针刺配合手法调整膝关节肌力平衡治疗膝骨性关节炎的临床对照试验

Clinical study on the treatment of knee osteoarthritis by acupuncture plus manipulative regulation of knee muscle balance

目的:研究应用症状、体征量表评分评价针刺配合手法调整膝关节肌力平衡疗法治疗膝骨性关节炎的临床疗效,为治疗该病提供临床疗效依据。方法:2008年1月至2009年12月将121例膝骨性关节炎患者随机分为两组。治疗组63例83膝,男16例,女47例,平均年龄(59.88±7.97)岁;对照组58例73膝,男13例,女45例,平均年龄(57.95±10.37)岁。治疗组用针刺配合手法调整膝关节肌力平衡疗法治疗,对照组口服双氯芬酸钠缓释片,分别在治疗前后、治疗结束后3个月采用症状、体征量表,疼痛程度数字评价量表法,关节功能、肿胀评分对患者进行评价,所有数据使用SPSS10.0统计软件进行统计学分析。结果:①治疗组治疗前后症状、体征积分分别为(39.81±3.92)、(9.69±8.08)分;关节疼痛(NRS)积分分别为(7.61±0.97)、(2.17±2.09)分;功能积分分别为(1.47±0.50)、(0.61±0.58)分;肿胀积分分别为(1.23±0.79)、(0.42±0.52)分。对照组治疗前后症状、体征积分分别为(39.89±3.78)、(13.62±7.83)分;关节疼痛积分分别为(7.55±0.71)、(3.34±2.32)分;功能积分分别为(1.33±0.47)、(0.93±0.67)分;肿胀积分分别为(0.97±0.88)、(0.58±0.52)分。两组治疗前后比较差异均有统计学意义(P<0.01);治疗后两组间症状、体征评分及关节疼痛、功能积分比较,治疗组优于对照组;治疗后两组间肿胀积分无明显差异。②治疗后治疗组临床痊愈12膝,显效48膝,有效19膝,无效4膝;对照组临床痊愈5膝,显效31膝,有效34膝,无效3膝;治疗结束3个月后,治疗组临床痊愈8膝,显效42膝,有效27膝,无效6膝;对照组临床痊愈5膝,显效21膝,有效37膝,无效10膝。治疗组综合疗效优于对照组。结论:针刺配合手法调整膝关节肌力平衡疗法能有效改善膝骨性关节炎患者的临床症状、体征及膝关节活动度,防止病情发展,是治疗膝骨性关节炎的有效手段。

Objective：To investigate and research the appraisal scores of the symptoms and physical signs index for the evaluation of the clinical efficacy of acupuncture and manipulative regulation of knee muscle balance for the treatment of knee osteoarthritis,and provide clinical basis for the treatment.Methods：From January 2008 to December 2009,121 patients with knee osteoarthritis were randomly divided into two groups.In the treatment group there were 63 cases of 83 knees including 16 males and 47 females,with an average age of（59.88±7.97） years;in the control group there were 58 cases of 73 knees including 13 males and 45 females,with an average age of（57.95±10.37） years.The patients in the treatment group were treated with acupuncture plus manipulative regulation of knee muscle balance,and the patients in the control group were treated with Diclofenac Sodium Sustained Release Tablets.The appraisal scores of the symptoms and physical signs index,numerical rating scale of pain,joint function,joint swelling were evaluated before and after the treatment,as well as 3 months after the treatment.All data were statistical analyzed by package SPSS 10.0.Results：① In the treatment group,before and after treatment the appraisal scores of the symptoms and physical signs index were（39.81±3.92） and（9.69±8.08）;numerical rating scale of pain were（7.61 ±0.97） and（2.17 ±2.09）;joint function were（1.47 ±0.50）and（0.61 ±0.58）;joint swelling were（1.23 ±0.79）and（0.42±0.52）.As well in the control group,above data were（39.89±3.78）,（13.62±7.83）,（7.55±0.71）,（3.34±2.32）,（1.33± 0.47）,（0.93±0.67）,an（0.97±0.88）,（0.58±0.52） respectively.Both group had obvious differences in the appraisal scores of the symptoms and physical signs index,numerical rating scale of pain,joint function,joint swelling between after and before treatment.The comparison between the two groups suggested that after the treatments the treatment group had better therapy effect than those of the control group in the appraisal scores of the symptoms and physical signs index,numerical rating scale of pain,joint function,but both group had no differences in the appraisal scores of joint swelling.② After the treatment,12 patients in the treatment group were clinically cured,48 had remarkable effects,19 good,and 4 ineffective.As well in the control group,above data were 5,31,34 and 3 respectively.Three months after the treatment,above data were 8,42,27 and 6 respectively in the treatment group.In the control group,above data were 5,21,37 and 10 respectively.The treatment group was superior to the control group after the treatments and 3 months after the treatment.Conclusion：Acupuncture plus manipulative regulation of knee muscle balance can effectively improve the clinical symptoms and knee joint＇s motor function of patients with knee osteoarthritis,and can avoid the further development of disease.It is a proved effective method for knee osteoarthritis.