经筋针刺+按摩拉伸+八式膝关节功能康复保健操治疗北方寒地早中期膝骨性关节炎(行痹/风痹、痛痹/寒痹)多中心随机平行对照研究

The Reinforcement Of Acupuncture Plus Massage Stretch + Bashi Knee Joint Function Rehabilitation Exercises To Treat The North Cold Early Metaphase Knee Osteoarthritis(Migratory Arthralgia-Wind Bi/行痹-风痹,Pain Bi-Cold Bi/痛痹-寒痹)Multi-Center Random Para

[目的]观察经筋针刺+按摩拉伸+八式膝关节功能康复保健操治疗北方寒地早中期膝骨性关节炎(行痹/风痹、痛痹/寒痹)疗效。[方法]使用随机平行对照方法,将180例住院患者按病志号抽签随机分两组。对照组90例针刺(承山、委阳、犊鼻、内膝眼、膝关、阴陵泉、阳陵泉、足三里等),一次性针灸针(0.35×40mm和0.35×50mm),承山、委阳、足三里等直刺10~20mm,犊鼻、内膝眼等斜向关节间隙,平补平泻,得气后留针15~20min。治疗组90例经筋针刺+按摩拉伸+八式膝关节功能康复保健操,(1)经筋针刺:膝部、腰部经筋点,一次性针灸针(0.35×40mm和0.35×50mm)直刺患处,膝部筋结点针刺达髌骨或胫骨、股骨骨面,腰髂部筋结点针刺达髂骨骨面,坐骨大切迹附近注意避开血管和大神经;腹股沟附近避开腹股沟内神经和血管,股骨大转子附近针刺达大转子面,1次/d;(2)经筋按摩拉伸:足三阳、足三阴经筋分布区域,按疼痛部位,选择相关肌肉,膝部前侧疼痛选股直肌,股内侧肌,长收肌和短收肌处结筋病灶点,膝部前内侧痛选股内侧肌,股薄肌,股直肌,缝匠肌,内收长肌和内收短肌处结筋病灶点;膝部外侧疼痛选股外侧肌结筋病灶点;膝部后侧疼痛选半腱肌和半膜肌,股二头肌(长头或短头),腘肌,腓肠肌,比目鱼肌,跖肌等处结筋病灶点,医者手指往复推动肌肉组织,寻找条索状物或硬结,出现疼痛或感传疼,关节活动因疼痛受限,即可确定为结筋病灶点,定点标记,由浅而深、由轻而重,以循、触、摸、按、切、拿、弹按、推按、拨刮、揉捏等,结合患者膝关节被动与主动屈伸旋转运动;(3)八式膝关节功能康复保健操:鹤步冰湖、鹤舞九天、晨鹤浴面、仙人舞鹤、天鹅引颈、幼鹿迎母、仙鹤顾翎、仙鹿启足,模仿动物姿态和动作,拉伸关节、肌肉、韧带,15~20min/次,2次/d,早晚各1次。连续治疗15d为1疗程。观测临床症状、VAS评分、WOMAC评分、红外热成像、不良反应。连续治疗2疗程(30d),判定疗效。[结果]治疗组显效31例,有效56例,无效3例,显效率34.44%;对照组显效18例,有效63例,无效9例,显效率20.00%;显效率治疗组优于对照组(P<0.05)。VAS评分、WOMAC评分两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01);红外热成像温度治疗组明显改善(P<0.01),对照组无明显变化(P>0.05)。[结论]经筋针刺+按摩拉伸+八式膝关节功能康复保健操治疗北方寒地早中期膝骨性关节炎(行痹/风痹、痛痹/寒痹),疗效满意,无严重不良反应,值得推广。

[Objective] To observe the effect of acupuncture combined with meridian tendons in the treatment of knee osteoarthritis in the early and mid-term of northern cold region [arthralgia（rheumatism arthralgia） and pain arthralgia（Hanbi）]. [Methods] Using random parallel control method, 180 hospitalized patients were randomly divided into two groups according to the number of disease records. In the control group, 90 cases of acupuncture（Chengshan, Weiyang, calf nose, inner knee, knee, Yin mausoleum, Yang Mausoleum, Zusanli, etc.） were selected as the reference of the national standard ＂the name and location of acupoints＂ by the national standard. In the treatment group, 90 cases were treated with tendon palpation and knee joint function exercises. 15 times of continuous treatment were 1 courses. The clinical symptoms and adverse reactions were observed. The 2 course of treatment was continuously treated to determine the curative effect. [Results] 31 cases were found in the treatment group, 56 cases were effective, 3 cases were invalid, the effective rate was 34.44%; The control group showed 18 cases, 63 cases were effective, 9 cases were invalid, the effective rate was 20%, the effective rate treatment group was superior to the control group（P〈0.05）. The VAS score, WOMAC score and infrared thermography temperature improvement in the treatment group were better than those in the control group（P〈0.01）. [Conclusion] The treatment of knee osteoarthritis in the early and midterm of northern cold region with acupuncture combined with tendons and tendons is satisfactory, without serious adverse reactions, and it is worth popularizing.