基于扶阳理论督灸联合温针灸治疗阳虚寒凝型膝关节骨关节炎疗效观察

Governor vessel moxibustion combined with warming acupuncture for knee osteoarthritis with yang deficiency and cold congelation based on the supporting-yang theory

目的:比较基于扶阳理论的督灸联合温针灸与单纯温针灸治疗阳虚寒凝型膝关节骨关节炎(KOA)的临床疗效。方法:将64例阳虚寒凝型KOA患者随机分为联合组(32例,脱落2例)和温针灸组(32例,脱落1例)。温针灸组于足三里、关元和患侧犊鼻、内膝眼等穴行温针灸,每日1次;联合组在温针灸组基础上加用督灸,每周1次,两组均治疗14 d为一疗程,共2个疗程,疗程间休息2 d。分别于治疗前后及治疗后12周随访时观察两组患者临床症状积分、视觉模拟量表(VAS)评分和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分,检测两组治疗前后髌上囊积液量,并于治疗后及随访时评定两组临床疗效。结果:治疗后及随访时,两组患者临床症状积分、VAS评分、WOMAC评分均较治疗前降低(P<0.05),且联合组低于温针灸组(P<0.05)。治疗后,两组患者髌上囊积液量较治疗前减少(P<0.05)。治疗后及随访时,联合组总有效率分别为93.3%(28/30)和86.7%(26/30),优于温针灸组的87.1%(27/31)和74.2%(23/31,P<0.05)。结论:督灸联合温针灸可改善阳虚寒凝型KOA患者疼痛、功能障碍等临床症状,减少髌上囊积液量,其近、远期疗效均优于单纯温针灸。

Objective To compare the clinical efficacy between governor vessel moxibustion combined with warming acupuncture based on the supporting-yang theory and simple warming acupuncture for knee osteoarthritis(KOA)with yang deficiency and cold congelation.Methods A total of 64 patients with KOA of yang deficiency and cold congelation were randomized into a combination group(32 cases,2 cases dropped off)and a warming acupuncture group(32 cases,1 case dropped off).In the warming acupuncture group,warming acupuncture was applied at Zusanli(ST 36),Guanyuan(CV 4)and Dubi(ST 35),Neixiyan(EX-LE 4),etc.on the affected side,once a day.On the basis of the treatment in the warming acupuncture group,governor vessel moxibustion was applied in the combination group,once a week.The 14-day treatment was taken as one course,and totally 2 courses with 2-day interval were required in the two groups.The clinical symptom score,the visual analogue scale(VAS)score and the Western Ontario and McMaster Universities arthritis index(WOMAC)score were observed before treatment,after treatment and in the follow-up of 12 weeks after treatment;the volume of suprapatellar bursa effusion was detected before and after treatment;the clinical efficacy was evaluated after treatment and in the follow-up in the two groups.Results After treatment and in the follow-up,the scores of clinical symptom,VAS and WOMAC were decreased compared before treatment in both groups(P<0.05),and those in the combination group were lower than the warming acupuncture group(P<0.05).After treatment,the volume of suprapatellar bursa effusion was decreased compared before treatment in both groups(P<0.05).After treatment and in the follow-up,the total effective rates were 93.3%(28/30)and 86.7%(26/30)in the combination group,which were superior to 87.1%(27/31)and 74.2%(23/31)in the warming acupuncture group respectively(P<0.05).Conclusion Governor vessel moxibustion combined with warming acupuncture can improve the clinical symptoms i.e.pain and dysfunction and reduce the volume of suprapatellar bursa effusion in KOA patients with yang deficiency and cold congelation,its short-term effect and long-term effect are both superior to simple warming acupuncture.