膝关节骨性关节炎不同分期不同治法随机对照研究  

Randomized controlled study on the treatment of knee osteoarthritis with different acupuncture methods at different stages

作　　者：程永 吴凯 成卓 朱艺 杨自国 马洪 王世文 蒋宗伦 

机构地区：[1]重庆市渝北区中医院,重庆401120

出　　处：《中国针灸》2013年第6期508-512,共5页Chinese Acupuncture & Moxibustion

基　　金：重庆市卫生局中医药科技项目:2010-2-91

摘　　要：目的:探讨针刺对膝关节骨性关节炎(KOA)不同分期不同针刺法的疗效。方法:180例KOA患者依病情分为瘀沫期、筋膜拘挛期、筋结病灶形成期,每期60例,随机分为分期治疗组与电针组各30例。分期治疗组:瘀沫期采用经脉压痛点针刺、电热温针法治疗,筋膜拘挛期采用小针刀联合刺络放血法治疗,筋结病灶形成期采用粗银质针电热温针法治疗;电针组:三期均采用固定穴位针刺电针法治疗,穴取梁丘、血海、阳陵泉等。结果:分期治疗组与电针组总有效率分别为96.1%(87/90)和91.1%(82/90),差异无统计学意义(P>0.05);但分期治疗组控制显效率88.9%(80/90),明显高于电针组的62.2%(56/90,P<0.001),而且电针组随病情的进展与病期的深入控制显效率随着下降。两组治疗后病情积分较治疗前明显降低(均P<0.001),分期治疗组较电针组积分降低更明显(P<0.001)。结论:分期针刺法能明显提高对KOA的临床疗效,更具针对性。"经筋病理"三期机制与分期论治是认识与治疗KOA的又一有效途径与方法。Objective To explore the efficacy on knee osteoarthritis （KOA） treated with different acupuncture methods at different stages. Methods One hundred and eighty cases of KOA were divided into stagnation stage, fascia cramp stage and tendon lesion stage according to the condition of disease, 60 cases in each stage. Each stage was randomized into a staging treatment group and an electroaeupuncture （EA） group, 30 cases in each one. In the staging treatment group, acupuncture at the tendon points of meridians and electric thermal needling method were adopted for the cases at the stagnation stage; the small needle-knife therapy and bleeding method were used for the cases at the fascia cramp stage; and the electric thermal therapy with thick silver needles was applied for the cases at the tendon lesion stage. In the EA group, EA was applied for the cases of all the three stages at Liangqiu （ST 34）, Xuehai （SP 10）, Yanglingquan （GB 34）, etc. Results The total effective rate was 96.1% （87/90） in the staging treatment group and was 91. 1% （82/90） in the EA group, without significant difference in comparison （P〉0.05）. The controlled and remarkably effective rate （88.9 %, 80/90） in the staging treatment group was higher apparently than （62.2%, 56/90） in the EA group （P〈0. 001）. And in the EA group, with the disease progression and the further disease stages, the controlled and remarkably effective rate was reduced. After treatment, the scores of symp- toms and signs were decreased in both groups （both P〈0. 001）, the improvement in the staging treatment group was su- perior to that in the EA group （P〈0.001）. Conclusion The different acupuncture methods at the three stages improve obviously the clinical effect and are highly targeted. The mechanism of the three stages on “meridian muscle region patho- logy” and the treatment based on the disease stages can be the effective approach to KOA.

关 键 词：膝 骨性关节炎 经筋疗法 分期针刺 随机对照试验 

分 类 号：R246.2[医药卫生—针灸推拿学]