针刺联合拔罐运动疗法治疗气滞血瘀型膝骨关节炎:随机对照研究
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摘要
目的:比较针刺联合拔罐运动疗法与针刺配合普通拔罐治疗气滞血瘀型膝骨关节炎的临床疗效,寻求治疗膝骨关节炎的较佳方案。方法:将78例气滞血瘀型膝骨关节炎患者随机分为观察组和对照组,每组39例(观察组脱落3例,对照组脱落2例)。两组均予针刺治疗,穴取内膝眼、犊鼻、血海、梁丘、鹤顶、足三里、阴陵泉、阳陵泉、悬钟。对照组在针刺治疗基础上联合普通拔罐治疗,血海、梁丘、风市选取4号玻璃拔罐器,阴陵泉选取3号玻璃拔罐器,阿是穴根据位置选取大小合适的玻璃拔罐器,留罐5 min;观察组在针刺基础上联合拔罐运动疗法治疗,拔罐取穴、拔罐器型号同对照组,拔罐后指导患者带罐进行膝屈伸,髋外展、内收、负重等方向的主动运动,每天治疗1次,10次为一疗程,疗程间休息2 d,共治疗3个疗程。分别于治疗前后记录患者的症状积分、疼痛评分及膝关节功能评分;同时采用B超检测患者关节积液量,酶联免疫吸附法(ELISA)检测关节液中白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的含量。结果:治疗后,观察组总有效率为94.4%(34/36),高于对照组的86.5%(32/37,P<0.05);与治疗前相比,两组患者治疗后症状积分、疼痛评分、关节积液量及关节液中IL-1、IL-6、TNF-α含量均降低、膝关节运动功能评分增加(均P<0.05);与对照组相比,观察组症状积分、疼痛评分,关节液中IL-1、TNF-α含量及关节积液量均较低,膝关节运动功能评分较高(均P<0.05),IL-6改善程度差异无统计学意义(P>0.05)。结论:针刺联合拔罐运动疗法治疗膝骨关节炎可减轻疼痛,改善关节功能,减少关节积液量,降低关节液中炎性因子含量,疗效优于针刺联合普通拔罐。
Objective To compare the clinical efficacy between acupuncture combined with cinesiotherapy cupping and acupuncture combined with conventional cupping for knee osteoarthritis(KOA) with qi stagnation and blood stasis syndrome, and to seek a better solution for KOA. Methods A total of 78 patients of KOA with qi stagnation and blood stasis syndrome were randomly divided into an observation group and a control group, 39 cases in each group(3 cases in the observation group and 2 cases in the control group lost contact). Both groups were treated with acupuncture at Neixiyan(EX-LE 4), Dubi(ST 35), Xuehai(SP 10), Liangqiu(ST 34), Heding(EX-LE 2), Zusanli(ST 36), Yinlingquan(SP 9), Yanglingquan(GB 34) and Xuanzhong(GB 39). Based on the acupuncture treatment, the control group was treated with conventional cupping. The No. 4 cupping glass was used for Xuehai(SP 10), Liangqiu(ST 34) and Fengshi(GB 31),while the No. 3 cupping glass was used for Yinlingquan(SP 9), while the cupping with appropriate size was used for ashi points; the cupping glass was retained for 5 min. Based on the acupuncture treatment, the observation group was treated with cinesiotherapy cupping. The selection of acupoint and cupping glass was identical as the control group. The patients were instructed to perform knee flexion-extension, hip abduction-adduction, weight-bearing and other active exercise while cupping; the treatment was given once a day, 10 times as a course of treatment; totally three courses were given with an interval of 2 days between the courses. The patient's symptom scores, pain scores and knee function scores were recorded before and after treatment. The amount of joint effusion was measured by ultrasound; the level of interleukin-1(IL-1), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) in joint effusion were measured by ELISA. Results After treatment, the total effective rate in the observation group was 94.4%(34/36), which was significantly higher than 86.5%(32/37) in the control group(P<0.05). Compared before treatment, the symptom scores, pain scores, amount of joint effusion and the levels of IL-1, IL-6, TNF-α in joint fluid in both groups all were decreased after treatment, whereas the knee function scores were increased(P<0.05). Compared with the control group, the symptom scores, pain scores, and the levels of IL-1, TNF-α and the amount of joint effusion all were significantly decreased, whereas the knee function scores were increased in the observation group(P<0.05). The level of IL-6 in joint effusion was not significantly different between the observation group and the control group(P>0.05). Conclusion The acupuncture combined with cinesiotherapy cupping could alleviate pain, improve joint function and reduce joint effusion, which is superior to acupuncture combined with conventional cupping.
Objective To compare the clinical efficacy between acupuncture combined with cinesiotherapy cupping and acupuncture combined with conventional cupping for knee osteoarthritis(KOA) with qi stagnation and blood stasis syndrome, and to seek a better solution for KOA. Methods A total of 78 patients of KOA with qi stagnation and blood stasis syndrome were randomly divided into an observation group and a control group, 39 cases in each group(3 cases in the observation group and 2 cases in the control group lost contact). Both groups were treated with acupuncture at Neixiyan(EX-LE 4), Dubi(ST 35), Xuehai(SP 10), Liangqiu(ST 34), Heding(EX-LE 2), Zusanli(ST 36), Yinlingquan(SP 9), Yanglingquan(GB 34) and Xuanzhong(GB 39). Based on the acupuncture treatment, the control group was treated with conventional cupping. The No. 4 cupping glass was used for Xuehai(SP 10), Liangqiu(ST 34) and Fengshi(GB 31),while the No. 3 cupping glass was used for Yinlingquan(SP 9), while the cupping with appropriate size was used for ashi points; the cupping glass was retained for 5 min. Based on the acupuncture treatment, the observation group was treated with cinesiotherapy cupping. The selection of acupoint and cupping glass was identical as the control group. The patients were instructed to perform knee flexion-extension, hip abduction-adduction, weight-bearing and other active exercise while cupping; the treatment was given once a day, 10 times as a course of treatment; totally three courses were given with an interval of 2 days between the courses. The patient's symptom scores, pain scores and knee function scores were recorded before and after treatment. The amount of joint effusion was measured by ultrasound; the level of interleukin-1(IL-1), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) in joint effusion were measured by ELISA. Results After treatment, the total effective rate in the observation group was 94.4%(34/36), which was significantly higher than 86.5%(32/37) in the control group(P<0.05). Compared before treatment, the symptom scores, pain scores, amount of joint effusion and the levels of IL-1, IL-6, TNF-α in joint fluid in both groups all were decreased after treatment, whereas the knee function scores were increased(P<0.05). Compared with the control group, the symptom scores, pain scores, and the levels of IL-1, TNF-α and the amount of joint effusion all were significantly decreased, whereas the knee function scores were increased in the observation group(P<0.05). The level of IL-6 in joint effusion was not significantly different between the observation group and the control group(P>0.05). Conclusion The acupuncture combined with cinesiotherapy cupping could alleviate pain, improve joint function and reduce joint effusion, which is superior to acupuncture combined with conventional cupping.
引文
[1]刘献祥.中医药治疗膝骨性关节炎的研究现状[J].中医正骨,2012,24(1):3-7.
[2]曹锐,杨红玲,何润东.针刺治疗膝骨性关节炎45例临床观察[J].中医杂志,2016,57(13):1133-1136.
[3]赵娟,王盛春.针灸治疗膝骨性关节炎临床研究近况[J].山东中医药大学学报,2015,39(6):578-580.
[4]戴中,柳洪胜,王少杰,等.针刺治疗膝关节骨性关节炎疗效评价:同期非随机对照试验[J].中国针灸,2014,34(4):329-333.
[5]戴中,刘强,白文,等.针刺治疗膝关节骨性关节炎疗效观察[J].中国针灸,2012,32(9):785-788.
[6]中华人民共和国国务院.医疗机构管理条例[S].北京:中国法制出版社,1994.
[7]中华医学会风湿病学分会.骨关节炎诊治指南(草案)[J].中华风湿病学杂志,2003,7(11):702-704.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
[9]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:119-123.
[10]国家质量监督检验检疫总局,国家标准化管理委员会.腧穴名称与定位(GB/T 12346-2006)[S].北京:中国标准出版社,2006.
[11]罗跃嘉.简化McGill疼痛评分表的临床应用评价[J].中国康复,1992,7(4):160-164.
[12]Tegner Y,Lysholm J.Rating systems in the evaluation of knee ligament injuries[J].Clin Orthop Relat Res,1985,198:43-49.
[13]Walther M,Harms H,Krenn V,et al.Synovial tissue of the hip at power Doppler US:correlation between vascularity and power Doppler US signal[J].Radiology,2002,225(1):225-231.
[14]袁望舒,刘忠良,乔士兴,等.中、西医治疗膝骨性关节炎疗效的临床对比观察[J].中国老年学杂志,2011,31(20):3931-3933.
[15]李具宝,张磊,屈尚可,等.膝骨关节炎近10年文献中内服方药功效和中医证型分析[J].中国中医骨伤科杂志,2014,22(3):20-21,24.
[16]苏敏芝,李奎,胡昔权.运动罐法结合针刺治疗急性腰扭伤疗效观察[J].上海针灸杂志,2016,35(4):449-451.
[17]吴泰炜,郭伟.针灸治疗肝肾亏虚型膝痹病的临床进展[J].按摩与康复医学,2018,9(1):30-31.
[18]孙士全,谭涛.针灸治疗膝骨关节炎的作用机制探讨[J].中国医药导报,2017,14(10):127-130.
[19]洪寿海,吴菲,卢轩,等.拔罐疗法作用机制探讨[J].中国针灸,2011,31(10):932-934.
[20]陈晨,张欢.基于数据挖掘对推拿治疗膝骨关节炎取穴规律的研究[J].海南医学,2018,29(18):2617-2619.
[21]罗荣,刘琦,孙丹.运动罐法的操作技术及临床应用[J].中国针灸,2013,33(7):665-667.
[22]Dannhauer T,Sattler M,Wirth W,et al.Longitudinal sensitivity to change of MRI-based muscle cross-sectional area versus isometric strength analysis in osteoarthritic knees with and without structural progression:pilot data from the osteoarthritis initiative[J].MAGMA,2014,27(4):339-347.
[2]曹锐,杨红玲,何润东.针刺治疗膝骨性关节炎45例临床观察[J].中医杂志,2016,57(13):1133-1136.
[3]赵娟,王盛春.针灸治疗膝骨性关节炎临床研究近况[J].山东中医药大学学报,2015,39(6):578-580.
[4]戴中,柳洪胜,王少杰,等.针刺治疗膝关节骨性关节炎疗效评价:同期非随机对照试验[J].中国针灸,2014,34(4):329-333.
[5]戴中,刘强,白文,等.针刺治疗膝关节骨性关节炎疗效观察[J].中国针灸,2012,32(9):785-788.
[6]中华人民共和国国务院.医疗机构管理条例[S].北京:中国法制出版社,1994.
[7]中华医学会风湿病学分会.骨关节炎诊治指南(草案)[J].中华风湿病学杂志,2003,7(11):702-704.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
[9]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:119-123.
[10]国家质量监督检验检疫总局,国家标准化管理委员会.腧穴名称与定位(GB/T 12346-2006)[S].北京:中国标准出版社,2006.
[11]罗跃嘉.简化McGill疼痛评分表的临床应用评价[J].中国康复,1992,7(4):160-164.
[12]Tegner Y,Lysholm J.Rating systems in the evaluation of knee ligament injuries[J].Clin Orthop Relat Res,1985,198:43-49.
[13]Walther M,Harms H,Krenn V,et al.Synovial tissue of the hip at power Doppler US:correlation between vascularity and power Doppler US signal[J].Radiology,2002,225(1):225-231.
[14]袁望舒,刘忠良,乔士兴,等.中、西医治疗膝骨性关节炎疗效的临床对比观察[J].中国老年学杂志,2011,31(20):3931-3933.
[15]李具宝,张磊,屈尚可,等.膝骨关节炎近10年文献中内服方药功效和中医证型分析[J].中国中医骨伤科杂志,2014,22(3):20-21,24.
[16]苏敏芝,李奎,胡昔权.运动罐法结合针刺治疗急性腰扭伤疗效观察[J].上海针灸杂志,2016,35(4):449-451.
[17]吴泰炜,郭伟.针灸治疗肝肾亏虚型膝痹病的临床进展[J].按摩与康复医学,2018,9(1):30-31.
[18]孙士全,谭涛.针灸治疗膝骨关节炎的作用机制探讨[J].中国医药导报,2017,14(10):127-130.
[19]洪寿海,吴菲,卢轩,等.拔罐疗法作用机制探讨[J].中国针灸,2011,31(10):932-934.
[20]陈晨,张欢.基于数据挖掘对推拿治疗膝骨关节炎取穴规律的研究[J].海南医学,2018,29(18):2617-2619.
[21]罗荣,刘琦,孙丹.运动罐法的操作技术及临床应用[J].中国针灸,2013,33(7):665-667.
[22]Dannhauer T,Sattler M,Wirth W,et al.Longitudinal sensitivity to change of MRI-based muscle cross-sectional area versus isometric strength analysis in osteoarthritic knees with and without structural progression:pilot data from the osteoarthritis initiative[J].MAGMA,2014,27(4):339-347.