针刺结合刺络放血疗法治疗膝关节骨性关节炎的临床随机对照研究

Randomized Controlled Clinical Trails on Treatment of Knee Osteoarthritis with Acupuncture Combined with Blood-letting Therapy

目的:观察针刺结合刺络放血疗法治疗膝关节骨性关节炎的临床疗效,探讨刺络放血疗法的增效作用。方法:将63例膝关节骨性关节炎患者随机分为治疗组31例(针刺阿是穴,患侧内膝眼、犊鼻、梁丘、血海、足三里、阳陵泉等,每周治疗3次,治疗4周;配合腘窝部浅表静脉刺络放血,每周治疗1次,治疗4周)和对照组32例(单纯采用针刺疗法)。以骨关节炎调查量表(WOMAC)及临床疗效为客观指标,比较两组第1次治疗后、疗程结束的疗效差异及各项指标的积分情况。结果:治疗组临床控制5例,显效17例,有效6例,无效3例,总有效率为90.32%(28/31);对照组临床控制4例,显效14例,有效10例,无效4例,总有效率为87.50%(28/32);两组比较,差异无统计学意义(P>0.05)。两组治疗后WOMAC各项指标均较治疗前明显改善,治疗组第1次治疗后与治疗前的疼痛分差值和总疗程后与治疗前的疼痛分差值及生理功能分差值均较对照组大(P<0.05)。结论:针刺结合刺络放血疗法能较好地改善患者的生理功能,缓解膝关节骨性关节炎的疼痛感觉,尤其对疼痛早期缓解效果更佳。

Objective To observe the therapeutic effect of acupuncture combined with blood-letting therapy for knee osteoarthritis （KOA） and to analyze the synergism of the blood-letting therapy. Methods Sixty-three cases of KOA patients were randomized into a treatment group （n = 31 ）and a control group（n = 32）. Patients of treatment group were treated with routine acupuncture at Ashi-points, Dubi （ST 35） and Neixiyan（EX-LE 4）, Zusanli（ST 36）, Yanglingquan（GB 34）, etc. on the affected side, 3 times a week for 4 weeks, in combination with blood-letting （at the superficial veins around popliteal fossa） once a week for 4 weeks. Patients of control group were treated with routine acupuncture only. Western Ontario and McMaster Universities osteoarthritis index scores （WOMAC） and clinical therapeutic effects served as the objective indexes for evaluating the efficacy of blood-letting therapy. Results After the treatment, of the 32 and 31 KOA patients in control and treatment groups, 4（12.50%） and 5（16. 13） were under control in their symptoms, 14（43.75%） and 17（54.84%） experienced marked improvement, 10（31.25%） and 6（19.35%） had an improvement, and 4（12.50%） and 3（9.68%） were failed, with the total effective rates being 87.50% and 90.32% respectively. No significant difference was found between the two groups in the therapeutic effect （P〉0.05）. In comparison with pre-treatment, WOMAC scores, pain index, and physiological integral scores in treatment and control groups after the first and the last treatment decreased significantly （P〈0.001）, and their joint stiffness index of the last treatment also lowered considerably （P〈0.001）. The difference values of the integral scores between post- and pre-treatment in WOMAC, pain index, and physiological function of treatment group were remarkably higher than those of control group （P〈0. 05）. Conclusion Acupuncture combined with blood-letting therapy can effectively improve KOA patients＇ physiological function and reduce joint pain especially in the early stage.