中医宫廷理筋术手法与现代关节松动术手法干预膝骨关节炎的比较研究  

Comparative Study of the Royal TCM-based Tendon-regulation Manipulation and Joint Mobilization for Knee Osteoarthritis

作　　者：韩思宇 李多多[1] 蔡美玲 于长禾[1] HAN Siyu;LI Duoduo;CAI Meiling;YU Changhe(Massage Department,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院推拿科,北京市100700

出　　处：《中国全科医学》2023年第2期210-219,共10页Chinese General Practice

基　　金：北京市科学技术委员会“首都临床特色应用研究”专项(Z181100001718165);中央高校基本科研业务费专项资金项目(2018-JYBZZ-JS092,2019-JYB-XS-153)。

摘　　要：背景正确有效地对膝骨关节炎(KOA)进行防治已成为目前各医疗机构所面临的难题之一,临床证据表明中医宫廷理筋术手法与现代医学关节松动术手法治疗KOA均具有临床疗效,但目前两者干预KOA的临床特点比较研究鲜见报道。目的比较中医宫廷理筋术手法与现代关节松动术手法治疗KOA的差异,促进世界范围内手法医学的规范化、标准化。方法于2020年10月至2021年6月在北京中医药大学东直门医院推拿科门诊招募符合要求的KOA患者67例,随机分为宫廷理筋术手法组(33例)与关节松动术手法组(34例),两组患者接受4周10次治疗,中途脱落4例,最终纳入63例患者。采用定量与定性相结合的混合方法,定量研究采用随机对照试验进行分析,治疗前后采用西安大略和麦克马斯特大学关节炎指数(WOMAC)评分进行疗效评价。定性研究采用半结构化个体访谈法,围绕两种手法治疗KOA的疗效、对推拿治疗的认知和对两种手法的评价等问题开展访谈,比较两种手法的异同,采用主题分析法构建主题框架。并通过并排比较与联合展示的方法对研究结果进行混合研究的整合分析。结果疗效评价:定量研究显示4周治疗后,两组患者WOMAC总分比较,差异无统计学意义(P>0.05),两组患者WOMAC总分均低于治疗前(P<0.05);定性研究显示4周治疗后,患者对两种手法治疗后的疗效评价(正、中、负向评价)无明显差异。认知评价:定性资料显示治疗前后两组患者对推拿认知感受的正、中、负向评价基本持平,经治疗后,患者对于推拿的认知感受向正向评价倾斜;定量分析结果显示疗效与既往是否于医院接受过推拿治疗无关,疗效与施盲的成功与否无关,施盲的成功与否与分组、既往推拿治疗情况之间无明显关联;患者对推拿的认知评价与本次治疗的疗效无关,且患者不论接受哪种手法治疗都不影响他们对推拿的认知。手Background Appropriate and effective prevention and treatment of knee osteoarthritis(KOA)has become a challenge faced by medical institutions.Clinical evidence shows that both the royal TCM-based tendon-regulation manipulation and joint mobilization are effective for KOA,but there are few comparative studies of them in KOA.Objective To compare the similarities and differences between the royal TCM-based tendon-regulation manipulation and joint mobilization in the treatment of KOA,promoting the normalization and standardization of manipulative medicine worldwide.Methods From October 2020 to June 2021,67 KOA patients who met the requirements were recruited from the Massage Department of Dongzhimen Hospital,Beijing University of Chinese Medicine.They were randomly divided into royal TCM-based tendon-regulation manipulation(n=33)and joint mobilization(n=34).The two groups of patients received 10 treatments for 4 weeks,4 cases fell off midway,and 63 patients were finally included.A mixed method of quantitative and qualitative analysis was adopted.Quantitative data collected were pre-and post-treatment assessment of the clinical responses in two groups with Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC).Qualitative data were collected using semi-structured individual interviews conducted in the participants based on topics of the efficacies and assessment of the two treatments for KOA,and understanding of the massage therapy.The similarities and differences between the two treatments were compared,and analyzed using thematic analysis.Parallel comparison and joint display were used for integrative analysis of the mixed data.Results Efficacy evaluation:there was no statistically significant difference in the total score of WOMAC between the two groups after 4 weeks of treatment(P>0.05),the total scores of WOMAC in both groups were lower than those before treatment(P<0.05).According to the interview,there were no significant differences in patient-assessed efficacies(positive,neutral or negative eva

关 键 词：骨关节炎 膝 肌肉骨骼手法 中医推拿学 中西医学比较研究 评价研究(主题) 宫廷理筋术 关节松动术 

分 类 号：R684.3[医药卫生—骨科学] R45[医药卫生—外科学]