不同刺灸法治疗膝骨关节炎的临床疗效观察

Comparision of therapertic effect of different acupuncture methods for knee osteoarthritis

目的:比较针刺、电针和艾灸治疗膝骨关节炎(KOA)的临床疗效差异。方法:84例KOA患者随机分为针刺组、电针组和艾灸组,每组28例。针刺组予毫针针刺,取穴为患侧的内膝眼、犊鼻、鹤顶、血海、梁丘、足三里、阿是穴,每次30 min;电针组予电针治疗,取穴同针刺组,采用电针治疗,每次30 min;艾灸组予艾灸箱进行膝关节局部治疗,每次60 min;各组治疗均为每两天1次,连续4周,共14次。于治疗前和治疗4周后观察3组患者疼痛数字评分(NRS)和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)并在治疗4周后进行疗效评定。结果:与本组治疗前比较,3组患者治疗后NRS评分、WOMAC疼痛评分、WOMAC僵硬评分、WOMAC功能评分及WOMAC总分均显著降低(P<0.05);与针刺组比较,电针组和艾灸组上述评分显著下降(P<0.05);与电针组比较,艾灸组上述指标显著下降(P<0.05)。针刺组、电针组和艾灸组有效率分别是39.29%(11/28)、60.71%(17/28)和78.57%(22/28),电针组和艾灸组显著高于针刺组,艾灸组显著高于电针组(P<0.05)。结论:3种刺灸法均可缓解患者膝关节疼痛、僵硬和功能障碍的症状,艾灸疗效优于电针,电针优于针刺。

Objective To compare the clinical efficacy of acupuncture,electroacupuncture(EA)and moxibustion in the treatment of knee osteoarthritis(KOA).Methods A total of eight-four patients with KOA were randomly and equally divided into acupuncture group,EA group and moxibustion group.Neixiyan(EX-LE40),Dubi(ST35),Heding(EX-LE2),Liangqiu(ST34),Xuehai(SP10),Zusanli(ST36)and Ashi-point on the affected side of the body were punctured with filiform needles or EA(2 Hz/100 Hz)for 30 min.In the moxibustion group,moxibustion was applied to the surrounding area of the affected joint for 60 min.The treatment was conducted once every other day for 4 weeks.The pain degree was assessed by using numerical rating scale(NRS)and the Western Ontario McMaster Universities Osteoarthritis Index(WOMAC)scale(0-240 points)was used to evaluate the severity of KOA.The"Minimal Clinically Important Improvement(MCII)"was used to assess the therapeutic effect after the treatment.Results After the treatment,the scores of NRS,and the pain,stiffness,motor function and total scores of WOMAC were significantly decreased in the three groups compared with their own pre-treatment(P<0.05),and were obviously lower in the EA and moxibustion groups than in the acupuncture group(P<0.05),and those of the moxibustion group was notably lower than those of the acupuncture group(P<0.05).Of the 28 cases in the acupuncture,EA and moxibustion groups,11,17 and 22 were effective,with the effective rate being 39.29%,60.71%and 78.57%,respectively.The comprehensive therapeutic effect of the moxibustion group was significantly superior to that of the acupuncture and EA groups(P<0.05).Conclusion All the three different kinds of acupuncture and moxibustion methods have positively regulatory effect on KOA,and moxibustion is the best for reducing the joint pain and stiffness,and improving the motor function.