邓晋丰教授中医药治疗膝骨性关节炎学术经验整理和研究
|
摘要
膝关节骨性关节炎(Osteoarthritis,OA),是一种常见的多发于中年以后的风湿性疾病。该病不仅发生关节软骨损害,还累及整个关节,包括软骨下骨、韧带、关节囊、滑膜和关节周围肌肉,最终发生关节软骨退变,纤维化、断裂、溃疡及整个关节面的损害。国内流行病学调查显示,男性和女性膝骨关节病峰值分别可达到24.7%和54.6%,其发展过程隐匿,极大危害人们健康,成为影响中老年人运动以及慢性残疾的首要原因。现代医学对膝OA的病因尚不十分明确,遗传、环境等因素,特别是老化过程,以及正常的磨损、慢性损伤、肥胖、饮食习惯等都是可能的致病因素。
目前西医在膝OA的治疗上,主要目的是缓解关节疼痛,改善功能并重建受损之软骨及骨结构。虽然治疗方法很多,但各种方法都有其局限性,不能从根本上治愈。中医药在膝OA的治疗上,经过历代医家在中医理论的指导下不断地研究和探索,积累了丰富的经验,临床效果满意。由于中医药治疗方法众多,副作用少,医疗费用低廉,因而具有广泛的优势,适合不同类型的人群以及不同时期的证候,充分体现了传统医学的整体观念和辨证论治的观念。
邓晋丰教授是全国第二批师带徒名老中医,从事中医骨伤科工作近50年,学贯中西,尤擅长应用中医药治疗膝OA,是当今岭南中医骨伤一代宗师。在近50年临床生涯中,他运用中医药治疗膝OA,对膝OA的病因病理发展以及预后有着深刻的认识,积累了丰富的治膝经验,并逐渐形成了具有岭南特色的独特风格,在岭南中医治膝学术上具有重要的地位。近年来笔者侍诊其左右,勤学不怠,将其运用中医药治疗膝OA的学术经验、心得和讲学,予以汇集整理成篇,以期能更好地研究和总结邓师的学术思想,并将之发扬光大,推广应用,造福于四方。
本论文主要分三部分进行,第一部分为邓晋丰教授简介,介绍邓教授的生平情况。第二部分为文献研究,系统地阐述了膝OA的西医致病因素研究、发病机制研究、现代诊断研究、中医药作用机制研究、西医治疗以及现代中医药治疗研究。第三部分为邓晋丰教授运用中医药治疗膝骨性关节炎学术经验整理和研究,分别从十个方面阐述其治膝的学术经验和思想:
一、邓晋丰教授对膝OA中医药发展沿革的研究
膝OA属于痹的范畴,其历史沿革从《内经》始,到后世有诸多的发挥,但其病因,仍然以内外因为主,内因为或气血亏损,或真阴不足,或元阳精亏,或痰浊瘀血,或脾胃失调而生内湿,或湿热内生,或七情失调等分为虚实两侯;外因则不论何者,皆没有脱离外感六淫的范畴。
二、邓晋丰教授对岭南人群体质特点的研究
人是天地自然的产物,人和自然环境有着密切的联系,自然环境影响和制约着人体健康和生理病理状况。岭南地区气候以“热”和“湿”区别于其他地区,特殊气候及饮食习惯形成了岭南人腠理不密,阳气常不足、上热下寒、阴湿偏盛、脾胃虚寒、外热内寒的体质特点。
三、邓晋丰教授对膝OA的分类研究
膝OA从五因上分析和痛痹、湿痹、顽痹关系最为密切;从患病深浅和肉、筋、骨关系最为相合;从五脏所属来分析,则与肝脾肾有直接联系。
四、邓晋丰教授对膝OA中医病因研究
膝OA的病因主要和年龄、饮食、劳逸、创伤、痰瘀、先天禀赋、外邪入侵、生活习惯以及气候地理环境等密切相关。特别是岭南独特的气候地理条件和饮食生活习惯是引起岭南人群膝OA的重要病理因素。
五、邓晋丰教授对膝OA发病机理的研究
发病机理包括营卫不和,气血失调,痰瘀互结,脏腑阴阳失调等方面。膝OA的演变过程可归纳为:病位于膝部,包括肌肤、经络、血脉和筋骨;病性为本虚标实、虚实夹杂。初起以标实多见,病势较浅,多为寒、湿、热、瘀、痰痹阻;久之虚实互现,或以虚为主、杂有标实,或标实为主、杂以虚侯,或虚实并作;病势由表入里,由浅入深,常累及脏腑,除寒、湿、热、瘀、痰之外,还出现气虚、血虚、阳虚、精亏、脾胃虚弱、肝肾虚损等病变,病变发展过程中主要累及肺、脾、肝、肾等脏腑;晚期则以疼痛、关节变形、畸形、功能障碍为主要临床表现。其突出的病理改变主要为不通,不荣。
六、邓晋丰教授对膝OA治疗原则的经验整理
膝OA治疗原则包括治未病、扶正祛邪、整局标本同治、三因制宜以及综合论治五大原则。
七、邓晋丰教授对膝OA常见症状表现研究
膝OA四大主症,“痛”、“拘”、“肿”、“畸”四大主症,其中以“痛”、“拘”、“肿”为最常见,“畸”通常发生在膝关节炎的晚期。
八、邓晋丰教授关于膝OA治疗大法经验整理
治疗方法除《内经》所述治痹三法之外,主要包括“调”、“温”、“补”、“通”四大治疗方法。调即调和、调理、协调之意,主要包括调和营卫、调理脾胃。温法包括温阳散寒、温阳化湿。补法不外乎从气、从血、从精,主要包括补益气血、补益肝肾、补肾填精。通法重点放在痰和瘀,包括活血化瘀、通经活络、行气活血、燥湿化痰、化痰通络、逐水化痰、温阳化痰、化痰散结、化痰通络、逐瘀涤痰、软坚散结等。
九、邓晋丰教授治疗膝OA用药经验整理
治疗膝OA用药精当,味少力专,长于温补、健运脾胃、祛湿化痰以及化瘀通络,针对所犯经络不同,习用引经药物,使药直达病所,并善于使用毒药、虫药、藤药以及南药进行治疗。其调脾扶正善用芪术和爪龙;温阳散寒善用麻桂姜附辛;祛湿善用三仁二泽苍藿兰;豁痰善用星芥半夏与僵蚕;逐瘀善用灵脂乳没与虫药;补益肝肾兼加有情之品;解挛善用芍桂草木瓜;杂合以治复法显效宏。
十、邓晋丰教授对膝OA预防和调护经验整理
对膝OA预防和调护应从预防开始,加强相关知识的宣教,对于已病则要早发现、早诊断和早治疗,做到正确地调护,走出治疗误区。
Osteoarthritis of knee joint(OAKJ)is a kind of common rheumatic disease, it often occurs at people over middle age.The disease is not only with articular cartilage injury,but also influences the bone below cartilage, ligament,joint capsule,synovial membrane and the muscles around the joint, and in the end causes deterioration of cartilage,fibrosis,rupture,ulcer and destruction of the whole joint surface.Domestic epidemiology shows the peak value of the male and female patients with OAKJ reach 24.7%and 54.6% respectively.The development of OAKJ is secret,it influences the health badly and has became the primary reason influencing the motion of people in middle and old age and causing chronic disability.The exact cause is unknown in modern medicine,congenital predisposition,environment,especial degenerative progress,and normal "wear and tear",chromic injury,obesity,dietetic habit maybe the causes.
Now the main treatment role in western medicine is to alleviate joint pain, improve joint function and reconstruct cartilage and bone structure.Though there are many kinds of methods,every method has its limitation and can not cure it from the root.The clinical effect of treating OAKJ with traditional Chinese medicine(TCM)is satisfied.TCM has widely advantages,because of its many kinds of methods,less side-effects,cheap pay,it fits different types of people and different period of symptoms and signs,fully incarnate the concept regarding the human body as a whole and selecting of treatment based on the differential diagnosis.
Professor Deng Jinfeng is one of the famous old doctor of.TCM,has engaged in Chinese osteotraumatology for 50 years,has rich knowledge on TCM and western medicine.He is good at treating OAKJ,and is a great master of Chinese osteotraumacology in Lingnan region.In the past 50 years he gets used to treat OAKJ with TCM and has impressive understanding on the cause,pathology, development and prognosis of OAKJ.He has accumulated rich experiences on treating OAKJ,formed his own distinctive theory with Lingnan style.The author has followed Professor Deng for many years.In order to study and sum up better his theory,he has sorted his scholarship on treating OAKJ with TCM into articles.All these are to carry forward his theory and benefit the society and patients.
This thesis includes three parts:the first part is the brief introduction of Professor Deng Jinfeng;the second is the literature review which systemmatically introduce the study of etiological factors,pathogenesis, modern diagnosis,action mechanism of Chinese medicine,treatment of western medicine and modern Chinese medicine;the third is the scholarship sorting and study of OAKJ treated by Professor Deng with TCM,which will be expounded from ten aspects.
1.The study on the development and change of OAKJ in TCM
OAKJ belongs to "Bi-syndrome" of Chinese medicine and is originated from NeiJing.Though the later generations develop and change it much,its etiological factors mainly are internal and external factors.The internal factors are deficiency of qi and blood,or deficiency of real-yin,or deficiency of yuanyang or phlegm and blood stasis blocking the channel,or disfunction of spleen and stomach causing internal wetness,or internal heat and wetness,or incoordination of seven emotions.All these factors can be divided into asthenia and excess syndromes;all the external factors belong to six exogenous pathogens.
2.The study on the characteristic of constitution in Lingnan region
Human are the production of the nature and have closed relationship with natural environment.It influences and restricts the health and physiological and pathological state."Heat" and "wetness" is the main characteristic of climate in tingnan region and different from other areas in China.So special climate conditions and food and drink habits formed the characteristics of constitution of rarefaction of the skin,often deficiency of yangqi,upper heat and lower cold,relative predominance of cold wetness,deficiency and cold of spleen and stomach and external heat and internal cold.
3.The study of classification on OAKJ
According to five factors pathology,OAKJ has the most closed relationship with pain,wet and obstinate bi-syndrome.If analyzing from the disease region, it coincides with muscle,tendon and bone bi-syndrome.In terms of the natures of five Zang-organs,it has immediate connections with the liver,spleen and kidney system.
4.The study of etiological factors of TCM on OAKJ
The etiological factors of OAKJ mainly have closed relationship with age, food and drink,overstrain and rest,trauma,phlegm and blood stasis, deficiency of innateness,invasion of exogenous pathogen,living habits,and climate and geographic environment,etc.The unique climate and geographic environment and living habits of Lingnan are the main pathogenic factors causing osteoarthritis of knee joint.
5.The study of pathogenic mechanism on OAKJ
The pathogenic mechanism includes imbalance between nutrient ying and defensive wei,incoordination between vital energy and blood,phlegm and blood stasis stagnation,disorders between yin and yang and states of viscera,etc. The evolvement of OAKJ can conclude the followed aspects:Firstly,the knee jointis the diseased region which involves in skin and muscle,meridian,blood vessel,tendon and bone;Secondly,the disease nature is deficiency of the root and sthenia of the branch,asthenia accompanied with sthenia.It first mainly shows sthenia syndrome of the branch,superficial disease region, mostly caused by cold,dampness,heat,blood stasis and phlegm blocking the channels.Late the asthenia and sthenia syndrome appear simultaneously,or asthenia syndrome accompanied with sthenia,or sthenia syndrome accompanied with asthenia.The disease region transmits from superficies to interior and often impairs the zang-fu organs.Except for the pathological changes of cold, dampness,heat,blood stasis,phlegm,there are deficiency of qi,blood and yang,insufficiency of essence of life,asthenia of spleen and stomach and hypofunction of liver and kidney which mainly damage the lung,spleen,liver, kidney system during the development.In advanced stage the mainly clinical symptoms are pain,deformity of knee,disfunction,and the prominent pathological changes are stasis and disnourishment.
6.The sorting of experience on the treatment principle of OAKJ
There are five treatment principles of OAKJ,which include preventive treatment,supporting healthy energy to eliminate evils,relieving the primary and secondary symptoms at the same time,treatment caused by three categories of etiological factors and selecting treatment based on the integration。
7.The study of common symptoms of OAKJ
There are four main symptoms which are "pain","stiffness","swell", "deformity".The first three symptoms are common and the "Deformity" symptom often occurs in advanced stage in OAKJ.
8.The sorting of experience on treatment methods of OAKJ
The therapeutic methods mainly include "regulating","warming", "invigorating" and "promoting" except for three kinds methods on bi-syndrome in NeiJing "Regulating" methods include regulating ying-energy and wei-energy,regulating spleen and stomach;"Warming" methods include expelling cold-evil by warming yang,driving out wet-evil by warming yang. "Invigorating" methods include invigorating qi and blood,strengthening liver and kidney,nourishing essence of life by invigorating kidney. "Promoting" methods focus on phlegm and blood stasis,they include activating blood and transforming the stasis,dredging the meridian passage, activating vital energy and blood circulation,drying the dampness-evil and eliminating phlegm,dissipating phlegm and dredging the meridian passage, eliminating phlegm by expelling excessive fluid,eliminating phlegm by warming yang,dissipating a mass by eliminating phlegm,dissipating blood stasis and eliminating phlegm,etc.
9.The sorting of experience on treating OAKJ by Professor Deng Jinfeng with Chinese herbs
Professor Deng treats OAKJ with rare Chinese herbs,the herbs are rare but the effect is good.He is good at the methods of warming and invigorating, strengthening the spleen and stomach,expelling the dampness-evil and eliminating phlegm,dissipating blood stasis and dredging the meridian passage. Professor Deng get used to prescribe guiding channel herbs according to the disease invade different meridian passage,make the herbs reach the disease region directly,and he is expert in using poison,worm,liana and southern Chinese herbs.
10.The sorting of experience on prophylaxis and nursing to OAKJ by Professor Deng Jinfeng
The prophylaxis and nursing to OAKJ should begin from prophylaxis,and the propaganda and education about OAKJ should be strengthened.Early discovery,early diagnosis and early treatment to the OAKJ patients are very important.The patients should make correct regulating and nursing methods and walk out the misunderstanding district.
目前西医在膝OA的治疗上,主要目的是缓解关节疼痛,改善功能并重建受损之软骨及骨结构。虽然治疗方法很多,但各种方法都有其局限性,不能从根本上治愈。中医药在膝OA的治疗上,经过历代医家在中医理论的指导下不断地研究和探索,积累了丰富的经验,临床效果满意。由于中医药治疗方法众多,副作用少,医疗费用低廉,因而具有广泛的优势,适合不同类型的人群以及不同时期的证候,充分体现了传统医学的整体观念和辨证论治的观念。
邓晋丰教授是全国第二批师带徒名老中医,从事中医骨伤科工作近50年,学贯中西,尤擅长应用中医药治疗膝OA,是当今岭南中医骨伤一代宗师。在近50年临床生涯中,他运用中医药治疗膝OA,对膝OA的病因病理发展以及预后有着深刻的认识,积累了丰富的治膝经验,并逐渐形成了具有岭南特色的独特风格,在岭南中医治膝学术上具有重要的地位。近年来笔者侍诊其左右,勤学不怠,将其运用中医药治疗膝OA的学术经验、心得和讲学,予以汇集整理成篇,以期能更好地研究和总结邓师的学术思想,并将之发扬光大,推广应用,造福于四方。
本论文主要分三部分进行,第一部分为邓晋丰教授简介,介绍邓教授的生平情况。第二部分为文献研究,系统地阐述了膝OA的西医致病因素研究、发病机制研究、现代诊断研究、中医药作用机制研究、西医治疗以及现代中医药治疗研究。第三部分为邓晋丰教授运用中医药治疗膝骨性关节炎学术经验整理和研究,分别从十个方面阐述其治膝的学术经验和思想:
一、邓晋丰教授对膝OA中医药发展沿革的研究
膝OA属于痹的范畴,其历史沿革从《内经》始,到后世有诸多的发挥,但其病因,仍然以内外因为主,内因为或气血亏损,或真阴不足,或元阳精亏,或痰浊瘀血,或脾胃失调而生内湿,或湿热内生,或七情失调等分为虚实两侯;外因则不论何者,皆没有脱离外感六淫的范畴。
二、邓晋丰教授对岭南人群体质特点的研究
人是天地自然的产物,人和自然环境有着密切的联系,自然环境影响和制约着人体健康和生理病理状况。岭南地区气候以“热”和“湿”区别于其他地区,特殊气候及饮食习惯形成了岭南人腠理不密,阳气常不足、上热下寒、阴湿偏盛、脾胃虚寒、外热内寒的体质特点。
三、邓晋丰教授对膝OA的分类研究
膝OA从五因上分析和痛痹、湿痹、顽痹关系最为密切;从患病深浅和肉、筋、骨关系最为相合;从五脏所属来分析,则与肝脾肾有直接联系。
四、邓晋丰教授对膝OA中医病因研究
膝OA的病因主要和年龄、饮食、劳逸、创伤、痰瘀、先天禀赋、外邪入侵、生活习惯以及气候地理环境等密切相关。特别是岭南独特的气候地理条件和饮食生活习惯是引起岭南人群膝OA的重要病理因素。
五、邓晋丰教授对膝OA发病机理的研究
发病机理包括营卫不和,气血失调,痰瘀互结,脏腑阴阳失调等方面。膝OA的演变过程可归纳为:病位于膝部,包括肌肤、经络、血脉和筋骨;病性为本虚标实、虚实夹杂。初起以标实多见,病势较浅,多为寒、湿、热、瘀、痰痹阻;久之虚实互现,或以虚为主、杂有标实,或标实为主、杂以虚侯,或虚实并作;病势由表入里,由浅入深,常累及脏腑,除寒、湿、热、瘀、痰之外,还出现气虚、血虚、阳虚、精亏、脾胃虚弱、肝肾虚损等病变,病变发展过程中主要累及肺、脾、肝、肾等脏腑;晚期则以疼痛、关节变形、畸形、功能障碍为主要临床表现。其突出的病理改变主要为不通,不荣。
六、邓晋丰教授对膝OA治疗原则的经验整理
膝OA治疗原则包括治未病、扶正祛邪、整局标本同治、三因制宜以及综合论治五大原则。
七、邓晋丰教授对膝OA常见症状表现研究
膝OA四大主症,“痛”、“拘”、“肿”、“畸”四大主症,其中以“痛”、“拘”、“肿”为最常见,“畸”通常发生在膝关节炎的晚期。
八、邓晋丰教授关于膝OA治疗大法经验整理
治疗方法除《内经》所述治痹三法之外,主要包括“调”、“温”、“补”、“通”四大治疗方法。调即调和、调理、协调之意,主要包括调和营卫、调理脾胃。温法包括温阳散寒、温阳化湿。补法不外乎从气、从血、从精,主要包括补益气血、补益肝肾、补肾填精。通法重点放在痰和瘀,包括活血化瘀、通经活络、行气活血、燥湿化痰、化痰通络、逐水化痰、温阳化痰、化痰散结、化痰通络、逐瘀涤痰、软坚散结等。
九、邓晋丰教授治疗膝OA用药经验整理
治疗膝OA用药精当,味少力专,长于温补、健运脾胃、祛湿化痰以及化瘀通络,针对所犯经络不同,习用引经药物,使药直达病所,并善于使用毒药、虫药、藤药以及南药进行治疗。其调脾扶正善用芪术和爪龙;温阳散寒善用麻桂姜附辛;祛湿善用三仁二泽苍藿兰;豁痰善用星芥半夏与僵蚕;逐瘀善用灵脂乳没与虫药;补益肝肾兼加有情之品;解挛善用芍桂草木瓜;杂合以治复法显效宏。
十、邓晋丰教授对膝OA预防和调护经验整理
对膝OA预防和调护应从预防开始,加强相关知识的宣教,对于已病则要早发现、早诊断和早治疗,做到正确地调护,走出治疗误区。
Osteoarthritis of knee joint(OAKJ)is a kind of common rheumatic disease, it often occurs at people over middle age.The disease is not only with articular cartilage injury,but also influences the bone below cartilage, ligament,joint capsule,synovial membrane and the muscles around the joint, and in the end causes deterioration of cartilage,fibrosis,rupture,ulcer and destruction of the whole joint surface.Domestic epidemiology shows the peak value of the male and female patients with OAKJ reach 24.7%and 54.6% respectively.The development of OAKJ is secret,it influences the health badly and has became the primary reason influencing the motion of people in middle and old age and causing chronic disability.The exact cause is unknown in modern medicine,congenital predisposition,environment,especial degenerative progress,and normal "wear and tear",chromic injury,obesity,dietetic habit maybe the causes.
Now the main treatment role in western medicine is to alleviate joint pain, improve joint function and reconstruct cartilage and bone structure.Though there are many kinds of methods,every method has its limitation and can not cure it from the root.The clinical effect of treating OAKJ with traditional Chinese medicine(TCM)is satisfied.TCM has widely advantages,because of its many kinds of methods,less side-effects,cheap pay,it fits different types of people and different period of symptoms and signs,fully incarnate the concept regarding the human body as a whole and selecting of treatment based on the differential diagnosis.
Professor Deng Jinfeng is one of the famous old doctor of.TCM,has engaged in Chinese osteotraumatology for 50 years,has rich knowledge on TCM and western medicine.He is good at treating OAKJ,and is a great master of Chinese osteotraumacology in Lingnan region.In the past 50 years he gets used to treat OAKJ with TCM and has impressive understanding on the cause,pathology, development and prognosis of OAKJ.He has accumulated rich experiences on treating OAKJ,formed his own distinctive theory with Lingnan style.The author has followed Professor Deng for many years.In order to study and sum up better his theory,he has sorted his scholarship on treating OAKJ with TCM into articles.All these are to carry forward his theory and benefit the society and patients.
This thesis includes three parts:the first part is the brief introduction of Professor Deng Jinfeng;the second is the literature review which systemmatically introduce the study of etiological factors,pathogenesis, modern diagnosis,action mechanism of Chinese medicine,treatment of western medicine and modern Chinese medicine;the third is the scholarship sorting and study of OAKJ treated by Professor Deng with TCM,which will be expounded from ten aspects.
1.The study on the development and change of OAKJ in TCM
OAKJ belongs to "Bi-syndrome" of Chinese medicine and is originated from NeiJing.Though the later generations develop and change it much,its etiological factors mainly are internal and external factors.The internal factors are deficiency of qi and blood,or deficiency of real-yin,or deficiency of yuanyang or phlegm and blood stasis blocking the channel,or disfunction of spleen and stomach causing internal wetness,or internal heat and wetness,or incoordination of seven emotions.All these factors can be divided into asthenia and excess syndromes;all the external factors belong to six exogenous pathogens.
2.The study on the characteristic of constitution in Lingnan region
Human are the production of the nature and have closed relationship with natural environment.It influences and restricts the health and physiological and pathological state."Heat" and "wetness" is the main characteristic of climate in tingnan region and different from other areas in China.So special climate conditions and food and drink habits formed the characteristics of constitution of rarefaction of the skin,often deficiency of yangqi,upper heat and lower cold,relative predominance of cold wetness,deficiency and cold of spleen and stomach and external heat and internal cold.
3.The study of classification on OAKJ
According to five factors pathology,OAKJ has the most closed relationship with pain,wet and obstinate bi-syndrome.If analyzing from the disease region, it coincides with muscle,tendon and bone bi-syndrome.In terms of the natures of five Zang-organs,it has immediate connections with the liver,spleen and kidney system.
4.The study of etiological factors of TCM on OAKJ
The etiological factors of OAKJ mainly have closed relationship with age, food and drink,overstrain and rest,trauma,phlegm and blood stasis, deficiency of innateness,invasion of exogenous pathogen,living habits,and climate and geographic environment,etc.The unique climate and geographic environment and living habits of Lingnan are the main pathogenic factors causing osteoarthritis of knee joint.
5.The study of pathogenic mechanism on OAKJ
The pathogenic mechanism includes imbalance between nutrient ying and defensive wei,incoordination between vital energy and blood,phlegm and blood stasis stagnation,disorders between yin and yang and states of viscera,etc. The evolvement of OAKJ can conclude the followed aspects:Firstly,the knee jointis the diseased region which involves in skin and muscle,meridian,blood vessel,tendon and bone;Secondly,the disease nature is deficiency of the root and sthenia of the branch,asthenia accompanied with sthenia.It first mainly shows sthenia syndrome of the branch,superficial disease region, mostly caused by cold,dampness,heat,blood stasis and phlegm blocking the channels.Late the asthenia and sthenia syndrome appear simultaneously,or asthenia syndrome accompanied with sthenia,or sthenia syndrome accompanied with asthenia.The disease region transmits from superficies to interior and often impairs the zang-fu organs.Except for the pathological changes of cold, dampness,heat,blood stasis,phlegm,there are deficiency of qi,blood and yang,insufficiency of essence of life,asthenia of spleen and stomach and hypofunction of liver and kidney which mainly damage the lung,spleen,liver, kidney system during the development.In advanced stage the mainly clinical symptoms are pain,deformity of knee,disfunction,and the prominent pathological changes are stasis and disnourishment.
6.The sorting of experience on the treatment principle of OAKJ
There are five treatment principles of OAKJ,which include preventive treatment,supporting healthy energy to eliminate evils,relieving the primary and secondary symptoms at the same time,treatment caused by three categories of etiological factors and selecting treatment based on the integration。
7.The study of common symptoms of OAKJ
There are four main symptoms which are "pain","stiffness","swell", "deformity".The first three symptoms are common and the "Deformity" symptom often occurs in advanced stage in OAKJ.
8.The sorting of experience on treatment methods of OAKJ
The therapeutic methods mainly include "regulating","warming", "invigorating" and "promoting" except for three kinds methods on bi-syndrome in NeiJing "Regulating" methods include regulating ying-energy and wei-energy,regulating spleen and stomach;"Warming" methods include expelling cold-evil by warming yang,driving out wet-evil by warming yang. "Invigorating" methods include invigorating qi and blood,strengthening liver and kidney,nourishing essence of life by invigorating kidney. "Promoting" methods focus on phlegm and blood stasis,they include activating blood and transforming the stasis,dredging the meridian passage, activating vital energy and blood circulation,drying the dampness-evil and eliminating phlegm,dissipating phlegm and dredging the meridian passage, eliminating phlegm by expelling excessive fluid,eliminating phlegm by warming yang,dissipating a mass by eliminating phlegm,dissipating blood stasis and eliminating phlegm,etc.
9.The sorting of experience on treating OAKJ by Professor Deng Jinfeng with Chinese herbs
Professor Deng treats OAKJ with rare Chinese herbs,the herbs are rare but the effect is good.He is good at the methods of warming and invigorating, strengthening the spleen and stomach,expelling the dampness-evil and eliminating phlegm,dissipating blood stasis and dredging the meridian passage. Professor Deng get used to prescribe guiding channel herbs according to the disease invade different meridian passage,make the herbs reach the disease region directly,and he is expert in using poison,worm,liana and southern Chinese herbs.
10.The sorting of experience on prophylaxis and nursing to OAKJ by Professor Deng Jinfeng
The prophylaxis and nursing to OAKJ should begin from prophylaxis,and the propaganda and education about OAKJ should be strengthened.Early discovery,early diagnosis and early treatment to the OAKJ patients are very important.The patients should make correct regulating and nursing methods and walk out the misunderstanding district.
引文
[1]徐卫东,吴岳嵩,张春才.骨关节炎的诊断与治疗.第二军医大学出版社,1
[2]施桂英主编.关节炎概要.北京:中国医药科技出版社,2000,327
[3]Guccione AA,Felson DT,Anderson JJ,et al.The effects of specific medical conditions on the functional limitations of elders in the Framingham study.Am J Public Health,1994;84:351-358
[4]Felson DT.Preventing knee and hip osteoarthritis.Bull Rheum Dis,1998,47:1-4
[5]Lane NE.Ann Rheum Dis,1996;55(9):671-673
[6]Felson DT,Andeson JJ,Naimark A,er al.Obesity and knee osteoarthritis.The Framingham Study.Ann Intern Med,1988;109:18-24
[7]Felson DT,Zhang YQ,Marian T,et al.Arthritis Rheum,1997;40(4):728-733
[8]Felson DT.Preventing knee and hip osteoarthritis.Bull Rheum Dis,1998;47:1-4
[9]Slemenda C,Heilman DK,Brandt KD,et al.Reduced quadriceps strength relative to body weight:a risk factor for knee osteoarthritis in women?Arthritis Rheum,1998;41:1951-1959
[10]Slemenda C,Brandt KD,Heilman D,et al.Quadriceps weakness and osteoarthritis of the knee.Ann Intern Med,1997;127:97-104
[11]Felson DT,Nevitt MC.The effects of estrogen on osteoarthritis.Curr Opin Rheumatol,1998;10:269-272
[12]Hart DJ,Mootoosamy I,Doyk DV,et al.Ann Rheum Dis.1994;53:158-162
[13]Burger H,Pavlvs LAVD,Odding E,et al.Arthritis Rheum.1996;39(1):81-86
[14]Schouteo JSAG,Quwdand VDFA,Volkenburg HA,et al.Br J Rheuma.1993;32:274-280
[15]Krans VB.Med clin North Ann.1997:81(1):85-122
[16]Pun Y,Moskowita P,Loc S,et al.Arthritis Rheum.1994:37:264-269
[17]王玉泉,守敏,柴举龙.蛋白多糖与骨性关节炎的研究[J].中医正骨,2005:17(4):60
[18]吴志运,吴求亮.细胞因子在退行性骨关节病中的作用.中华口腔医学杂志,1993:28:123-125
[19]Radin EL,Paul IL.Does cartilage compliance reduce skeletal impact loads? The relative force-attenuating properties of articular cartilage,synovial fluid,periarticular soft tissues and bone.Arthritis Rheum,1970;13:139-144
[20]Barrey Halliwell.Oxygen radicals,nitric oxide and human inflammatory joint disease.Ann Rheum Dis,1995;54:505-510
[21]康勇,魏西秦,周兰华,等.自由基对体外培养兔关节软骨细胞的影响.中华病理学杂志,1991;20(2):100-102
[22]田华,党耕町,娄思权等.基质金属蛋白酶及其抑制剂在软骨细胞中的表达及其意义[J].北京医科大学学报,1999;31:189
[23]郭常安,陈峥蝾,张秀荣.骨性关节炎基质金属蛋白酶1、2、3及其抑制物的表达与软骨退变的关系[J].复旦学报(医学版),2002;29:244
[24]Pelletier JP,Dibattista JA,Roughley P,et al.Cytokines and inflammation in cartilage degradation.Rheum Dis Clin North Am,1993:19:545-568
[25]Mccord JM.Free radicas and inflammotion.Science,1994;185:529-531
[26]Merry P,Grootreld M,Lanec J,et al.Oxidative damage to lipids with the inflamed human provides evidence of radical-mediated hypoxic-reperfusion injury.Am J Clin Nutr,1991;56:362-369
[27]刘淑芳,李莹辉,徐团才.骨性关节炎的生化及病理变化.中国临床康复,2004;8(5):938-939
[28]Largo R,Alvarez-SoriaMA,Diez-Ortego I,et al.Glucosamine inhibits IL-1 beta induced NfkappaB activation in human osteoarthritic chondrocytes[J].Osteoarthritis Cartilage,2003;11(4):290-298
[29]田华,娄思权,党耕町,等.肿瘤坏死因子TNF-a导致软骨损伤的机制探讨.中华外科杂志,2000;38(1):76
[30]陈百成,张静主编.骨关节炎.北京:人民卫生出版社,2004,137
[31]娄思权.软骨修复和重建基础研究的现状[J].当代医学,2001;7(2):35
[32]程爱新,韩文玲,马大龙等.趋化素样因子1(CKLF1)对关节软骨细胞增殖及代谢的影响[J].北京大学学报(医学版),2003;35(4):399
[33]陈百成,张静主编.骨关节炎.北京:人民卫生出版社,2004,35-39
[34]金伟,陈廖斌.生物自由基与骨性关节炎[J].湖北预防医学杂志,2002;13:13
[35]孙材江,王惠,杨锡兰,等.退行膝关节炎骨在氧自由基代谢的观察.中华骨科杂志,1992;12(6):433-435
[36]刘耕陶.一氧化氮研究前景.中华医学杂志,1996;76(3):563-564
[37]Culotta E,Koshl DE.NO news is good news.Science,1992;258:1862-1865
[38]Murrell GA,Jang O,Williams Rj.Nitric oxide activates metaloprotease enzymes in articular cartilage.Biochem Biophy Res Commun,1995;206:15-21
[39]Blanco F,Lotz M.IL-1 induced nitric oxide inhibits chondrocytes prolixferation via PGB2.FASEBJ,1994;8(1):365-371
[40]Stefanovic-Racic M,Stadlter J,Gerogesc H,et al.Nitric oxide and energy production in arthicular chondrocytes.J Cell Physiol,1994;159:274-280
[41]Francisco JB,Robert LO,Herbert S,et al.Chondrocyte apoptosiss induced by nitric oxide.Am J Path,1995;146:75-85
[42]Hatori M,Klatle KJ,Teixeira CC,et al.End labeling studies of fragmented DNA in the avian growth plate:evidence of apoptosiss in the terminally differentiated chondrocytes.J Bone Miner Res,1995;10(12):1960-1968
[43]Roach HI,Erenpreisa J,Aigner T.Osteogenic Differentiatin of hypertrophyic chondrocytes involves asymmetriz cell divisions and apoptosiss.J Cell Bio,1995;131(2):485-494
[44]袁国华.骨关节炎患者血清抗软骨细胞抗体测定及意义.中华风湿学杂志,1997;(1):15
[45]孙材江,彭丹.退行性骨关节病的临床基础研究近况.医师进修杂志(外科版),2004:27(5):1-3
[46]Blaw FJ,Guistian R,Vazguez ME,et al.Osteoarthritis chon.dmcytes die by apoptosis:A possible pathway for osteoarthritis pathology.Arthdtis Rheum,1998;41(2):284-289
[47]潘浩,胡庆丰,李雄峰,等.补肾壮筋汤对兔早期实验性膝骨关节炎软骨细胞凋亡及增殖细胞核抗原表达的影响.中国骨伤,2005;18(5):278-281
[48]Lotz M,Hashimoto S,Kuhn K.Mechanisms of chondmcyteapoptosis.Osteoarthritis Cartilage,1999;7(4):389
[49]毛宾尧,刘洪涛.胫、股骨内压与膝关节疼痛关系的研究和治疗方法探讨[J].骨与关节损伤杂志,1992;7(4):206
[50]陈清汉,许振华,刘家勇,等.膝部疼痛与骨内压关系的临床研究[J].中华骨科杂志,1996;16(1):25-27
[51]何永清,孙仲篪,王坤正.骨内高压与退行性膝关节病关系的临床研究[J].中国骨伤,1999;12(6):3-4
[52]郭开今,王业华.静脉回流对膝关节骨内压影响的动态观察.徐州医学院学报,1995;15(4):389-390
[53]Hurley MV,Newham DJ.The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early unilateral osteoarthritic knees.Br J Rheumatol,1993;32:127-131
[54]贾庆平.类风湿关节炎和骨关节炎患者关节内皮素的测定.中华骨科杂 志,1996;35(11):790
[55]Alman R,E,Block D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and therapeutic criteria committee of the American Rheumatism Association.Arthritis Rheum,1986;29:1039-1049
[56]刘源,曾庆余,池莲花,等.膝症状性骨关节炎X线特点及其意义.中华放射学杂志,1998;32(6):425-426
[57]季卫平,王小玲,吕国强,等.膝关节退变的X线量化分析.中国中医骨伤科,1995;3(6):9
[58]叶永平,蒋垚,曾炳芳.膝骨关节炎病因、X线片及临床表现分析.临床骨科杂志,2000;3(3):169-173
[59]杜宁,任峰,杨琦.膝关节骨关节病体征与功能的相互关系的研究[J].中国中医骨伤科杂志,1996,4(1):8-11
[60]吴林生.触按叩听诊断髌骨软骨软化症.中国骨伤,2001;14(7):434-435
[61]刘宗礼,潘子翔,刘仲秋.成年人髌股关节痛的X线改变.中华骨科杂志,1999;19(3):145-148
[62]娄思权.骨关节炎的病理与发病因素.中华骨科杂志,1996,16(1):56-59
[63]陆庄樵,谭乾,宋立坚,等.关节镜冲洗液治疗膝关节骨关节炎.中华骨科杂志,1990;10(5):281-283
[64]杨斌辉,刘继超,李维等.膝关节骨性关节炎关节镜诊断治疗.航空航天医药,2006;17(4):193-194
[65]Fisher SP,FoX JM,Del pizzow,et al.Accuracy of diagnoses From magnetil Resonanll imaging of the knee[J].J Bone Toint Surg[Am],1981;73(1):20
[66]Hayes CW,Sawyer RW,Comway WF.patellar cartilage lesions:in vitro detection and staging with MR imaging and pathologic correlatin[J].Radiology,1990;176(2):479-483
[67]郭大庆,吴焕卿,任明丽,等.膝关节退行性骨关节病的MRI临床诊断.中国误诊学杂志,2005;5(7):1313-1314
[68]孙材江,彭丹.膝关节骨性关节炎的诊断与治疗.医师进修杂志(外科版),2004;27(5):1-3
[69]李晓声,王家让.膝关节骨性关节炎的诊断与治疗概况.医师进修杂志(外科版),2004;27(5):10-11
[70]戴生明,韩星海,刘太华等.膝关节炎的B超和x线检查比较.第二军医大学学报,2002;23(1):108-109
[71]沈霖,杨家玉,高兰,等.兔膝关节骨关节病模型的复制及健骨汤的治疗作用[J]. 中国骨伤,1992;5(4):6-8
[72]李同生,李强,王胜利.补肾健骨汤治疗骨性关节病的临床研究[J].中国中医骨伤科,1993;1(1):18-20
[73]李承军,吴志奎,陈玉英.补肾壮骨药对老年大鼠软骨代谢作用的研究[J].中药药理与临床,1995;11(1):34-36
[74]岳珍,王嘉芙,吕红斌.行气消肿类中药对体外培养的软骨细胞代谢的影响[J].中国运动医学杂志,1998;17(1):34-37
[75]郭建刚,赵然,侯桂英.壮筋活血汤对骨性关节炎软骨退变防治作用的组织血及组织化学研究.中医正骨,1998;10(1):5
[76]郭建刚,冯坤,赵然,等.壮筋活血汤对骨性关节炎软骨退变防治作用的生化研究[J].中国骨伤,1999;12(5):19
[77]彭太平,潘成龙,汤成华.益肾蠲痹液离子导入法治疗骨性关节炎的实验研究.中医正骨,1998;10(5):6
[78]王耶,刘建宇,宋艳.丹参和透明质酸钠注射液对骨性关节炎治疗作用的实验研究.中国生化药物杂志,1998;19(5):248-250
[79]郭颖杰,周秋丽,刘平,等.鹿茸多肽对骨、软骨细胞增殖的实验研究.中国生化药物杂志 1998;19(2):74
[80]高文香,刘元禄,李永生,等.补肾法防治膝关节骨性关节炎的病理形态学观察[J].中医正骨,1999;11(12):13-15
[81]冯坤,郭建刚,王健智.补肾活血对骨性关节炎软骨退变的拮抗作用研究[J].辽宁中医杂志,1999;26(11):523-524
[82]曹月龙,张戈,石印玉,等.软骨Ⅱ号方对家兔关节炎软骨承受压缩载荷的影响.医用生物力学,2001;16(2):116
[83]王国文,潘海乐,曲波,等.参麦注射液对骨关节炎模型动物关节软骨胶原含量的影响[J].中国中医骨伤科杂志,2001;9(2):14-16
[84]褚立希,周恩元,赵敏辉.关节Ⅰ号方治疗骨关节炎的实验研究[J].上海中医药大学学报,2001;15(1):47-50
[85]石印玉,汪青春,沈培芝.分期论治膝骨关节炎的对比研究[J].中国学术期刊文摘,1997;7(3):890
[86]冯伟,石印玉,沈培芝.中药对软骨细胞代谢的影响[J].中国中医骨伤科杂志,2000;8(2):9-11
[87]冯伟,石印玉,沈培芝.补肾方利柔肝方含药血清对软骨细胞增殖动力学研究[J].浙江中医学院学报,2001;25(4):15-17
[88]晏雪生,彭亚琴,明安萍.川芎嗪注射液对体外培养软骨细胞影响的实验研究[J].中国中医骨伤科杂志,2002;10(1):15-17
[89]Fujisato-T,Sajiki-T,Liu-Q.Effect of basic fibroblast growth factor Oil cartilage regeneration in chondrocyte-seeded collagen sponge scaffold[J].Biomaterials,1996;17(2):155-162
[90]唐勇,姜杰,孟辉,等.补肾益气活血方对兔实验性膝骨关节炎软骨细胞bFGF-mRNA表达的影响.云南中医学院学报,2005;28(4):24-26
[91]汪青春,石印玉,沈培芝,等.中药对膝骨关节炎小鼠关节软骨IL-1、iNOS基因表达的影响[J].山西医药杂志,1999;28(5):381-383
[92]潘海乐,曲波,王耶.参麦注射液对骨性关节炎动物模型血液中白细胞介素-1 水平的影响.中华风湿病学杂志,2000;4(2):106
[93]愈杰,明顺培,张秀芬.针刀疗法对兔膝骨关节炎关节液中IL-1 β、IL-6、TNF-α水平的影响.中国中医骨伤杂志,2002;10(4):13
[94]王秀华,刘元禄,苏姿兵,等.丹参关节内注射对兔膝骨关节炎细胞因子IL-1及TNF的影响.中医正骨,2003;15(10):577
[95]王济纬,符诗聪,史灿镔,等.中药对实验性骨关节炎膝旁骨内压的影响[J].中医正骨,1997;9(4):3-4
[96]黄涛,徐传毅,邹季,等.活血止痛汤治疗早期骨性关节炎的实验研究[J].中医正骨,1999;11(5):3-5
[97]许学猛,王羽丰,邓晋丰,等.补肾活血胶囊影响兔膝关节退行性疾病骨内高压变化的实验研究.中国中医骨伤科杂志,2001;9(4):24
[98]马建兵,刘德玉,李湛印,等.中药对家兔实验性膝关节骨性关节炎氧化自由基代谢的影响[J].中医正骨,2000;12(1):8
[99]汪青春,沈培芝,徐宇.不同方药治疗膝骨关节炎的组织形态学对比研究[J].中国中医骨伤科,1998;6(2):1
[100]周尊谦,谢林,孙达武.丹紫康膝冲剂治疗膝关节退行性骨关节病临床研究.中医骨伤,1999;12(2):49
[101]王文瑞,刘宏泽,卫小春,等.川芎嗪防治膝关节软骨退变的实验研究.中国骨伤,2004;17(2):80-82
[102]汪青春,石印玉,沈培芝.中药对膝骨关节炎黑鼠血清SOD、HA、NO水平的影响[J].中医正骨,1999;11(5):6-8
[103]毛小兵,邹季.风湿骨痛药酒药槌外治法防治关节软骨退变的实验研究.中国骨伤,2002;15(4):221-222
[104]苏友新,陈顺有,林清坚,等.壮骨健膝方对膝骨性关节炎患者关节滑液细胞因子、NO的影响.福建中医学院学报,2006;16(2):38-40
[105]方苏亭,王胜利,王希,等.松凝分筋手法治疗兔膝骨关节病的实验研究.中国中医骨伤科杂志,2001;9(2):27
[106]张力,张闻生,邹季.风湿骨痛药酒药楗外治法治疗兔膝关节骨关节炎的实验研究.中医正骨,2001;13(7):9
[107]曹月龙,冯伟,李宗举,等.软骨Ⅱ号对骨关节炎兔不同部位PGE_2选择性抑制作用的实验研究.2001;14(10):597-598
[108]万荣,杨庆铭,邓廉大.黑虎丹治疗兔骨关节炎的实验研究[J].中国骨伤,2001;14(2):85-87
[109]沈霖,沈耀,杨述华.丹参注射液对维甲酸诱导的软骨细胞凋亡的影响[J].中国中医骨伤科杂志,2002;10(5):1-8
[110]江伟达,郑效文,郑清波,等.中药关节Ⅲ号方治疗家兔膝骨关节炎的实验研究[J].中国中医骨伤科,1994;2(1):1-3
[111]魏玉玲,刘营杰,梁克玉.消痹灵治疗骨性关节炎的机制探讨.现代康复,2001;54(6):64
[112]黄枫,唐勇,郑晓辉.补肾强膝方对绝经后妇女膝骨性关节炎的影响[J].中医正骨,2002;14(4):12
[113]Superio-Cabuslay E,Ward MM,Lorig KR.Patient education interventions in osteoarthritis and rheumatoid arthritis:a meta analytic comparison with nonsteroidal anti-inflammatory rug treatment.Arthritis Care Res,1996;9:292-301
[114]Mazzuca SA,Brandt KD,Katz BPC,et al.Effeccts of self-care education on the health status of inner-city patients with osteoarthritis of the knee.Arthritis rheum,1997;40:1446-1474
[115]Yasuda K,Sasaki T.The mechanics of treatment of the osteoarthritic knee with a wedged insole.Clin Orthop,1987;215:162-172
[116]玄男,鲁艳莉,李晶.膝关节骨性关节炎的运动疗法[J].中国康复医学杂志,2003;18(9):523-524
[117]Felson DT,Anderson JJ,Naimark A,et al.Obesity and knee osteoarthritis.The Framingham Study.Ann Intern Med,1998;109:18-24
[118]陈景藻.现代物理治疗学.北京:人民军医出版社,2001
[119]李晶,顾新,李艳,等.老年病物理治疗的经验和体会.中华理疗杂志,1999;22:218-220
[120]江建民,金在地,刘成山,等.电磁式体外冲击波膝关节退变疗效观察[J].中国矫形外科杂志,2001;8(9):850-852
[121]张兰,陆廷仁,陆琳.微电脑康复治疗仪治疗膝骨性关节炎64例[J].中国临床康复,2002;6(20):3099
[122]Towheed TE.A systematic review of pharmacological therapy in OA[J].Semin Arthritis Rheum,1997;26(5):755-756
[123]Jokhio IA.Study of efficacy and tolerance of ketoprofen and diclofenac sodium[J].J Pak Med Assoc,1998;48(12):373-374
[124]滕玉芬,武丽君.非甾体类抗体药物的临床应用[J].中国新药杂志,1999;9:601-601
[125]Altman RD,IAP Study Group.buprofen,acetaminophen and placebo in osteoarthritis of the knee:a six—day double—blind study.Abstract.Arthritis Rheum,1999;42(suppl 9):404
[126]陈俊辉,陈韧,孙瑛,等.非甾体抗炎药的胃肠副作用4417例临床分析.中华风湿病学杂志,2001;5(3):194-196
[127]刘雁,李志军.非甾体抗炎药物的药理及临床应用进展.中国医院药学杂志,2000;20(12):748-750
[128]Lanza FL,and the Members of the Ad Hoc Committee On Practice Parameters of the American College of Gastroenterology.A guideline for the treatment and prevention of NSAID-induced ulcers.Am J Gastroenterol,1998;93:2037-2046
[129]Bijlsma JW.Withdrawal of rofecoxib:a sign to be careful with coxibs in patients with increased cardiovascular risk.Ned Tijdsehr Geneeskd,2004;148(44):2162-2164
[130]Schnitzer TJ,Kamin M,Olson WH.Tramadol allows reduction of naproxen dose among patients with naproxen-responsive osteoarthritis pain:a randomized,double-blind.Placebo-controlled study.Arthritis Rheum,1990;42(7):1370-1377
[131]American Pain Society.Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain.5th ed.Glenview,Ⅲ.American Pain Society,2003
[132]Mcalindon TE,Lavalley MP,Gulin JP.Glucosamine and chondroitin for treatment of osteoarthritis:a systematic quality assessment and meta-analysis.JAMA,2000;283(11):1469-1475
[133]Ahmad SR,Kortepeter C,Brinker A,et al.Renal failure associated with the use of elecoxib and rofecoxib[J].Drug Safety,2002;25:537-544
[134]Reginster JY,Deroisy R,Rovati LC,et al.Longterm effects of glucosmine sulphate on osteoarthritis progression:a randomized,placebo controlled clinical trial[J].Lancet,2001;357:251-256
[135]姜海,梁晓军.外源性透明质酸钠治疗骨性关节炎机理研究进展[J].骨与关节损伤杂志,2001;16(6):474-476
[136]Gossec L,Dougados M.intra-articular treatments in osteoarthritis: from the symptoma tic to the structure modifying.Ann Rheum Dis,2004;63(5):478-482
[137]Ascher B,Cerceau M,Baspeyras M.Soft tissue filling with hyaluronic acid.Ann Chir Plast Esthet,2004;49(5):465-485
[138]Patel RN,Attur MG,Dave MN,et al.A novel mechanism of action of chemically modified tetracyelines:inhibition of COX-2 mediated prostaglandin E2production.J Immunol,1999;163(6):3459-3467
[139]Mendes AF,Caramona MM,Carvalho AP,et al.Diacerhein and rhein prevent interleukin-1 beta induced nuclear factor kappa B activation by inhibiting the degradation of inhibitor kappa B Alpha[J].Pharmacol Zoxicol.2002;91:22-28
[140]Recommendations for the medical management of ostearthritis of the hip and knee:2000 update.American College of RheumatologySubcommittee on Osteoarthritis Guidelines.Arthritis Rheum,2000;43(9):1905-1915
[141]Burks RT.Arthrosocopy and degenerative arthritis of the knee:a review of the literature.Arthrosocopy,1990;6:43-47
[142]王建中,郝建军.冲洗疗法治疗膝关节骨性关节炎[J].实用骨科杂志,2003;9(1):84
[143]Fukuda K.Intra-articular injection of hyaluronan for the treatment of knee osteoarthritis.Clin Calcium,2004;14(7):104-107
[144]Creamer P.Intra-articular corticosteroid treatment in osteoarthritis.Curt Opin Rheumatol,1999;11:417-421
[145]张晓玲,于长隆.骨关节炎基因治疗现状与前景.北京大学学报,2002;34(5):579-584
[146]孙仲,程文武,赵京龙.胫骨高位截骨术治疗膝关节骨性关节炎[J].中国矫形外科杂志,1996;1:46
[147]孙中华,王发平,胡冰,等.骨钻孔减压配合中药治疗膝骨性关节炎疗效分析.中医正骨,2003;15(1):12-13
[148]黄品,方洪松,彭吴,等.关节镜清理术治疗关节炎[J].中国矫形外科杂志,2001;1:35-35
[149]马克勇,刘旭东,吴健,等.关节镜下清理术治疗膝骨性关节炎.山东医药,2005;45(33):48
[150]Csonge L,Bravo D,Newman-Gage H.Ban king of osteehondral allografts,Part Ⅱ.Preservation of Chondrocyte Viability During Long-Term Storage.Cell Tissue Bank,2002;3(3):161-168
[151]Hangedy L,Fules P.Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints:ten years of experimental and clinical experience[J].J Bone Joint Surg(Am),2003;85(2):25-32
[152]狄欧,杨志祥,赵奇峰,等.自体骨膜延迟游离移植修复关节软骨缺损(附9例报告)[J].骨与关节损伤杂志,1997;12(3):154
[153]Lorentzon R.Treatment of deep cartilage defects in the knee with periosteum transplantation[Z].Presented at the second world congress on sports trauma,22nd annual meeting of the American Orthopedic Society for Sports Medicine,June 1996;Lake Buena Vista,Florida
[154]Yueqing W,Siquan L.Direct protective efect of interleukin-10 on articular chondrocytes in vitro[J].Chinese Medical Journal,2001;144:723
[155]Petrou G,Petrou H,Tilkeridis C,et al.Medium-term results with a primary cemented rotating-hinge total knee replacement.A 7-to-15-year follow-up.J Bone Joint Surg Br,2004;86(6):813-817
[156]吴林生,金嫣莉.中药及手法治疗膝关节骨性关节炎121例疗效分析[J].中医杂志,1993;34(12):742
[157]张建福.骨质增生病的中西医诊疗.北京:中国中医药出版社,1995,59
[158]刘洪旺,刘志刚,孙宝金.退行性膝关节骨性关节病的中医辨证施治.中国骨伤,1997;10(4):27
[159]董忠.63例膝关节骨性关节炎的中医康复治疗.福建中医学院学报.2000;10(2):24-25
[160]莫少庸.内外合治结合辨证用药治疗膝关节骨性关节炎89例[J].新中医,2000;32(6):28
[161]马明明.中医辨证治疗中老年膝关节骨性关节炎98例[J].河北中医,2002;24(2):107-108
[162]郭建刚,冯坤,赵移畛.中药内服治疗骨性关节炎新进展.中医正骨,2002;14(4):54
[163]宏树臣.中医指针综合治疗膝关节骨性关节炎[J].中国骨伤,1998,11(5):23
[164]王少山,张世华,邱红明,等.骨病中西医诊断学[M].北京:中国中医药出版社,2001,341
[165]朱正刚.疗骨丸治疗膝关节增生性关节炎42例临床观察[J].中医杂志,1992;(11):38
[166]蒋连泓.“关节消肿止痛冲剂”治疗各种关节炎102例疗效观察[J].天津中医,1992;4:13-15
[167]刘金陵.补肝汤加减治疗骨性膝关节炎76例[J].广西中医药,1995;(2):50-11
[168]李恒敏.软坚化瘀法治疗骨关节病.中医杂志,1995;36(3):147
[169]陈广桢,李心沁,梁安民.从瘀血痰湿论治膝关节骨性关节炎58例.山东中医药大学学报,1998;22(1):30-31
[170]陈南星.补气活血法治疗膝部骨关节炎临床应用体会.光明中医,1998;13(3):48
[171]雷波,刘定安.从瘀血痰湿论治膝关节骨关节病48例临床观察.湖南中医杂志,1999;15(2):12
[172]严培军,孙玉明,周福贻.从痰瘀水论治膝关节骨性关节炎176例[J].南京中医药大学学报,2000;16(4):249
[173]王玉明.女性膝骨关节炎从肝论治90例临床观察.北京中医,2001;(6):29
[174]王艳珍.补肾活血化瘀法治疗膝关节骨性关节炎128例[J].吉林中医药,2001;(3):19
[175]陈建宗.中药外用内服治疗膝骨关节病66例[J].成都中医药大学学报,2001;(1):24
[176]石仰山,王敖明.石氏调中保元汤治疗老年性膝关节病[J].上海中医药大学学报,2002;(7):34
[177]邓伟.补脾益肾化瘀法治疗膝骨关节炎.中药材,2003;26(7):535
[178]吕振军,张月珍.药蜡外敷治疗膝关节炎60例[J].中医外治,1998;7(1):12
[179]张军.通络止痛膏治疗膝关节骨性关节病临床观察[J].中国骨伤,2000;13(7):415
[180]魏会东.乌鸡膏治疗膝关节骨性关节炎260例[J].山东中医杂志,2001;20(2):94-95
[181]康帼.生马钱子浸渍液外洗治疗骨性关节病[J].河南中医,2002;22(5):63
[182]梁志强,张葆青,石宇雄.金桂外洗方湿热敷治疗膝关节骨性关节炎[J].甘肃中医学院学报,2002;19(1):20-21
[183]钟远鸣,韦贵康,米琨,等.冲药熏洗治疗膝关节骨性关节病疗效观察[J].中医正骨,2004;16(1):3
[184]王维佳,马亚明.川芎嗪关节内注入合损伤洗剂治疗膝关节骨关节炎60例.实用中西医结合杂志,1998;11(3):215
[185]沈霖,沈耀,杨述华.丹参注射液对维甲酸诱导的软骨细胞调亡的影响[J].中国中医骨伤科杂志,2002;10(5):1-6
[186]邓芳.高乌甲素关节腔阻滞治疗膝关节骨性关节炎的疗效观察[J].浙江临床医学,2003;5(12):928-929
[187]蒋顺婉,林春阳,苗峻,等.刺五加注射液灌洗治疗膝骨关节炎疗效观察[J].中 医正骨,2004;16(7):16
[188]张红兵,潘国英.综合治疗退行性膝关节病疗效观察[J].中华现代中西医杂志,2004;2(3):85-86
[189]陈文治,葛洪庆,王君鳌,等.关节腔注射参麦液治疗膝关节骨性关节炎的临床疗效观察.天津中医药,2005;22(6):512
[190]彭太平,潘科龙,陈明,等.益肾蠲痹液电离子导入治疗骨性关节炎的临床研究.江西中医药,1997;28(6):35-36
[191]孙娟,陈晔,沈娟清.中药离子导入治疗慢性骨关节病[J].中国骨伤,1999;12(5):5
[192]陆国强,王杞.中药离子导入法治疗膝骨关节炎80例[J].中国中医骨伤科杂志,2001;9(1):34
[193]刁维珍,毕鸿雁,伊长松.中药离子导入治疗退行性膝骨关节炎1000例疗效分析[J].山东中医药大学学报,2003;27(3):199-200
[194]陈利新,马少云,莫卫海.中药离子导入治疗膝关节骨性关节炎400例临床报告[J].医学理论与实践,20031;16(5):557-558
[195]杜引平.齐刺治疗老年性膝骨性关节炎50例[J].湖北中医杂志,2002;24(7):49
[196]滕蔚然,杜宁,史炜镔.手法治疗膝骨关节病对膝关节功能改善的研究[J].中国中医骨伤科杂志,2000;8(5):46-48
[197]鲍铁周.手法为主综合治疗膝关节增生性关节炎[J].山西中医,2004;20(5):376
[198]仇培九.推拿疗法机理初探[J].甘肃中医,2003;17(2):34-35
[199]冯金升,敬红平,刘明江.推拿疗法的作用机理[J].按摩与导引,2001;17(5):4-6
《黄帝内经》《伤寒杂病论》《说文解字》《中藏经》《易经通注》《内经博义》《诸病源侯论》《备急千金要方》《三因极一病证方论》《儒门事亲》《丹溪心法》《格致余论》《脾胃论》《妇人良方大全》《证治要决》《古今医鉴》《景岳全书》《傅青主男科》《医门法律》《临证指南医案》《医衡》《医碥》《顾松园医镜》《杂证会心录》《医学从众录》《温病条辨》《医林改错》《血证论》《友渔斋医话》《医学传心录》《岭南卫生方》《本草正义》《本草备要》《神农本草经》《本草逢原》《本草求真》《本草汇言》《名医别录》《本草纲目》《本经疏证》《药品化义》《本草新编》《开宅本草》《类证治裁》
[2]施桂英主编.关节炎概要.北京:中国医药科技出版社,2000,327
[3]Guccione AA,Felson DT,Anderson JJ,et al.The effects of specific medical conditions on the functional limitations of elders in the Framingham study.Am J Public Health,1994;84:351-358
[4]Felson DT.Preventing knee and hip osteoarthritis.Bull Rheum Dis,1998,47:1-4
[5]Lane NE.Ann Rheum Dis,1996;55(9):671-673
[6]Felson DT,Andeson JJ,Naimark A,er al.Obesity and knee osteoarthritis.The Framingham Study.Ann Intern Med,1988;109:18-24
[7]Felson DT,Zhang YQ,Marian T,et al.Arthritis Rheum,1997;40(4):728-733
[8]Felson DT.Preventing knee and hip osteoarthritis.Bull Rheum Dis,1998;47:1-4
[9]Slemenda C,Heilman DK,Brandt KD,et al.Reduced quadriceps strength relative to body weight:a risk factor for knee osteoarthritis in women?Arthritis Rheum,1998;41:1951-1959
[10]Slemenda C,Brandt KD,Heilman D,et al.Quadriceps weakness and osteoarthritis of the knee.Ann Intern Med,1997;127:97-104
[11]Felson DT,Nevitt MC.The effects of estrogen on osteoarthritis.Curr Opin Rheumatol,1998;10:269-272
[12]Hart DJ,Mootoosamy I,Doyk DV,et al.Ann Rheum Dis.1994;53:158-162
[13]Burger H,Pavlvs LAVD,Odding E,et al.Arthritis Rheum.1996;39(1):81-86
[14]Schouteo JSAG,Quwdand VDFA,Volkenburg HA,et al.Br J Rheuma.1993;32:274-280
[15]Krans VB.Med clin North Ann.1997:81(1):85-122
[16]Pun Y,Moskowita P,Loc S,et al.Arthritis Rheum.1994:37:264-269
[17]王玉泉,守敏,柴举龙.蛋白多糖与骨性关节炎的研究[J].中医正骨,2005:17(4):60
[18]吴志运,吴求亮.细胞因子在退行性骨关节病中的作用.中华口腔医学杂志,1993:28:123-125
[19]Radin EL,Paul IL.Does cartilage compliance reduce skeletal impact loads? The relative force-attenuating properties of articular cartilage,synovial fluid,periarticular soft tissues and bone.Arthritis Rheum,1970;13:139-144
[20]Barrey Halliwell.Oxygen radicals,nitric oxide and human inflammatory joint disease.Ann Rheum Dis,1995;54:505-510
[21]康勇,魏西秦,周兰华,等.自由基对体外培养兔关节软骨细胞的影响.中华病理学杂志,1991;20(2):100-102
[22]田华,党耕町,娄思权等.基质金属蛋白酶及其抑制剂在软骨细胞中的表达及其意义[J].北京医科大学学报,1999;31:189
[23]郭常安,陈峥蝾,张秀荣.骨性关节炎基质金属蛋白酶1、2、3及其抑制物的表达与软骨退变的关系[J].复旦学报(医学版),2002;29:244
[24]Pelletier JP,Dibattista JA,Roughley P,et al.Cytokines and inflammation in cartilage degradation.Rheum Dis Clin North Am,1993:19:545-568
[25]Mccord JM.Free radicas and inflammotion.Science,1994;185:529-531
[26]Merry P,Grootreld M,Lanec J,et al.Oxidative damage to lipids with the inflamed human provides evidence of radical-mediated hypoxic-reperfusion injury.Am J Clin Nutr,1991;56:362-369
[27]刘淑芳,李莹辉,徐团才.骨性关节炎的生化及病理变化.中国临床康复,2004;8(5):938-939
[28]Largo R,Alvarez-SoriaMA,Diez-Ortego I,et al.Glucosamine inhibits IL-1 beta induced NfkappaB activation in human osteoarthritic chondrocytes[J].Osteoarthritis Cartilage,2003;11(4):290-298
[29]田华,娄思权,党耕町,等.肿瘤坏死因子TNF-a导致软骨损伤的机制探讨.中华外科杂志,2000;38(1):76
[30]陈百成,张静主编.骨关节炎.北京:人民卫生出版社,2004,137
[31]娄思权.软骨修复和重建基础研究的现状[J].当代医学,2001;7(2):35
[32]程爱新,韩文玲,马大龙等.趋化素样因子1(CKLF1)对关节软骨细胞增殖及代谢的影响[J].北京大学学报(医学版),2003;35(4):399
[33]陈百成,张静主编.骨关节炎.北京:人民卫生出版社,2004,35-39
[34]金伟,陈廖斌.生物自由基与骨性关节炎[J].湖北预防医学杂志,2002;13:13
[35]孙材江,王惠,杨锡兰,等.退行膝关节炎骨在氧自由基代谢的观察.中华骨科杂志,1992;12(6):433-435
[36]刘耕陶.一氧化氮研究前景.中华医学杂志,1996;76(3):563-564
[37]Culotta E,Koshl DE.NO news is good news.Science,1992;258:1862-1865
[38]Murrell GA,Jang O,Williams Rj.Nitric oxide activates metaloprotease enzymes in articular cartilage.Biochem Biophy Res Commun,1995;206:15-21
[39]Blanco F,Lotz M.IL-1 induced nitric oxide inhibits chondrocytes prolixferation via PGB2.FASEBJ,1994;8(1):365-371
[40]Stefanovic-Racic M,Stadlter J,Gerogesc H,et al.Nitric oxide and energy production in arthicular chondrocytes.J Cell Physiol,1994;159:274-280
[41]Francisco JB,Robert LO,Herbert S,et al.Chondrocyte apoptosiss induced by nitric oxide.Am J Path,1995;146:75-85
[42]Hatori M,Klatle KJ,Teixeira CC,et al.End labeling studies of fragmented DNA in the avian growth plate:evidence of apoptosiss in the terminally differentiated chondrocytes.J Bone Miner Res,1995;10(12):1960-1968
[43]Roach HI,Erenpreisa J,Aigner T.Osteogenic Differentiatin of hypertrophyic chondrocytes involves asymmetriz cell divisions and apoptosiss.J Cell Bio,1995;131(2):485-494
[44]袁国华.骨关节炎患者血清抗软骨细胞抗体测定及意义.中华风湿学杂志,1997;(1):15
[45]孙材江,彭丹.退行性骨关节病的临床基础研究近况.医师进修杂志(外科版),2004:27(5):1-3
[46]Blaw FJ,Guistian R,Vazguez ME,et al.Osteoarthritis chon.dmcytes die by apoptosis:A possible pathway for osteoarthritis pathology.Arthdtis Rheum,1998;41(2):284-289
[47]潘浩,胡庆丰,李雄峰,等.补肾壮筋汤对兔早期实验性膝骨关节炎软骨细胞凋亡及增殖细胞核抗原表达的影响.中国骨伤,2005;18(5):278-281
[48]Lotz M,Hashimoto S,Kuhn K.Mechanisms of chondmcyteapoptosis.Osteoarthritis Cartilage,1999;7(4):389
[49]毛宾尧,刘洪涛.胫、股骨内压与膝关节疼痛关系的研究和治疗方法探讨[J].骨与关节损伤杂志,1992;7(4):206
[50]陈清汉,许振华,刘家勇,等.膝部疼痛与骨内压关系的临床研究[J].中华骨科杂志,1996;16(1):25-27
[51]何永清,孙仲篪,王坤正.骨内高压与退行性膝关节病关系的临床研究[J].中国骨伤,1999;12(6):3-4
[52]郭开今,王业华.静脉回流对膝关节骨内压影响的动态观察.徐州医学院学报,1995;15(4):389-390
[53]Hurley MV,Newham DJ.The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early unilateral osteoarthritic knees.Br J Rheumatol,1993;32:127-131
[54]贾庆平.类风湿关节炎和骨关节炎患者关节内皮素的测定.中华骨科杂 志,1996;35(11):790
[55]Alman R,E,Block D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and therapeutic criteria committee of the American Rheumatism Association.Arthritis Rheum,1986;29:1039-1049
[56]刘源,曾庆余,池莲花,等.膝症状性骨关节炎X线特点及其意义.中华放射学杂志,1998;32(6):425-426
[57]季卫平,王小玲,吕国强,等.膝关节退变的X线量化分析.中国中医骨伤科,1995;3(6):9
[58]叶永平,蒋垚,曾炳芳.膝骨关节炎病因、X线片及临床表现分析.临床骨科杂志,2000;3(3):169-173
[59]杜宁,任峰,杨琦.膝关节骨关节病体征与功能的相互关系的研究[J].中国中医骨伤科杂志,1996,4(1):8-11
[60]吴林生.触按叩听诊断髌骨软骨软化症.中国骨伤,2001;14(7):434-435
[61]刘宗礼,潘子翔,刘仲秋.成年人髌股关节痛的X线改变.中华骨科杂志,1999;19(3):145-148
[62]娄思权.骨关节炎的病理与发病因素.中华骨科杂志,1996,16(1):56-59
[63]陆庄樵,谭乾,宋立坚,等.关节镜冲洗液治疗膝关节骨关节炎.中华骨科杂志,1990;10(5):281-283
[64]杨斌辉,刘继超,李维等.膝关节骨性关节炎关节镜诊断治疗.航空航天医药,2006;17(4):193-194
[65]Fisher SP,FoX JM,Del pizzow,et al.Accuracy of diagnoses From magnetil Resonanll imaging of the knee[J].J Bone Toint Surg[Am],1981;73(1):20
[66]Hayes CW,Sawyer RW,Comway WF.patellar cartilage lesions:in vitro detection and staging with MR imaging and pathologic correlatin[J].Radiology,1990;176(2):479-483
[67]郭大庆,吴焕卿,任明丽,等.膝关节退行性骨关节病的MRI临床诊断.中国误诊学杂志,2005;5(7):1313-1314
[68]孙材江,彭丹.膝关节骨性关节炎的诊断与治疗.医师进修杂志(外科版),2004;27(5):1-3
[69]李晓声,王家让.膝关节骨性关节炎的诊断与治疗概况.医师进修杂志(外科版),2004;27(5):10-11
[70]戴生明,韩星海,刘太华等.膝关节炎的B超和x线检查比较.第二军医大学学报,2002;23(1):108-109
[71]沈霖,杨家玉,高兰,等.兔膝关节骨关节病模型的复制及健骨汤的治疗作用[J]. 中国骨伤,1992;5(4):6-8
[72]李同生,李强,王胜利.补肾健骨汤治疗骨性关节病的临床研究[J].中国中医骨伤科,1993;1(1):18-20
[73]李承军,吴志奎,陈玉英.补肾壮骨药对老年大鼠软骨代谢作用的研究[J].中药药理与临床,1995;11(1):34-36
[74]岳珍,王嘉芙,吕红斌.行气消肿类中药对体外培养的软骨细胞代谢的影响[J].中国运动医学杂志,1998;17(1):34-37
[75]郭建刚,赵然,侯桂英.壮筋活血汤对骨性关节炎软骨退变防治作用的组织血及组织化学研究.中医正骨,1998;10(1):5
[76]郭建刚,冯坤,赵然,等.壮筋活血汤对骨性关节炎软骨退变防治作用的生化研究[J].中国骨伤,1999;12(5):19
[77]彭太平,潘成龙,汤成华.益肾蠲痹液离子导入法治疗骨性关节炎的实验研究.中医正骨,1998;10(5):6
[78]王耶,刘建宇,宋艳.丹参和透明质酸钠注射液对骨性关节炎治疗作用的实验研究.中国生化药物杂志,1998;19(5):248-250
[79]郭颖杰,周秋丽,刘平,等.鹿茸多肽对骨、软骨细胞增殖的实验研究.中国生化药物杂志 1998;19(2):74
[80]高文香,刘元禄,李永生,等.补肾法防治膝关节骨性关节炎的病理形态学观察[J].中医正骨,1999;11(12):13-15
[81]冯坤,郭建刚,王健智.补肾活血对骨性关节炎软骨退变的拮抗作用研究[J].辽宁中医杂志,1999;26(11):523-524
[82]曹月龙,张戈,石印玉,等.软骨Ⅱ号方对家兔关节炎软骨承受压缩载荷的影响.医用生物力学,2001;16(2):116
[83]王国文,潘海乐,曲波,等.参麦注射液对骨关节炎模型动物关节软骨胶原含量的影响[J].中国中医骨伤科杂志,2001;9(2):14-16
[84]褚立希,周恩元,赵敏辉.关节Ⅰ号方治疗骨关节炎的实验研究[J].上海中医药大学学报,2001;15(1):47-50
[85]石印玉,汪青春,沈培芝.分期论治膝骨关节炎的对比研究[J].中国学术期刊文摘,1997;7(3):890
[86]冯伟,石印玉,沈培芝.中药对软骨细胞代谢的影响[J].中国中医骨伤科杂志,2000;8(2):9-11
[87]冯伟,石印玉,沈培芝.补肾方利柔肝方含药血清对软骨细胞增殖动力学研究[J].浙江中医学院学报,2001;25(4):15-17
[88]晏雪生,彭亚琴,明安萍.川芎嗪注射液对体外培养软骨细胞影响的实验研究[J].中国中医骨伤科杂志,2002;10(1):15-17
[89]Fujisato-T,Sajiki-T,Liu-Q.Effect of basic fibroblast growth factor Oil cartilage regeneration in chondrocyte-seeded collagen sponge scaffold[J].Biomaterials,1996;17(2):155-162
[90]唐勇,姜杰,孟辉,等.补肾益气活血方对兔实验性膝骨关节炎软骨细胞bFGF-mRNA表达的影响.云南中医学院学报,2005;28(4):24-26
[91]汪青春,石印玉,沈培芝,等.中药对膝骨关节炎小鼠关节软骨IL-1、iNOS基因表达的影响[J].山西医药杂志,1999;28(5):381-383
[92]潘海乐,曲波,王耶.参麦注射液对骨性关节炎动物模型血液中白细胞介素-1 水平的影响.中华风湿病学杂志,2000;4(2):106
[93]愈杰,明顺培,张秀芬.针刀疗法对兔膝骨关节炎关节液中IL-1 β、IL-6、TNF-α水平的影响.中国中医骨伤杂志,2002;10(4):13
[94]王秀华,刘元禄,苏姿兵,等.丹参关节内注射对兔膝骨关节炎细胞因子IL-1及TNF的影响.中医正骨,2003;15(10):577
[95]王济纬,符诗聪,史灿镔,等.中药对实验性骨关节炎膝旁骨内压的影响[J].中医正骨,1997;9(4):3-4
[96]黄涛,徐传毅,邹季,等.活血止痛汤治疗早期骨性关节炎的实验研究[J].中医正骨,1999;11(5):3-5
[97]许学猛,王羽丰,邓晋丰,等.补肾活血胶囊影响兔膝关节退行性疾病骨内高压变化的实验研究.中国中医骨伤科杂志,2001;9(4):24
[98]马建兵,刘德玉,李湛印,等.中药对家兔实验性膝关节骨性关节炎氧化自由基代谢的影响[J].中医正骨,2000;12(1):8
[99]汪青春,沈培芝,徐宇.不同方药治疗膝骨关节炎的组织形态学对比研究[J].中国中医骨伤科,1998;6(2):1
[100]周尊谦,谢林,孙达武.丹紫康膝冲剂治疗膝关节退行性骨关节病临床研究.中医骨伤,1999;12(2):49
[101]王文瑞,刘宏泽,卫小春,等.川芎嗪防治膝关节软骨退变的实验研究.中国骨伤,2004;17(2):80-82
[102]汪青春,石印玉,沈培芝.中药对膝骨关节炎黑鼠血清SOD、HA、NO水平的影响[J].中医正骨,1999;11(5):6-8
[103]毛小兵,邹季.风湿骨痛药酒药槌外治法防治关节软骨退变的实验研究.中国骨伤,2002;15(4):221-222
[104]苏友新,陈顺有,林清坚,等.壮骨健膝方对膝骨性关节炎患者关节滑液细胞因子、NO的影响.福建中医学院学报,2006;16(2):38-40
[105]方苏亭,王胜利,王希,等.松凝分筋手法治疗兔膝骨关节病的实验研究.中国中医骨伤科杂志,2001;9(2):27
[106]张力,张闻生,邹季.风湿骨痛药酒药楗外治法治疗兔膝关节骨关节炎的实验研究.中医正骨,2001;13(7):9
[107]曹月龙,冯伟,李宗举,等.软骨Ⅱ号对骨关节炎兔不同部位PGE_2选择性抑制作用的实验研究.2001;14(10):597-598
[108]万荣,杨庆铭,邓廉大.黑虎丹治疗兔骨关节炎的实验研究[J].中国骨伤,2001;14(2):85-87
[109]沈霖,沈耀,杨述华.丹参注射液对维甲酸诱导的软骨细胞凋亡的影响[J].中国中医骨伤科杂志,2002;10(5):1-8
[110]江伟达,郑效文,郑清波,等.中药关节Ⅲ号方治疗家兔膝骨关节炎的实验研究[J].中国中医骨伤科,1994;2(1):1-3
[111]魏玉玲,刘营杰,梁克玉.消痹灵治疗骨性关节炎的机制探讨.现代康复,2001;54(6):64
[112]黄枫,唐勇,郑晓辉.补肾强膝方对绝经后妇女膝骨性关节炎的影响[J].中医正骨,2002;14(4):12
[113]Superio-Cabuslay E,Ward MM,Lorig KR.Patient education interventions in osteoarthritis and rheumatoid arthritis:a meta analytic comparison with nonsteroidal anti-inflammatory rug treatment.Arthritis Care Res,1996;9:292-301
[114]Mazzuca SA,Brandt KD,Katz BPC,et al.Effeccts of self-care education on the health status of inner-city patients with osteoarthritis of the knee.Arthritis rheum,1997;40:1446-1474
[115]Yasuda K,Sasaki T.The mechanics of treatment of the osteoarthritic knee with a wedged insole.Clin Orthop,1987;215:162-172
[116]玄男,鲁艳莉,李晶.膝关节骨性关节炎的运动疗法[J].中国康复医学杂志,2003;18(9):523-524
[117]Felson DT,Anderson JJ,Naimark A,et al.Obesity and knee osteoarthritis.The Framingham Study.Ann Intern Med,1998;109:18-24
[118]陈景藻.现代物理治疗学.北京:人民军医出版社,2001
[119]李晶,顾新,李艳,等.老年病物理治疗的经验和体会.中华理疗杂志,1999;22:218-220
[120]江建民,金在地,刘成山,等.电磁式体外冲击波膝关节退变疗效观察[J].中国矫形外科杂志,2001;8(9):850-852
[121]张兰,陆廷仁,陆琳.微电脑康复治疗仪治疗膝骨性关节炎64例[J].中国临床康复,2002;6(20):3099
[122]Towheed TE.A systematic review of pharmacological therapy in OA[J].Semin Arthritis Rheum,1997;26(5):755-756
[123]Jokhio IA.Study of efficacy and tolerance of ketoprofen and diclofenac sodium[J].J Pak Med Assoc,1998;48(12):373-374
[124]滕玉芬,武丽君.非甾体类抗体药物的临床应用[J].中国新药杂志,1999;9:601-601
[125]Altman RD,IAP Study Group.buprofen,acetaminophen and placebo in osteoarthritis of the knee:a six—day double—blind study.Abstract.Arthritis Rheum,1999;42(suppl 9):404
[126]陈俊辉,陈韧,孙瑛,等.非甾体抗炎药的胃肠副作用4417例临床分析.中华风湿病学杂志,2001;5(3):194-196
[127]刘雁,李志军.非甾体抗炎药物的药理及临床应用进展.中国医院药学杂志,2000;20(12):748-750
[128]Lanza FL,and the Members of the Ad Hoc Committee On Practice Parameters of the American College of Gastroenterology.A guideline for the treatment and prevention of NSAID-induced ulcers.Am J Gastroenterol,1998;93:2037-2046
[129]Bijlsma JW.Withdrawal of rofecoxib:a sign to be careful with coxibs in patients with increased cardiovascular risk.Ned Tijdsehr Geneeskd,2004;148(44):2162-2164
[130]Schnitzer TJ,Kamin M,Olson WH.Tramadol allows reduction of naproxen dose among patients with naproxen-responsive osteoarthritis pain:a randomized,double-blind.Placebo-controlled study.Arthritis Rheum,1990;42(7):1370-1377
[131]American Pain Society.Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain.5th ed.Glenview,Ⅲ.American Pain Society,2003
[132]Mcalindon TE,Lavalley MP,Gulin JP.Glucosamine and chondroitin for treatment of osteoarthritis:a systematic quality assessment and meta-analysis.JAMA,2000;283(11):1469-1475
[133]Ahmad SR,Kortepeter C,Brinker A,et al.Renal failure associated with the use of elecoxib and rofecoxib[J].Drug Safety,2002;25:537-544
[134]Reginster JY,Deroisy R,Rovati LC,et al.Longterm effects of glucosmine sulphate on osteoarthritis progression:a randomized,placebo controlled clinical trial[J].Lancet,2001;357:251-256
[135]姜海,梁晓军.外源性透明质酸钠治疗骨性关节炎机理研究进展[J].骨与关节损伤杂志,2001;16(6):474-476
[136]Gossec L,Dougados M.intra-articular treatments in osteoarthritis: from the symptoma tic to the structure modifying.Ann Rheum Dis,2004;63(5):478-482
[137]Ascher B,Cerceau M,Baspeyras M.Soft tissue filling with hyaluronic acid.Ann Chir Plast Esthet,2004;49(5):465-485
[138]Patel RN,Attur MG,Dave MN,et al.A novel mechanism of action of chemically modified tetracyelines:inhibition of COX-2 mediated prostaglandin E2production.J Immunol,1999;163(6):3459-3467
[139]Mendes AF,Caramona MM,Carvalho AP,et al.Diacerhein and rhein prevent interleukin-1 beta induced nuclear factor kappa B activation by inhibiting the degradation of inhibitor kappa B Alpha[J].Pharmacol Zoxicol.2002;91:22-28
[140]Recommendations for the medical management of ostearthritis of the hip and knee:2000 update.American College of RheumatologySubcommittee on Osteoarthritis Guidelines.Arthritis Rheum,2000;43(9):1905-1915
[141]Burks RT.Arthrosocopy and degenerative arthritis of the knee:a review of the literature.Arthrosocopy,1990;6:43-47
[142]王建中,郝建军.冲洗疗法治疗膝关节骨性关节炎[J].实用骨科杂志,2003;9(1):84
[143]Fukuda K.Intra-articular injection of hyaluronan for the treatment of knee osteoarthritis.Clin Calcium,2004;14(7):104-107
[144]Creamer P.Intra-articular corticosteroid treatment in osteoarthritis.Curt Opin Rheumatol,1999;11:417-421
[145]张晓玲,于长隆.骨关节炎基因治疗现状与前景.北京大学学报,2002;34(5):579-584
[146]孙仲,程文武,赵京龙.胫骨高位截骨术治疗膝关节骨性关节炎[J].中国矫形外科杂志,1996;1:46
[147]孙中华,王发平,胡冰,等.骨钻孔减压配合中药治疗膝骨性关节炎疗效分析.中医正骨,2003;15(1):12-13
[148]黄品,方洪松,彭吴,等.关节镜清理术治疗关节炎[J].中国矫形外科杂志,2001;1:35-35
[149]马克勇,刘旭东,吴健,等.关节镜下清理术治疗膝骨性关节炎.山东医药,2005;45(33):48
[150]Csonge L,Bravo D,Newman-Gage H.Ban king of osteehondral allografts,Part Ⅱ.Preservation of Chondrocyte Viability During Long-Term Storage.Cell Tissue Bank,2002;3(3):161-168
[151]Hangedy L,Fules P.Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints:ten years of experimental and clinical experience[J].J Bone Joint Surg(Am),2003;85(2):25-32
[152]狄欧,杨志祥,赵奇峰,等.自体骨膜延迟游离移植修复关节软骨缺损(附9例报告)[J].骨与关节损伤杂志,1997;12(3):154
[153]Lorentzon R.Treatment of deep cartilage defects in the knee with periosteum transplantation[Z].Presented at the second world congress on sports trauma,22nd annual meeting of the American Orthopedic Society for Sports Medicine,June 1996;Lake Buena Vista,Florida
[154]Yueqing W,Siquan L.Direct protective efect of interleukin-10 on articular chondrocytes in vitro[J].Chinese Medical Journal,2001;144:723
[155]Petrou G,Petrou H,Tilkeridis C,et al.Medium-term results with a primary cemented rotating-hinge total knee replacement.A 7-to-15-year follow-up.J Bone Joint Surg Br,2004;86(6):813-817
[156]吴林生,金嫣莉.中药及手法治疗膝关节骨性关节炎121例疗效分析[J].中医杂志,1993;34(12):742
[157]张建福.骨质增生病的中西医诊疗.北京:中国中医药出版社,1995,59
[158]刘洪旺,刘志刚,孙宝金.退行性膝关节骨性关节病的中医辨证施治.中国骨伤,1997;10(4):27
[159]董忠.63例膝关节骨性关节炎的中医康复治疗.福建中医学院学报.2000;10(2):24-25
[160]莫少庸.内外合治结合辨证用药治疗膝关节骨性关节炎89例[J].新中医,2000;32(6):28
[161]马明明.中医辨证治疗中老年膝关节骨性关节炎98例[J].河北中医,2002;24(2):107-108
[162]郭建刚,冯坤,赵移畛.中药内服治疗骨性关节炎新进展.中医正骨,2002;14(4):54
[163]宏树臣.中医指针综合治疗膝关节骨性关节炎[J].中国骨伤,1998,11(5):23
[164]王少山,张世华,邱红明,等.骨病中西医诊断学[M].北京:中国中医药出版社,2001,341
[165]朱正刚.疗骨丸治疗膝关节增生性关节炎42例临床观察[J].中医杂志,1992;(11):38
[166]蒋连泓.“关节消肿止痛冲剂”治疗各种关节炎102例疗效观察[J].天津中医,1992;4:13-15
[167]刘金陵.补肝汤加减治疗骨性膝关节炎76例[J].广西中医药,1995;(2):50-11
[168]李恒敏.软坚化瘀法治疗骨关节病.中医杂志,1995;36(3):147
[169]陈广桢,李心沁,梁安民.从瘀血痰湿论治膝关节骨性关节炎58例.山东中医药大学学报,1998;22(1):30-31
[170]陈南星.补气活血法治疗膝部骨关节炎临床应用体会.光明中医,1998;13(3):48
[171]雷波,刘定安.从瘀血痰湿论治膝关节骨关节病48例临床观察.湖南中医杂志,1999;15(2):12
[172]严培军,孙玉明,周福贻.从痰瘀水论治膝关节骨性关节炎176例[J].南京中医药大学学报,2000;16(4):249
[173]王玉明.女性膝骨关节炎从肝论治90例临床观察.北京中医,2001;(6):29
[174]王艳珍.补肾活血化瘀法治疗膝关节骨性关节炎128例[J].吉林中医药,2001;(3):19
[175]陈建宗.中药外用内服治疗膝骨关节病66例[J].成都中医药大学学报,2001;(1):24
[176]石仰山,王敖明.石氏调中保元汤治疗老年性膝关节病[J].上海中医药大学学报,2002;(7):34
[177]邓伟.补脾益肾化瘀法治疗膝骨关节炎.中药材,2003;26(7):535
[178]吕振军,张月珍.药蜡外敷治疗膝关节炎60例[J].中医外治,1998;7(1):12
[179]张军.通络止痛膏治疗膝关节骨性关节病临床观察[J].中国骨伤,2000;13(7):415
[180]魏会东.乌鸡膏治疗膝关节骨性关节炎260例[J].山东中医杂志,2001;20(2):94-95
[181]康帼.生马钱子浸渍液外洗治疗骨性关节病[J].河南中医,2002;22(5):63
[182]梁志强,张葆青,石宇雄.金桂外洗方湿热敷治疗膝关节骨性关节炎[J].甘肃中医学院学报,2002;19(1):20-21
[183]钟远鸣,韦贵康,米琨,等.冲药熏洗治疗膝关节骨性关节病疗效观察[J].中医正骨,2004;16(1):3
[184]王维佳,马亚明.川芎嗪关节内注入合损伤洗剂治疗膝关节骨关节炎60例.实用中西医结合杂志,1998;11(3):215
[185]沈霖,沈耀,杨述华.丹参注射液对维甲酸诱导的软骨细胞调亡的影响[J].中国中医骨伤科杂志,2002;10(5):1-6
[186]邓芳.高乌甲素关节腔阻滞治疗膝关节骨性关节炎的疗效观察[J].浙江临床医学,2003;5(12):928-929
[187]蒋顺婉,林春阳,苗峻,等.刺五加注射液灌洗治疗膝骨关节炎疗效观察[J].中 医正骨,2004;16(7):16
[188]张红兵,潘国英.综合治疗退行性膝关节病疗效观察[J].中华现代中西医杂志,2004;2(3):85-86
[189]陈文治,葛洪庆,王君鳌,等.关节腔注射参麦液治疗膝关节骨性关节炎的临床疗效观察.天津中医药,2005;22(6):512
[190]彭太平,潘科龙,陈明,等.益肾蠲痹液电离子导入治疗骨性关节炎的临床研究.江西中医药,1997;28(6):35-36
[191]孙娟,陈晔,沈娟清.中药离子导入治疗慢性骨关节病[J].中国骨伤,1999;12(5):5
[192]陆国强,王杞.中药离子导入法治疗膝骨关节炎80例[J].中国中医骨伤科杂志,2001;9(1):34
[193]刁维珍,毕鸿雁,伊长松.中药离子导入治疗退行性膝骨关节炎1000例疗效分析[J].山东中医药大学学报,2003;27(3):199-200
[194]陈利新,马少云,莫卫海.中药离子导入治疗膝关节骨性关节炎400例临床报告[J].医学理论与实践,20031;16(5):557-558
[195]杜引平.齐刺治疗老年性膝骨性关节炎50例[J].湖北中医杂志,2002;24(7):49
[196]滕蔚然,杜宁,史炜镔.手法治疗膝骨关节病对膝关节功能改善的研究[J].中国中医骨伤科杂志,2000;8(5):46-48
[197]鲍铁周.手法为主综合治疗膝关节增生性关节炎[J].山西中医,2004;20(5):376
[198]仇培九.推拿疗法机理初探[J].甘肃中医,2003;17(2):34-35
[199]冯金升,敬红平,刘明江.推拿疗法的作用机理[J].按摩与导引,2001;17(5):4-6
《黄帝内经》《伤寒杂病论》《说文解字》《中藏经》《易经通注》《内经博义》《诸病源侯论》《备急千金要方》《三因极一病证方论》《儒门事亲》《丹溪心法》《格致余论》《脾胃论》《妇人良方大全》《证治要决》《古今医鉴》《景岳全书》《傅青主男科》《医门法律》《临证指南医案》《医衡》《医碥》《顾松园医镜》《杂证会心录》《医学从众录》《温病条辨》《医林改错》《血证论》《友渔斋医话》《医学传心录》《岭南卫生方》《本草正义》《本草备要》《神农本草经》《本草逢原》《本草求真》《本草汇言》《名医别录》《本草纲目》《本经疏证》《药品化义》《本草新编》《开宅本草》《类证治裁》