中医整脊疗法治疗膝骨关节炎的临床研究
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摘要
目的观察中医整脊疗法治疗膝骨关节炎(KOA)的临床疗效,探讨膝骨关节炎的发病原因。方法选取2016年11月-2017年10月东南大学附属中大医院中医骨伤科门诊诊治的80例膝骨关节炎患者,随机分为治疗组和对照组各40例,治疗组采用中医整脊疗法治疗,对照组采用塞来昔布胶囊口服治疗,每次200mg,每日1次,于治疗前和治疗4周后对患膝行磁共振检查和浮髌试验检查,于治疗前、治疗4周后、治疗后3月采用膝骨关节炎WOMAC评分进行评定,用骨关节炎严重程度指数(ISOA)改善率判定疗效。结果 2组患者滑膜炎程度和关节积液程度、膝骨关节炎WOMAC评分均较治疗前明显改善(P<0.01),且除关节积液程度外以治疗组的改善幅度较显著(P<0.01)。2组均未发现有明显不良反应。结论用整脊疗法从腰部着手治疗膝骨关节炎是一种简便而且疗效满意的方法。上腰段椎间盘移位可能是导致膝骨关节炎的原因。
OBJECTIVE To observe the clinical effect of Traditional Chinese Spinal Orthopedic Manipulation(TCSOM)in treating knee osteoarthritis(KOA)in comparison with Celecoxib Capsules(CC),and to assess a possible cause for KOA.METHODS 80 cases of KOA patients in department of Orthopaedic Surgery,Zhongda Hospital Affiliated to Southeast University form Nov.2016 to Oct.2017 were randomly divided into two groups:treatment group and control group,40 cases in each group.The treatment group was treated by TCSOM,while the control group was treated by CC orally,200 mg each time,once a day.Magnetic resonance examination and floating patellar test were performed on the knee before and 4 weeks after treatment.WOMAC score was used to evaluate KOA before treatment,4 weeks after treatment and 3 months after treatment,and the improvement rate of osteoarthritis severity index(ISOA)was used to judge the curative effect.RESULTS The degree of synovitis,joint effusion and WOMAC score of KOA in the two groups were significantly improved(P<0.01),and the improvement in the treatment group was significant(P<0.01).No obvious adverse reactions were found in both groups.CONCLUSION It is a simple and effective method to treat KOA from waist with TCSOM.Displacement of upper lumbar intervertebral disc may be the cause of KOA.
OBJECTIVE To observe the clinical effect of Traditional Chinese Spinal Orthopedic Manipulation(TCSOM)in treating knee osteoarthritis(KOA)in comparison with Celecoxib Capsules(CC),and to assess a possible cause for KOA.METHODS 80 cases of KOA patients in department of Orthopaedic Surgery,Zhongda Hospital Affiliated to Southeast University form Nov.2016 to Oct.2017 were randomly divided into two groups:treatment group and control group,40 cases in each group.The treatment group was treated by TCSOM,while the control group was treated by CC orally,200 mg each time,once a day.Magnetic resonance examination and floating patellar test were performed on the knee before and 4 weeks after treatment.WOMAC score was used to evaluate KOA before treatment,4 weeks after treatment and 3 months after treatment,and the improvement rate of osteoarthritis severity index(ISOA)was used to judge the curative effect.RESULTS The degree of synovitis,joint effusion and WOMAC score of KOA in the two groups were significantly improved(P<0.01),and the improvement in the treatment group was significant(P<0.01).No obvious adverse reactions were found in both groups.CONCLUSION It is a simple and effective method to treat KOA from waist with TCSOM.Displacement of upper lumbar intervertebral disc may be the cause of KOA.
引文
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[6]杨玉鹏,田烨.塞来昔布治疗骨关节炎患者的有效性和安全性[J].中国老年学杂志,2014,34(1):5-7.
[7]吴楠,郅新,赖云耀,等.磁共振膝关节骨关节炎MOAKS评分在中国人群中的应用[J].中国医学影像学杂志,2016,24(4):312-315.
[8]BELLAMY N,BUCHANAN WW,GOLDSMITH CH,et al.Validation study of WOMAC:A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee[J].J Rheumatol,1988,15(12):1833-1840.
[9]南京中医学院中医系.黄帝内经灵枢译释[M].上海:上海科学技术出版社,1996:236.
[10]黄乐天,和晓峰,刘兵.引起膝关节骨性关节炎常见临床症状的病因分析[J].湖南中医药大学学报,2012,32(10):69-70.
[11]QU LX,XING LY,WANDA N,et al.Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of chondromalacia patellae[J].J Tradit Chin Med,2016,36(6):718-723.
[12]宣蛰人.宣蛰人软组织外科学[M].上海:文汇出版社,2009.87.
[13]PEAT G,DUNCAN RC,WOOD LR,et al.Clinical features of symptomatic patellofemoral joint osteoarthritis[J].Arthritis Res Ther,2012,14(2):R63.
[14]袁高明,范伏元,张瑾.“针刀三部曲”治疗膝关节骨性关节炎68例[J].针灸临床杂志,2011,27(2):36-38.
[2]TANG X,WANG S,ZHAN S,et al.The prevalence of symptomatic knee osteoarthritis in China:Results from the China health and retirement longitudinal study[J].Arthrit Rheumat,2016,68(3):648-653.
[3]QU LX,XING LY,WANDA N,et al.Irritable bowel syndrome treated by traditional Chinese spinal orthopedic manipulation[J].J Tradit Chin Med,2012,32(4):565-570.
[4]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.
[5]任伟亮,朱艳风,韩昆,等.骨氏葆方治疗肾虚血瘀型膝重度骨关节炎的临床研究[J].南京中医药大学学报,2016,32(2):118-121.
[6]杨玉鹏,田烨.塞来昔布治疗骨关节炎患者的有效性和安全性[J].中国老年学杂志,2014,34(1):5-7.
[7]吴楠,郅新,赖云耀,等.磁共振膝关节骨关节炎MOAKS评分在中国人群中的应用[J].中国医学影像学杂志,2016,24(4):312-315.
[8]BELLAMY N,BUCHANAN WW,GOLDSMITH CH,et al.Validation study of WOMAC:A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee[J].J Rheumatol,1988,15(12):1833-1840.
[9]南京中医学院中医系.黄帝内经灵枢译释[M].上海:上海科学技术出版社,1996:236.
[10]黄乐天,和晓峰,刘兵.引起膝关节骨性关节炎常见临床症状的病因分析[J].湖南中医药大学学报,2012,32(10):69-70.
[11]QU LX,XING LY,WANDA N,et al.Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of chondromalacia patellae[J].J Tradit Chin Med,2016,36(6):718-723.
[12]宣蛰人.宣蛰人软组织外科学[M].上海:文汇出版社,2009.87.
[13]PEAT G,DUNCAN RC,WOOD LR,et al.Clinical features of symptomatic patellofemoral joint osteoarthritis[J].Arthritis Res Ther,2012,14(2):R63.
[14]袁高明,范伏元,张瑾.“针刀三部曲”治疗膝关节骨性关节炎68例[J].针灸临床杂志,2011,27(2):36-38.