不同产地艾灸治疗中重度原发性膝骨关节炎的效果比较
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摘要
目的比较不同产地艾灸治疗中重度膝骨关节炎的效果。方法选择2016年8月～2017年11月北京市第一中西医结合医院针灸科门诊收治的膝骨关节炎患者85例,通过登录中国中医科学院临床研究中央随机系统获得随机分组号,将患者分为治疗1组(34例)、治疗2组(34例)和对照组(17例)。治疗1组采用蕲春艾条,治疗2组采用南阳艾条,对照组采用茵陈灸条治疗,连续治疗2周,治疗结束后1个月进行随访。治疗后2周、随访时,观察比较三组治疗膝骨关节疼痛及临床症状的有效性。结果治疗前,三组视觉模拟评分(VAS)和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)的疼痛、僵硬、功能活动评分比较,差异无统计学意义(P> 0.05)。治疗后2周,三组VAS评分差值(与治疗前比较,下同)、WOMAC功能活动评分差值比较,差异均有统计学意义(P <0.05),而三组WOMAC疼痛评分差值、僵硬评分差值比较,差异无统计学意义(P> 0.05)。治疗结束后1个月随访,三组VAS评分差值、WOMAC疼痛评分差值、WOMAC功能活动评分差值比较,差异有统计学意义(P <0.05或P <0.01),而三组WOMAC僵硬评分差值比较,差异无统计学意义(P> 0.05)。结论三组治疗均能缓解膝关节疼痛,改善活动功能,其中治疗1组疼痛效果最优,治疗2组其次,对照组效果最差。
Objective To compare the effects of moxibustion in different habitats in the treatment of moderate and severe primary knee osteoarthritis. Methods From August 2016 to November 2017, 85 patients with knee osteoarthritis admitted to Outpatient Department of Acupuncture and Moxibustion of Beijing First Hospital of Integrated Chinese and Western Medicine were selected. Through logging on the central random system of clinical research of China Academy of Chinese Medical Sciences, the random group number was achieved, then the patients were randomly divided into treatment group 1(34 cases), treatment group 2(34 cases) and control group(17 cases). Treatment group 1 was treated with Qichun moxa, treatment group 2 was treated with Nanyang moxa and the control group was treated with oriental wormwood moxibustion, the treatment lasted for 2 weeks continously, the follow-up was perfomed at one month after the end of treatment. After treatment for 2 weeks and at the time of follow-up, the knee pain and the efficacy of clinical symptoms among the three groups were observed and compared. Results Before treatment, there were no significant differences in visual analogue scale(VAS), the pain score, stiffness score and functional activity score of Western Ontario McMaster University osteoarthritis index(WOMAC) among the three groups(P > 0.05). After treatment for 2 weeks,the difference values(compared with those before treatment, the same below) of VAS pain scores and WOMAC functional activity scores among the three groups had statistically significant differences(P < 0.05), but there were no significant differences in the differencevalues of WOMAC pain score and stiffness scores among the three groups(P > 0.05). At the follow-up of one month after the end of treatment, the difference values of VAS scores, WOMAC pain scores, WOMAC functional activity scores among the three groups had statistically significant differences(P < 0.05 or P < 0.01), while there was no significant difference in the difference values of WOMAC stiffness scores among the three groups(P > 0.05). Conclusion The treatment of all three groups can alleviate knee pain, improve the function of movement, among which, treatment group1 may alleviates pain best, followed by treamtnet group 2, control group.
Objective To compare the effects of moxibustion in different habitats in the treatment of moderate and severe primary knee osteoarthritis. Methods From August 2016 to November 2017, 85 patients with knee osteoarthritis admitted to Outpatient Department of Acupuncture and Moxibustion of Beijing First Hospital of Integrated Chinese and Western Medicine were selected. Through logging on the central random system of clinical research of China Academy of Chinese Medical Sciences, the random group number was achieved, then the patients were randomly divided into treatment group 1(34 cases), treatment group 2(34 cases) and control group(17 cases). Treatment group 1 was treated with Qichun moxa, treatment group 2 was treated with Nanyang moxa and the control group was treated with oriental wormwood moxibustion, the treatment lasted for 2 weeks continously, the follow-up was perfomed at one month after the end of treatment. After treatment for 2 weeks and at the time of follow-up, the knee pain and the efficacy of clinical symptoms among the three groups were observed and compared. Results Before treatment, there were no significant differences in visual analogue scale(VAS), the pain score, stiffness score and functional activity score of Western Ontario McMaster University osteoarthritis index(WOMAC) among the three groups(P > 0.05). After treatment for 2 weeks,the difference values(compared with those before treatment, the same below) of VAS pain scores and WOMAC functional activity scores among the three groups had statistically significant differences(P < 0.05), but there were no significant differences in the differencevalues of WOMAC pain score and stiffness scores among the three groups(P > 0.05). At the follow-up of one month after the end of treatment, the difference values of VAS scores, WOMAC pain scores, WOMAC functional activity scores among the three groups had statistically significant differences(P < 0.05 or P < 0.01), while there was no significant difference in the difference values of WOMAC stiffness scores among the three groups(P > 0.05). Conclusion The treatment of all three groups can alleviate knee pain, improve the function of movement, among which, treatment group1 may alleviates pain best, followed by treamtnet group 2, control group.
引文
[1]Conaghan PG,Dickson J,Grant RL,et al.Care and management of osteoarthritis in adults:summary of nice guidance[J].BMJ,2008,336(7642):502-503.
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[6]McAlindon TE,Bannuru RR,Sullivan MC,et al.OARSIguidelines for the non-surgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388.
[7]Kim TH,Kim KH,Kang JW,et al.Moxibustion treatment for knee osteoarthritis:a multi-centre,non-blinded,randomised controlled trial on the effectiveness and safety of the moxibustion treatment versus usual care in knee osteoarthritis patients[J].PLoS One,2014,9(7):e101973.
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[9]周艳丽,李璟,侯文光,等.艾灸治疗膝骨关节炎临床观察[J].上海针灸杂志,2014,33(12):1086-1088.
[10]Altman R,Asch E,Bloch D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis Rheum,1986,29(8):1039-1049.
[11]Bellamy N,Buchanan WW,Goldmith CH,et al.Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to the hip or knee[J].J Rheumatol,1988,15(12):1833-1840.
[12]Wolfe F.Determints of WOMAC function,pain and difiness scores:evidence of the role of low back pain,symptom counts,fatigues and depression in osteoarthritis,rheumatoid arthritis and fibromyalgial[J].Rheumatology,1999,38:355-361.
[13]Kellgren JH,Lawrence JS.Radiological assessment of osteoarthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[14]Ren XM.Preliminary clinical randomized controlled trial on knee osteoarthritis treated with moxibution[J].WJAM,2012,22(2):28-33.
[15]孙兵,车晓明.视觉模拟评分法(VAS)[J].中华神经外科杂志,2012,28(6):645.
[16]Higss R.Osteoarthritis:Concentrated efforts to detect early OA[J].Nat Rev Rheumatol,2010,6(11):616.
[17]Baker K,McAlindon T.Exercise for knee osteoanhritis[J].Currpin Rheumatol,2000,12(5):456-463.
[18]Deeks JJ,Smith LA,Bradley MD.Efficacy tolerability and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis:systematic review of RCTs[J].BMJ,2002,325(7365):619.
[19]贺小卉,张少明.不同针灸方式对虚寒型膝骨关节炎患者WOMAC评分及疼痛症状的影响比较[J].陕西中医,2017,38(4):511-512.
[20]张强,赵同德,杨甜甜,等.针药联合治疗膝骨关节炎临床观察[J].针灸临床杂志,2016,32(3):37-39.
[21]Zhao L,Cheng K,Wang L,et al.Effectiveness of moxibustion treatment as adjunctive therapy in osteoarthritis of the knee:a randomized,double-blinded,placebocontrolled clinical trial[J].Arthritis Res Ther,2014,16(3):R133.
[22]吴焕淦,翁志军,刘慧荣,等.基于免疫相关性疾病的艾灸镇痛与抗炎免疫研究[J].世界中医药,2017,11(12):2505-2520.
[23]刘晴,刘维,吴沅皞.针灸治疗膝关节骨性关节炎选穴规律现代文献研究[J].山东中医杂志,2015,34(11):824-826.
[24]洪宗国.蕲艾的地道性研究[J].中南民族大学学报,2015,34(2):33-37.
[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(16):2887-2888.
[3]邱贵兴.骨关节炎流行病学和病因学进展[J].中华医学信息导报,2008,24(12):22.
[4]Driban JB,Mcalindon TE,Amin M,et al.Risk Factors can Classify In-dividuals who Develop Accelerated Knee Osteoarthritis:Data from the Osteoarthritis Initiative[J].JOrthop Res,2017,8(4):1-5.
[5]李宁华.中老年人群骨关节炎的流行病学特征[J].中国临床康复,2005,9(38):133-135.
[6]McAlindon TE,Bannuru RR,Sullivan MC,et al.OARSIguidelines for the non-surgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388.
[7]Kim TH,Kim KH,Kang JW,et al.Moxibustion treatment for knee osteoarthritis:a multi-centre,non-blinded,randomised controlled trial on the effectiveness and safety of the moxibustion treatment versus usual care in knee osteoarthritis patients[J].PLoS One,2014,9(7):e101973.
[8]Zhao L,Cheng K,Wang L,et al.Effectiveness of moxibustion treatment as adjunctive therapy in osteoarthritis of the knee:a randomized,double-blinded,placebo-controlled clinical trial[J].Arthritis Res Ther,2014,16(3):R133.
[9]周艳丽,李璟,侯文光,等.艾灸治疗膝骨关节炎临床观察[J].上海针灸杂志,2014,33(12):1086-1088.
[10]Altman R,Asch E,Bloch D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis Rheum,1986,29(8):1039-1049.
[11]Bellamy N,Buchanan WW,Goldmith CH,et al.Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to the hip or knee[J].J Rheumatol,1988,15(12):1833-1840.
[12]Wolfe F.Determints of WOMAC function,pain and difiness scores:evidence of the role of low back pain,symptom counts,fatigues and depression in osteoarthritis,rheumatoid arthritis and fibromyalgial[J].Rheumatology,1999,38:355-361.
[13]Kellgren JH,Lawrence JS.Radiological assessment of osteoarthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[14]Ren XM.Preliminary clinical randomized controlled trial on knee osteoarthritis treated with moxibution[J].WJAM,2012,22(2):28-33.
[15]孙兵,车晓明.视觉模拟评分法(VAS)[J].中华神经外科杂志,2012,28(6):645.
[16]Higss R.Osteoarthritis:Concentrated efforts to detect early OA[J].Nat Rev Rheumatol,2010,6(11):616.
[17]Baker K,McAlindon T.Exercise for knee osteoanhritis[J].Currpin Rheumatol,2000,12(5):456-463.
[18]Deeks JJ,Smith LA,Bradley MD.Efficacy tolerability and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis:systematic review of RCTs[J].BMJ,2002,325(7365):619.
[19]贺小卉,张少明.不同针灸方式对虚寒型膝骨关节炎患者WOMAC评分及疼痛症状的影响比较[J].陕西中医,2017,38(4):511-512.
[20]张强,赵同德,杨甜甜,等.针药联合治疗膝骨关节炎临床观察[J].针灸临床杂志,2016,32(3):37-39.
[21]Zhao L,Cheng K,Wang L,et al.Effectiveness of moxibustion treatment as adjunctive therapy in osteoarthritis of the knee:a randomized,double-blinded,placebocontrolled clinical trial[J].Arthritis Res Ther,2014,16(3):R133.
[22]吴焕淦,翁志军,刘慧荣,等.基于免疫相关性疾病的艾灸镇痛与抗炎免疫研究[J].世界中医药,2017,11(12):2505-2520.
[23]刘晴,刘维,吴沅皞.针灸治疗膝关节骨性关节炎选穴规律现代文献研究[J].山东中医杂志,2015,34(11):824-826.
[24]洪宗国.蕲艾的地道性研究[J].中南民族大学学报,2015,34(2):33-37.