针刺配合艾灸治疗膝关节骨性关节炎:随机对照研究  

Treatment of knee osteoarthritis with acupuncture and moxibustion:a randomized controlled trial

作　　者：续龙 井蕾[1] 贺琨[1] 王俊磊[1] 王莹[1] 

机构地区：[1]山东省泰山疗养院康复科,泰安271000

出　　处：《中国针灸》2013年第10期871-876,共6页Chinese Acupuncture & Moxibustion

摘　　要：目的:比较针刺配合艾灸与西药治疗膝关节骨性关节炎的疗效差异,探寻治疗本病的较佳疗法。方法:选取160例患者,按就诊先后顺序,采用随机数字表法分为针灸组和西药组,每组80例。针灸组以疼痛局部取穴为主加以辨证配穴和循经远端取穴。经穴施以提插或捻转行针手法,依据辨证给予补泻;奇穴、阿是穴施以"短刺"或"输刺"手法,针感均以患者耐受为度,起针后用纯艾灸条在膝关节周围疼痛局部和肾俞穴上找寻热敏点施以腧穴热敏化艾灸疗法。针刺、艾灸均每天1次,5天为一疗程,疗程间休息2天。西药组口服硫酸氨基葡萄糖胶囊,每次2粒,每天3次,配合关节腔内注射,治疗第1天注射玻璃酸钠25mg+醋酸曲安奈德注射液50mg,以后第8、15、22、29天只注射玻璃酸钠注射液25mg。两组均接受5周治疗,统计治疗后的疗效,并于治疗后3个月、6个月各随访1次。采用骨关节炎指数评估量表(WOMAC)、视觉模拟量表(VAS)评价关节功能恢复情况。结果:治疗5周后两组疗效差异有统计学意义(P<0.05),西药组疗效优于针灸组;安全性评价有明显差异(P<0.01),针灸组明显优于西药组。治疗后3个月随访膝关节功能无明显差异(P>0.05)。治疗后6个月随访膝关节功能有明显差异(P<0.01),针灸组明显优于西药组。结论:针刺配合艾灸治疗膝关节骨性关节炎安全、有效、不良反应少,短期效果不如西药明显,但远期疗效明显优于西药治疗。Objective To compare the difference of the efficacy on knee osteoartbritis （KOA） between the combined therapy of acupuncture and moxibustion and western medication, and explore the better therapeutic method for KOA. Methods One hundred and sixty patients were divided into a combined therapy group and a western medication group, 80 cases in each one according to the visit sequence, with the random number table a-opted. In the combined therapy group, the main points were selected from the local painful sites, combined with the acupoints based on the syndrome differentiation and distal acupoints on the affected meridians. The lifting, thrusting or rotating technique was used and the reinforcing or reducing manipulation was applied according to the syndrome differentiation. ＂Duanci＂ or ＂Shuci＂ needling technique was used specially at the extra points and Ashi points. The needling sensation relied on the patients＇ tolerance. After acupuncture, the heat-sensitive moxibustion with pure moxa stick was applied over the local painful sites around knee joint and Shenshu （BL 23） to detect the heat-sensitized points. Acupuncture and moxibustion were given once every day. The treatment of 5 days made 1 session. There were 2 days at the interval between two sessions. In the western medication group, glucosamine sulfate capsules were prescribed for oral administration, 2 capsules each time, three times a day. Additionally, the joint cavity injection was combined. On the first day, sodium hyaluronate 25 mg and triamcinolone acetonide acetate 50 mg were injected. Afterwards, on the 8th, 15th, 22nd and 29th days, sodium hyaluronate injection 25 mg was used only. The treatment was for 5 weeks totally in the two groups. The efficacy was analyzed statistically in 5 weeks. The follow-up visit was conducted in 3 months and 6 months after 5 weeks treatment, respectively. The Western Ontario and Mcmaster Universities Osteoarthritis Index （WOMAC） and visual analogue scale （VAS） were adopted to assess the recovery

关 键 词：膝关节 骨性关节炎 针刺 艾灸 玻璃酸钠 糖皮质激素 随机对照试验 

分 类 号：R246.2[医药卫生—针灸推拿学]