基于德尔菲法的手法诊疗膝骨关节病“筋骨评估”模式  

The “Tendon and Bone Assessment” Mode of Traditional Chinese Medicine Manipulation Treatment of Knee Osteoarthropathy Based on Delphi Method

作　　者：张进霖 李玉梅 张昊[1] 奚小冰[1] 颜威 王强 胡劲松[1] 李飞跃[1] ZHANG Jinlin;LI Yumei;ZHANG Hao;XI Xiaobing;YAN Wei;WANG Qiang;HU Jingsong;LI Feiyue(Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 201810,China;Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China)

机构地区：[1]上海交通大学医学院附属瑞金医院,上海201810 [2]上海中医药大学附属上海市中医医院

出　　处：《中国中医骨伤科杂志》2024年第6期57-61,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：上海市临床重点专科建设项目(shslczdzk04802);上海市2023年度“科技创新行动计划”自然科学基金面上项目(23ZR1440400);上海市卫生健康委员会中医药科研专项(2022QN026);上海市2023年度创新医疗器械应用示范项目(23SHS0400-02);上海市嘉定区卫生健康委员会中医药科研课题(2020-QN-ZYY-03)。

摘　　要：目的:构建手法诊疗膝骨关节病“筋骨评估”模式。方法:通过查阅文献资料、总结临床经验、研究小组讨论等方法制定专家咨询问卷,通过德尔菲法对20名专家进行两轮问卷调查,对问卷结果进行统计分析。结果:两轮专家积极系数均为100%。第一轮肯德尔和谐系数为0.51,差异有统计学意义(P<0.05),专家权威系数为0.78,问卷信度为0.94;第二轮肯德尔和谐系数为0.30,差异有统计学意义(P<0.05),专家权威系数为0.82,问卷信度为0.91,且第二轮所有评估内容的变异系数均<0.5,故结束问卷调查。确立了中医手法治疗膝骨关节病时筋骨评估的五个方面内容:触诊检查、姿势体位、压痛点、肌张力、影像学检查。结论:手法诊疗膝骨关节病“筋骨评估”模式内容包含触诊检查(膝关节活动度、膝关节屈伸活动度、麦氏征、髌骨研磨试验、侧副韧带挤压试验、抽屉试验、股四头肌肌力、股二头肌肌力)、姿势体位(膝关节内翻、膝关节外翻、膝关节过伸)、压痛点(膝关节髌骨周围、膝关节间隙、膝关节腘窝)、肌张力(腘绳肌、股四头肌、腘肌、腓肠肌)、影像学检查(膝关节Q角、膝过伸角、下肢力线)。Objective:To establish the mode of tendon and bone assessment in traditional Chinese medicine(TCM)manipulation treatment of knee osteoarthropathy(KOA).Methods:Expert consultation questionnaire was drew up by referring to literature,summarizing clinical experience and discussion in research groups.Two rounds of questionnaire were distributed and collected from 20 experts by Delphi method,and the results were statistically analyzed.Results:The positive coefficient of experts in both rounds was 100%.In the first round,the Kendall concordance coefficient was 0.51(P<0.05),the expert authority coefficient was 0.78,and the Cronbach's Alpha was 0.94.In the second round,the Kendall concordance coefficient was 0.30(P<0.05),and the expert authority coefficient was 0.82.The Cronbach's Alpha was 0.91,and the coefficient of variation of all evaluation contents in the second round was less than 0.5,so the questionnaire survey was ended.Five aspects of tendon and bone evaluation in the treatment of KOA by TCM were established:palpation examination,postural position,tender point,muscle tension and imaging examination.Conclusion:The manipulation diagnosis and treatment of knee arthropathy “tendon and bone assessment” model includes palpation examination(knee motion,knee flexion and extension motion,McGannell's sign,patella grinding test,collateral ligament compression test,draw test,quadriceps muscle strength,biceps femoris muscle strength),postural position(knee varus,knee valgus,knee hyperextension),tender points(knee patella circumference,knee closure joint space,knee popliteal fossa),muscle tone(hamstring,quadriceps,popliteus,gastrocnemius),imaging(Q angle of knee,hyperextension angle of knee,line of force of lower limb).

关 键 词：膝骨关节病 中医手法 筋骨评估 德尔菲法 

分 类 号：R684.3[医药卫生—骨科学]