来昔布治疗,两组疗程均为4周。通过观察治疗前与治疗结束后及治疗结束后4周的膝关节WOMAC量表评分、VAS评分,比较两组患者临床疗效。结果 (1)治疗结束后:两组总有效率差异无统计学意义(P>0.05);WOMAC量表评分及VAS评分,两组自身比较差异有统计学意义(均P<0.01),组间比较差异无统计学意义(P>0.05);(2)治疗结束4周后:两组总有效率差异有统计学意义(P<0.05);与治疗前比较,两组WOMAC量表评分降低差异有统计学意义(P<0.01),治疗组VAS评分降低差异有统计学意义(P<0.01),对照组差异无统计学意义(P=0.05);组间比较,两组WOMAC量表评分及VAS评分差异均有统计学意义(P<0.05)。结论短刺法配合电针肌肉起止点对改善膝关节功能、减少疼痛近期疗效与塞来昔布等效,中期疗效优于塞来昔布。
Objective To observe the clinical efficacy of short thrust needing combined with electroacupuncture at the starting point and ending point of the muscle in the treatment of knee osteoarthritis. Methods A total of 60 cases of knee osteoarthritis were randomly divided into the treatment group and control group, 30 cases in each group.The treatment group was treated with short thrust needing and electroacupuncture on the starting point and ending point of the muscle, and the control group was received celebrex treatment, with a course of four weeks. The scores of Western Ontario and Mc Master University(WOMAC) Osteoarthritis Index and the VAS score were compared before and after treatment. The clinical efficacy was observed. Evaluating the result after 4 weeks follow-up. Results(1) After treatment: the total effective rate was 86.67%in the treatment group and 80.00% in the control group, there were no significant differences(P>0.05). The WOMAC scores and the VAS scores in the two groups after and before treatment were statistically significant(P <0.05), but the differences between the two groups were not significant(P>0.05).(2) At 4 weeks after treatment: the total effective rate of two groups were statistically significant(P <0.05). The WOMAC score of the two groups decreased after treatment, the difference was statistically significant(P<0.05). The VAS score of the treatment group decreased after treatment, the difference was statisticallysignificant(P<0.05). The difference in the control group was not significant(P>0.05). The WOMAC scores and the VAS scores between the two groups were statistically significant(P<0.05). Conclusion The therapy of short thrust needing combined with electroacupuncture at the starting point and ending point of the muscle has equivalent effect with Celebrex in short term treatment, and it is better than celebrex in mid term effect.
Objective To observe the clinical efficacy of short thrust needing combined with electroacupuncture at the starting point and ending point of the muscle in the treatment of knee osteoarthritis. Methods A total of 60 cases of knee osteoarthritis were randomly divided into the treatment group and control group, 30 cases in each group.The treatment group was treated with short thrust needing and electroacupuncture on the starting point and ending point of the muscle, and the control group was received celebrex treatment, with a course of four weeks. The scores of Western Ontario and Mc Master University(WOMAC) Osteoarthritis Index and the VAS score were compared before and after treatment. The clinical efficacy was observed. Evaluating the result after 4 weeks follow-up. Results(1) After treatment: the total effective rate was 86.67%in the treatment group and 80.00% in the control group, there were no significant differences(P>0.05). The WOMAC scores and the VAS scores in the two groups after and before treatment were statistically significant(P <0.05), but the differences between the two groups were not significant(P>0.05).(2) At 4 weeks after treatment: the total effective rate of two groups were statistically significant(P <0.05). The WOMAC score of the two groups decreased after treatment, the difference was statistically significant(P<0.05). The VAS score of the treatment group decreased after treatment, the difference was statisticallysignificant(P<0.05). The difference in the control group was not significant(P>0.05). The WOMAC scores and the VAS scores between the two groups were statistically significant(P<0.05). Conclusion The therapy of short thrust needing combined with electroacupuncture at the starting point and ending point of the muscle has equivalent effect with Celebrex in short term treatment, and it is better than celebrex in mid term effect.
引文
[1]陆艳红,石晓兵.膝骨关节炎国内外流行病学研究现状及进展[J].中国中医骨伤科杂志,2012,20(6):81-84.
[2]FEJER R,RUHE A.What is the prevalence of musculoskeletal problems in the elderly population in developed countries A systematiccritical literature review[J].Chiropr Man Therap,2012,20(1):31.
[3]中华医学会骨科医学会.骨关节炎诊治指南(2007年版)[J].中华关节外科杂志(电子版),2007,1(4):281-285.
[4]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:48.
[5]BELLAMY N,WILSON C,HENDRIKZ J.Population-based normative values for the Western Ontario and Mc Master(WOMAC)Osteoarthritis Index:part I[J].Semin Arthritis Rheum,2011,41(2):139-148.
[6]王宁华.疼痛定量评定的进展[J].中国临床康复,2002,6(18):2738-2739.
[7]BENNELL K L,WRIGLEY T V,HUNT M A,et al.Update on the role of muscle in the genesis and management of knee osteoarthritis[J].Rheum Dis Clin North Am,2013,39(1):145-176.
[8]范刚启,赵杨,符仲华.针刺的方向、角度、深度与针刺镇痛的关系[J].中国针灸,2010,30(11):965-968.
[9]杨俊兴,袁颖嘉,李田珂,等.等速向心肌力训练对膝关节骨性关节炎患者关节功能水平的影响[J].中国康复医学杂志,2012,27(7):631-632.
[10]任毅,刘菲,张愉,等.“短刺法”对兔膝骨关节炎软骨中Ⅱ型胶原及其标记物表达的影响及影像学观察[J].中国针灸,2016,36(6):622-628.
[11]刘菲,李学智,付妮妮,等.短刺法对兔膝骨关节炎软骨细胞Sox9、VEGF和Col X表达的影响[J].南方医科大学学报,2016,36(7):997-1003.
[12]席小芳,李学智,刘菲,等.短刺加电针法对膝骨关节炎兔膝关节软骨修复的影响[J].针刺研究,2016,41(2):124-130.
[13]付妮妮,李学智,杨晓光,等.短刺法结合电针对兔膝骨关节炎软骨细胞增殖及凋亡的影响[J].四川大学学报(医学版),2016,47(5):708-713.
[14]包飞,张燕,吴志宏,等.电针治疗膝骨关节炎疗效观察及对软骨磁共振T2图的影响[J].中国针灸,2013,33(3):196-197.
[15]安丙辰,郑洁皎,沈利岩.膝骨关节炎与膝关节伸、屈肌群肌力的相关性研究[J].医用生物力学,2015,30(2):174-178.
[16]CONAGHAN P G,DICKSON J,BOLTEN W,et al.A multicentre,randomized,placebo-and active-controlled trial comparing the efficacy and safety of topical ketoprofen in Transfersome gel(IDEA-033)with ketoprofen free vehicl(TDT064)and oral celecoxib for knee pain associated with osteoarthritis[J].Rheumatology(Oxford),2013,52(7):1303-1312.
[17]PARK Y G,HA C W,HAN C D,et al.A prospective,randomized,double-blind,multicenter comparative study on the safety and efficacy of celecoxib and GCSB-5,dried extracts of six herbs,for the treatment of osteoarthritis of knee joint[J].J Ethnopharmacol,2013,149(3):816-824.
[18]胡萍.塞来昔布治疗膝骨关节炎疗效观察[J].中国当代医药,2011,18(22):58-59.
[19]BRUCE C.M.WANG,谢小平,Wesley Furnback,等.塞来昔布在中国治疗骨关节炎的成本效果研究[J].中国药房,2017,28(5):586-590.
[2]FEJER R,RUHE A.What is the prevalence of musculoskeletal problems in the elderly population in developed countries A systematiccritical literature review[J].Chiropr Man Therap,2012,20(1):31.
[3]中华医学会骨科医学会.骨关节炎诊治指南(2007年版)[J].中华关节外科杂志(电子版),2007,1(4):281-285.
[4]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:48.
[5]BELLAMY N,WILSON C,HENDRIKZ J.Population-based normative values for the Western Ontario and Mc Master(WOMAC)Osteoarthritis Index:part I[J].Semin Arthritis Rheum,2011,41(2):139-148.
[6]王宁华.疼痛定量评定的进展[J].中国临床康复,2002,6(18):2738-2739.
[7]BENNELL K L,WRIGLEY T V,HUNT M A,et al.Update on the role of muscle in the genesis and management of knee osteoarthritis[J].Rheum Dis Clin North Am,2013,39(1):145-176.
[8]范刚启,赵杨,符仲华.针刺的方向、角度、深度与针刺镇痛的关系[J].中国针灸,2010,30(11):965-968.
[9]杨俊兴,袁颖嘉,李田珂,等.等速向心肌力训练对膝关节骨性关节炎患者关节功能水平的影响[J].中国康复医学杂志,2012,27(7):631-632.
[10]任毅,刘菲,张愉,等.“短刺法”对兔膝骨关节炎软骨中Ⅱ型胶原及其标记物表达的影响及影像学观察[J].中国针灸,2016,36(6):622-628.
[11]刘菲,李学智,付妮妮,等.短刺法对兔膝骨关节炎软骨细胞Sox9、VEGF和Col X表达的影响[J].南方医科大学学报,2016,36(7):997-1003.
[12]席小芳,李学智,刘菲,等.短刺加电针法对膝骨关节炎兔膝关节软骨修复的影响[J].针刺研究,2016,41(2):124-130.
[13]付妮妮,李学智,杨晓光,等.短刺法结合电针对兔膝骨关节炎软骨细胞增殖及凋亡的影响[J].四川大学学报(医学版),2016,47(5):708-713.
[14]包飞,张燕,吴志宏,等.电针治疗膝骨关节炎疗效观察及对软骨磁共振T2图的影响[J].中国针灸,2013,33(3):196-197.
[15]安丙辰,郑洁皎,沈利岩.膝骨关节炎与膝关节伸、屈肌群肌力的相关性研究[J].医用生物力学,2015,30(2):174-178.
[16]CONAGHAN P G,DICKSON J,BOLTEN W,et al.A multicentre,randomized,placebo-and active-controlled trial comparing the efficacy and safety of topical ketoprofen in Transfersome gel(IDEA-033)with ketoprofen free vehicl(TDT064)and oral celecoxib for knee pain associated with osteoarthritis[J].Rheumatology(Oxford),2013,52(7):1303-1312.
[17]PARK Y G,HA C W,HAN C D,et al.A prospective,randomized,double-blind,multicenter comparative study on the safety and efficacy of celecoxib and GCSB-5,dried extracts of six herbs,for the treatment of osteoarthritis of knee joint[J].J Ethnopharmacol,2013,149(3):816-824.
[18]胡萍.塞来昔布治疗膝骨关节炎疗效观察[J].中国当代医药,2011,18(22):58-59.
[19]BRUCE C.M.WANG,谢小平,Wesley Furnback,等.塞来昔布在中国治疗骨关节炎的成本效果研究[J].中国药房,2017,28(5):586-590.