膝三针配合艾灸治疗老年膝关节退行性骨关节炎临床研究
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摘要
研究目的
通过观察靳三针疗法中的膝三针配合艾灸治疗老年膝关节退行性骨关节炎的临床疗效,为其临床作用机制提供依据,以利于推广应用。
研究方法
收集年龄在60岁(含60岁)以上的膝关节退行性骨关节炎患者,按照就诊顺序随机分为两组。治疗组采用膝三针配合艾灸治疗;对照组选用膝三针治疗。治疗组的主穴为膝三针,由血海、梁丘及内外膝眼穴组成;配穴根据辩证选穴。行痹选风池和膈俞穴;痛痹选肾俞与关元穴;着痹选阴陵泉及足三里穴;热痹选大椎同风池穴。治疗组主穴的针刺操作方法为屈膝取穴,如果取仰卧位针刺,需在患者膝下垫上一个高枕,使患者双膝呈自然屈曲状。各穴位行常规消毒后,内外膝眼穴以1.5寸针向内侧刺入,可刺1-1.2寸深,禁止刺入关节腔;血海、梁丘穴以1.5寸针,直刺1.2寸深左右,得气为度。配穴用常规针刺方法。针刺后,用点燃的清艾条在有关穴位上轮流悬灸,并根据证型施行艾灸及针刺提插补泻手法。留针45分钟。对照组的针刺取穴及操作方法与治疗组相同。留针45分钟,并根据证型施行针刺提插补泻手法。各组每周治疗3次,9次为一疗程,2个疗程后观察疗效。观察指标为简式MPQ疼痛问卷表、膝关节退行性骨关节炎严重程度计分标准(Lequesne MG)、加拿大WOMAC膝关节退行性骨关节炎症状及肢体功能评定指数(WOMAC Index Of Osteoarthritis)和膝关节退行性骨关节炎治疗效果判定标准(JOA)。各组疗效评定采用尼莫地平法,即(治疗前计分一治疗后计分)/治疗前计分×100%。
两组基线比较
1治疗组30例,男性12例,女性18例,平均年龄65.45±2.91岁,平均病程6.25±0.49年。其中行痹5人,痛痹10人,着痹14人,热痹1人。对照组31例,男性14例,女性17例,平均年龄68.31±3.99岁,平均病程6.86±0.61年。其中行痹4人,痛痹13人,着痹12人,热痹2人。两组病例在性别、年龄、病程、证型方面无明显差异,具有可比性(P＞0.05)。
2经t检验,两组治疗前各项观察指标之间无显著性差异(P＞0.05),表示两组样本来自同一总体,可以进行同步研究。
研究结果
经过两个疗程的治疗后,治疗组临床基本痊愈者4例,显效者11例,有效者14例,无效者1例,总有效率93.33%。对照组临床基本痊愈者2例,显效者9例,有效者13例,无效者7例,总有效率77.42%。经X~2检验,治疗组疗效明显优于对照组(0.01＜P＜0.05),说明采用针刺配合艾灸治疗老年膝关节退行性骨关节炎比单纯针刺治疗疗效更显著。
研究结论
本研究表明,经治疗后,治疗组与对照组的患者在膝关节疼痛及肿胀程度、膝关节僵硬时间长短及屈曲程度、无疼痛步行距离长短、上下楼梯难易程度及日常生活质量等方面均较治疗前有所改善。其中,治疗组的疗效比对照组更佳,主要体现在缓解膝关节疼痛及缩短膝关节僵硬时间方面。由此可见,针刺配合艾灸治疗膝关节退行性骨关节炎在镇痛及温通气血方面均比单纯针刺有优势。
Objective
By observing the clinical effect on senile knee osteoarthritis treated by Jin's 3-knee points with moxibustion,we intend to provide a strong evidence for the clinical mechanism of the treatment and widely apply the treatment in clinical practice.
Method
In this research,we collected patients with knee osteoarthritis,aged 60 or older.We then randomly divided these patients into a Jin's 3-knee points with moxibustion treatment group and a Jin's 3-Knee Points controlled group. Jin's 3-Knee Points contain acupoints of Xuehai(SP 10),Liangqiu(ST 34) and both Xiyan(extra).Others are chosen according to a patient's Chinese medical syndromes.We used Fengchi(GB 20) and Geshu(BL 17) for Moving Bi,Shenshu (BL 23) and Guanyuan(RN 4) for Painful Bi,Yinlingquan(SP 9) and Zusanli (ST 36) for Fixed Bi as well as Dazhui(DU 14) and Fengchi(GB 20) for Heat Bi.For the treatment group,it's necessary for a patient to bend the knee when related acupoints are located.If one needles the patient in a supine position,a pillow should be placed under the knees to elevate them into a bent position.After routine sterilization of each acupoint,we needled both Xiyan(extra) using a 1.5-cun needle medial toward the patella to a depth of 1-1.2 cun.Needling into the articular cavity was prohibited.Xuehai(SP 10) and Liangqiu(ST 34) were needled with a 1.5-cun needle to a depth of approximately 1.2 cun.The degree of depth was dictated by the need to get Qi.Other acupoints were needled by commonly held method.After all the points were needled,we moxaed each of the main acupoints by holding a burned moxa stick over it.We manipulated both the needle and moxa stick to conduct either tonification or sedation according to a patient's Chinese medical syndromes.Needles were kept for 45 minutes.Patients of the controlled group were treated using the same needling technique as it was performed on patients of the treatment group.Needles were also kept for 45 minutes. According to a patient's Chinese medical syndromes,we manipulated the needles up and down in order to conduct either tonification or sedation.Each group of patients was treated 3 times a week,3 weeks a course.After two courses of treatment we evaluated the clinical effect.The clinical effect was evaluated by four different observation forms,and they are Simplified MPQ Pain Questionnaire(MPQ),Marking Standard of Degree of Seriousness of KOA (Lequesne MG),WOMAC Index Of Osteoarthritis(WOMAC) and Judging Standard of Clinical Effect On KOA(JOA).The total clinical effect on each group was evaluated by using the Nimodipine calculating method,that is,(mark before treatment - mark after treatment) / mark before treatment×100%.
Fundamental group comparison
1 The treatment group contained 30 patients,12 males and 18 females.The average age of the group was 65.45±2.91 years old.The average course of the disease was 6.25±0.49 years.Each of the 30 patients was categorized into one of the 4 classes according to their Chinese medical syndromes.Among the 30 patients,5 were categorized into Moving Bi,10 Painful Bi,14 Fixed Bi and 1 Heat Bi.The controlled group contained 31 patients,14 males and 17 females.The average age of the group was 68.31±3.99 years old.The average course of the disease was 6.86±0.61 years. Among the 31 patients,4 were categorized into Moving Bi,13 Painful Bi, 12 Fixed Bi and 2 Heat Bi.There were no obvious differences on gender, age,course of disease and class of Chinese medical syndromes between the two groups.Therefore,the two groups were comparable(P＞0.05).
2 According to the statistical t test,we found that there was no obvious difference on each of the observation categories between the two groups before treatment(P＞0.05).Therefore,the two samples were from the same population and could be studied simultaneously.
Results
After two courses of treatment,the treatment group had a total effective rate of 93.33%.Among the 30 patients,4 were clinically and basically recovered,11 had obvious effect,14 had fair effect and i had no effect.The controlled group had a total effective rate of 77.42%.Among the 31 patients, 2 were clinically and basically recovered,9 had obvious effect,13 had fair effect and 7 had no effect.According to the statistical X~2test,the clinical effect of the treatment group was obviously superior to it of the controlled group(0.01＜P＜0.05 ).This finding shows that the clinical effect on treating senile knee osteoarthritis by acupuncture with moxibustion is more outstanding than it by acupuncture alone.
Conclusion
The clinical research presented here showed that after two courses of treatment,both group of the patients had improved in the aspects of pain and swelling degrees of knees,time span of knee stiffness,angle of bending knees, painless walking distance,difficulties in climbing up and walking down steps, qualities of daily life,and so on.The clinical effect of treatment group is better than it of controlled group in the aspects of pain relief of knees and shortening time span of knee stiffness.As a result,in terms of relieving pains as well as circulating blood and Qi,treating senile knee osteoarthritis by using acupuncture with moxibustion is superior to it by using acupuncture alone
通过观察靳三针疗法中的膝三针配合艾灸治疗老年膝关节退行性骨关节炎的临床疗效,为其临床作用机制提供依据,以利于推广应用。
研究方法
收集年龄在60岁(含60岁)以上的膝关节退行性骨关节炎患者,按照就诊顺序随机分为两组。治疗组采用膝三针配合艾灸治疗;对照组选用膝三针治疗。治疗组的主穴为膝三针,由血海、梁丘及内外膝眼穴组成;配穴根据辩证选穴。行痹选风池和膈俞穴;痛痹选肾俞与关元穴;着痹选阴陵泉及足三里穴;热痹选大椎同风池穴。治疗组主穴的针刺操作方法为屈膝取穴,如果取仰卧位针刺,需在患者膝下垫上一个高枕,使患者双膝呈自然屈曲状。各穴位行常规消毒后,内外膝眼穴以1.5寸针向内侧刺入,可刺1-1.2寸深,禁止刺入关节腔;血海、梁丘穴以1.5寸针,直刺1.2寸深左右,得气为度。配穴用常规针刺方法。针刺后,用点燃的清艾条在有关穴位上轮流悬灸,并根据证型施行艾灸及针刺提插补泻手法。留针45分钟。对照组的针刺取穴及操作方法与治疗组相同。留针45分钟,并根据证型施行针刺提插补泻手法。各组每周治疗3次,9次为一疗程,2个疗程后观察疗效。观察指标为简式MPQ疼痛问卷表、膝关节退行性骨关节炎严重程度计分标准(Lequesne MG)、加拿大WOMAC膝关节退行性骨关节炎症状及肢体功能评定指数(WOMAC Index Of Osteoarthritis)和膝关节退行性骨关节炎治疗效果判定标准(JOA)。各组疗效评定采用尼莫地平法,即(治疗前计分一治疗后计分)/治疗前计分×100%。
两组基线比较
1治疗组30例,男性12例,女性18例,平均年龄65.45±2.91岁,平均病程6.25±0.49年。其中行痹5人,痛痹10人,着痹14人,热痹1人。对照组31例,男性14例,女性17例,平均年龄68.31±3.99岁,平均病程6.86±0.61年。其中行痹4人,痛痹13人,着痹12人,热痹2人。两组病例在性别、年龄、病程、证型方面无明显差异,具有可比性(P＞0.05)。
2经t检验,两组治疗前各项观察指标之间无显著性差异(P＞0.05),表示两组样本来自同一总体,可以进行同步研究。
研究结果
经过两个疗程的治疗后,治疗组临床基本痊愈者4例,显效者11例,有效者14例,无效者1例,总有效率93.33%。对照组临床基本痊愈者2例,显效者9例,有效者13例,无效者7例,总有效率77.42%。经X~2检验,治疗组疗效明显优于对照组(0.01＜P＜0.05),说明采用针刺配合艾灸治疗老年膝关节退行性骨关节炎比单纯针刺治疗疗效更显著。
研究结论
本研究表明,经治疗后,治疗组与对照组的患者在膝关节疼痛及肿胀程度、膝关节僵硬时间长短及屈曲程度、无疼痛步行距离长短、上下楼梯难易程度及日常生活质量等方面均较治疗前有所改善。其中,治疗组的疗效比对照组更佳,主要体现在缓解膝关节疼痛及缩短膝关节僵硬时间方面。由此可见,针刺配合艾灸治疗膝关节退行性骨关节炎在镇痛及温通气血方面均比单纯针刺有优势。
Objective
By observing the clinical effect on senile knee osteoarthritis treated by Jin's 3-knee points with moxibustion,we intend to provide a strong evidence for the clinical mechanism of the treatment and widely apply the treatment in clinical practice.
Method
In this research,we collected patients with knee osteoarthritis,aged 60 or older.We then randomly divided these patients into a Jin's 3-knee points with moxibustion treatment group and a Jin's 3-Knee Points controlled group. Jin's 3-Knee Points contain acupoints of Xuehai(SP 10),Liangqiu(ST 34) and both Xiyan(extra).Others are chosen according to a patient's Chinese medical syndromes.We used Fengchi(GB 20) and Geshu(BL 17) for Moving Bi,Shenshu (BL 23) and Guanyuan(RN 4) for Painful Bi,Yinlingquan(SP 9) and Zusanli (ST 36) for Fixed Bi as well as Dazhui(DU 14) and Fengchi(GB 20) for Heat Bi.For the treatment group,it's necessary for a patient to bend the knee when related acupoints are located.If one needles the patient in a supine position,a pillow should be placed under the knees to elevate them into a bent position.After routine sterilization of each acupoint,we needled both Xiyan(extra) using a 1.5-cun needle medial toward the patella to a depth of 1-1.2 cun.Needling into the articular cavity was prohibited.Xuehai(SP 10) and Liangqiu(ST 34) were needled with a 1.5-cun needle to a depth of approximately 1.2 cun.The degree of depth was dictated by the need to get Qi.Other acupoints were needled by commonly held method.After all the points were needled,we moxaed each of the main acupoints by holding a burned moxa stick over it.We manipulated both the needle and moxa stick to conduct either tonification or sedation according to a patient's Chinese medical syndromes.Needles were kept for 45 minutes.Patients of the controlled group were treated using the same needling technique as it was performed on patients of the treatment group.Needles were also kept for 45 minutes. According to a patient's Chinese medical syndromes,we manipulated the needles up and down in order to conduct either tonification or sedation.Each group of patients was treated 3 times a week,3 weeks a course.After two courses of treatment we evaluated the clinical effect.The clinical effect was evaluated by four different observation forms,and they are Simplified MPQ Pain Questionnaire(MPQ),Marking Standard of Degree of Seriousness of KOA (Lequesne MG),WOMAC Index Of Osteoarthritis(WOMAC) and Judging Standard of Clinical Effect On KOA(JOA).The total clinical effect on each group was evaluated by using the Nimodipine calculating method,that is,(mark before treatment - mark after treatment) / mark before treatment×100%.
Fundamental group comparison
1 The treatment group contained 30 patients,12 males and 18 females.The average age of the group was 65.45±2.91 years old.The average course of the disease was 6.25±0.49 years.Each of the 30 patients was categorized into one of the 4 classes according to their Chinese medical syndromes.Among the 30 patients,5 were categorized into Moving Bi,10 Painful Bi,14 Fixed Bi and 1 Heat Bi.The controlled group contained 31 patients,14 males and 17 females.The average age of the group was 68.31±3.99 years old.The average course of the disease was 6.86±0.61 years. Among the 31 patients,4 were categorized into Moving Bi,13 Painful Bi, 12 Fixed Bi and 2 Heat Bi.There were no obvious differences on gender, age,course of disease and class of Chinese medical syndromes between the two groups.Therefore,the two groups were comparable(P＞0.05).
2 According to the statistical t test,we found that there was no obvious difference on each of the observation categories between the two groups before treatment(P＞0.05).Therefore,the two samples were from the same population and could be studied simultaneously.
Results
After two courses of treatment,the treatment group had a total effective rate of 93.33%.Among the 30 patients,4 were clinically and basically recovered,11 had obvious effect,14 had fair effect and i had no effect.The controlled group had a total effective rate of 77.42%.Among the 31 patients, 2 were clinically and basically recovered,9 had obvious effect,13 had fair effect and 7 had no effect.According to the statistical X~2test,the clinical effect of the treatment group was obviously superior to it of the controlled group(0.01＜P＜0.05 ).This finding shows that the clinical effect on treating senile knee osteoarthritis by acupuncture with moxibustion is more outstanding than it by acupuncture alone.
Conclusion
The clinical research presented here showed that after two courses of treatment,both group of the patients had improved in the aspects of pain and swelling degrees of knees,time span of knee stiffness,angle of bending knees, painless walking distance,difficulties in climbing up and walking down steps, qualities of daily life,and so on.The clinical effect of treatment group is better than it of controlled group in the aspects of pain relief of knees and shortening time span of knee stiffness.As a result,in terms of relieving pains as well as circulating blood and Qi,treating senile knee osteoarthritis by using acupuncture with moxibustion is superior to it by using acupuncture alone
引文
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