手法治疗膝骨关节炎研究进展

Research Progress on Manipulation Treatment of Knee Osteoarthritis

手法治疗膝关节骨性关节炎(knee osteoarthritis,KOA)以松解膝关节周围软组织为主,并结合运动关节类手法,能够影响关节软骨的代谢,抑制炎症因子的产生。众多医家在治疗KOA时多遵循从点(腧穴)出发、以痛为腧的手法,并重视线(经脉)面(经筋)结合、以筋为先。目前,临床治疗KOA多结合辨证论治、现代解剖学及生物力学,整体施治。此外,手法联合温针灸、中药熏洗、中药内服、运动疗法均能有效改善老年KOA。然而目前手法治疗KOA仍存在一些问题:如KOA的发病机制尚不明确,手法治疗KOA的作用机制研究尚处于探索阶段;手法的运用虽呈百家争鸣之势,但多侧重于对某种手法的临床疗效观察,对疗效原理的研究稍显欠缺;临床观测指标的客观性不足;手法与辨病、辨证的结合尚存在不足。针对上述问题,未来亟须进一步投入多中心、大样本临床研究以及更为深入的力学、分子生物学、细胞学等方面的实验研究,同时在现有基础上,综合国内外手法治疗的疗效原理进行深入的理论研究,并考虑纳入更加客观的影像学、生物力学、步态分析等指标。此外,无论是从局部、整体,抑或是综合疗法的使用,需进一步明确对症、对因依据,制定更加规范的辨证分型和疗效评估标准。

The treatment of knee osteoarthritis( KOA) by manipulation is mainly to loosen the soft tissues around the knee joint.In combination with sports joints,it can affect the metabolism of articular cartilage and inhibit the production of inflammatory factors. Many medical practitioners follow the method of starting from the point( acupoint) and treating pain as a pain,and attach importance to the combination of the line( meridian) and the surface( menstrual tendon). At present,the clinical treatment of KOA is mostly combined with syndrome differentiation,modern anatomy and biomechanics,and overall treatment. In addition,techniques combined with warm acupuncture,Chinese medicine fumigation and washing,Chinese medicine orally,and exercise therapy can effectively improve elderly KOA. However,there are still some problems with manual treatment of KOA: for example,the pathogenesis of KOA is not clear,and the research on the mechanism of treatment of KOA is still in the exploratory stage. Although the application of the method is controversial,it is mostly focused on the clinical application of a certain method. Observation of curative effect,the research on the principle of curative effect is slightly lacking;the objectiveness of clinical observation indicators is insufficient;the combination of methods and syndrome differentiation is still insufficient. In view of the above problems,it is urgent to further invest in multi-center,large-sample clinical research,and more in-depth experimental research in mechanics,molecular biology,and cytology. At the same time,based on the existing foundation,the efficacy of domestic and foreign manual treatments will be integrated. In-depth theoretical research on the principle,and consider the inclusion of more objective imaging,biomechanics,gait analysis and other indicators. In addition,whether it is from the use of local,overall,or comprehensive therapies,the symptomatic basis should be further clarified,and more standardized syndrome differentiation and curative effect evaluation standards should be formulated.