温针灸与小针刀联合推拿治疗气滞血瘀、肝肾阴虚膝骨关节炎随机平行对照研究

The Radom Parallel Control Study of Acupuncture And Moxibustion,Acupotomology Therapy Combined With Massage In The Treatment Of Knee Osteoarthritis

[目的]观察温针灸与小针刀联合推拿治疗气滞血瘀、肝肾阴虚膝骨关节炎疗效。[方法]使用随机平行对照方法,将64例住院患者按就诊顺序编号简单随机分为两组。对照组32例推拿1推法：以大鱼际自关节上方由近及远平推;2揉法：拇指点揉肌肉结节和内侧韧带;3推髌：拇指刮揉患者髌骨两侧缘,轻推髌骨;4点穴：点压膝关节部位穴位,如膝眼、血海、足三里等;5屈伸：使患者被动屈伸膝关节,逐渐加大幅度以患者能耐受为度。治疗组32例温针灸1双膝下垫枕以避免膝关节悬空;2取膝眼、血海、阴陵泉、阳陵泉、足三里、鹤顶针刺,得气后留针;3将一段2cm左右的艾条插在针柄上,点燃艾条;4待艾条燃尽后去除灰烬,取针;1次/d,连续6d;小针刀,治疗第7日,患者取仰卧位,明确压痛点,取1~3个进针点,小针刀刺入皮肤,平行进刀,小针刀尖端贴紧欲剥离组织,横向剥离后,纵向切割,以横向链接的纤维组织松懈剥离为度,术中避开大血管和神经,出针按压,覆盖创面;推拿治疗同对照组。连续治疗7d为1疗程。观测临床症状、膝关节功能、疼痛程度VAS评分、生存质量SF-36问卷、不良反应。治疗1疗程（7d）,判定疗效。[结果]治疗组临床控制12例,显效11例,有效7例,无效2例,总有效率93.75%。对照组临床控制6例,显效8例,有效9例,无效9例,总有效率71.88%。治疗组疗效优于对照组（P〈0.05）。膝关节功能两组均有改善（P〈0.01）,治疗组优于对照组（P〈0.01）;疼痛程度两组均有改善（P〈0.01）,治疗组优于对照组（P〈0.01）;生存质量两组均明显改善（P〈0.01,P〈0.05）,治疗组优于对照组（P〈0.01）。[结论]温针灸与小针刀联合推拿治疗气滞血瘀、肝肾阴虚膝骨关节炎,疗效满意,无副作用,值得推广。

[ Objective ] To observe the clinical efficacy of acupuncture and moxibustion, acupotomology therapy combined with massage in the treatment of knee osteoarthritis. [ Methods ] Used random parallel control method, divided 64 patients （ hospital/clinic ） into two groups randomly according to the doctor order number. The 32 cases of control group was massage group. （1）Pushing manipulation：used flat-pushing manipulation with thenar eminence from near to the distant above the joints. （2）Kneading Manipulation： used point-kneading manipulation with the thumb on muscle nodules and medial ligaments. （3）Patellar apprehension：used scrapekneading manipulation with the thumb on patellar edge of both sides of patients, jogged patella. （4）Pointing Therapy：used point pressure on the acupoints of knee joints, such as knee eyes, Xuehai and Zusanli. （5）Flexion-extension：made the knee joints of the patients flexion and extension passively, and increased amplitude gradually to the patients can＇ t tolerate. The 32 cases of treatment group was acupuncture and moxibustion group. （1）Put the pillows under two knees to avoid knee joints dangling. （2）Acupunctured the knee eyes, Xuehai, Yinlingquan, Yanglingquan, Zusanli and Heding, after bring about the desired sensation retaining needles. （3）Inserted a period of 2cm moxa sticks on the needle handle, and ignited the moxa sticks. （4）Removed the ash after the moxa sticks burnt out, and removed the needles. The massage method was same with the control group. Massage and acupuncture and moxibustion continued treatment 6 days, 1 time/d. acupotomology therapy, the 7 day of the treatment, patients were maintained at supine position, and cleared pressure points, chosen 1 - 3 needle entry points and routine preoperative preparation. Given the localized anesthesia at needle entry points, penetrated into the skin with small needle-knife and parallel feed, the tip of the small needle-knife stick close with the divest organization, after striping longitude cutting, to the transverse link fibrous tissue lax striping. Avoided the large blood vessels and nerves during operation, removed needle- knife and pressed, and covered the wound. The massage therapy was same with the control group. 7 days as a treatment course. Observe the clinical symptoms, knee joint function, VAS score of pain degree, SF-36 questionnaires of survival quality. Treated one course （ 7 days ） and determined the clinical efficacy. [ Results ] Treatment group 12 cases were clinical control, 11 cases were markedly effective, 7 cases were effective, and 2 cased had no effect, the total effective rate was 93.75%. Control group 6 cases were clinical control, 8 cases were markedly effective, 9cases were effective, and 9cased had no effect, the total effective rate was 71.88%. The clinical efficacy of treatment group was better than control group （ P〈0.0 ）o Knee joint function： Both of the groups were improved （P〈0.01）, treatment group was better than control group. Pain degree： Both of the groups were improved （P〈0.01）, , treatment group was better than control group （P〈0.01）, no obvious difference between the two groups （P〉0.01） .Quality of life： Both of the groups were significantly increased （P〈0.05, P〈0.01 ）, treatment group was better than control group （P〈0.01, P〈0.05 ）, no obvious difference between the two groups （ P〉0.01 ） . [ Conclusion ] The clinical efficacy of acupuncture and moxibustion, acupotomology therapy combined with massage in the treatment of knee osteoarthritis was satisfied, no negative side effects and is worth to be widely applied .