基于高频超声评价不同针刺深度治疗膝骨关节炎的临床研究  

Clinical study on different needling depths in treating knee osteoarthritis based on high-frequency ultrasound evaluation

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作  者:崔雨洁 琪丽妲 李媛媛 李月馨 李源 胡慧 李华 CUI Yujie;KASANDRA Sicilia Muntianu Fajardo;LI Yuanyuan;LI Yuexin;LI Yuan;HU Hui;LI Hua(The Second Clinical Medical College of Beijing University of Chinese Medicine,Moxibustion&Tuina,Beijing University of Chinese Medicine,Beijing 100078,China;Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China)

机构地区:[1]The Second Clinical Medical College of Beijing University of Chinese Medicine,Moxibustion&Tuina,Beijing University of Chinese Medicine,Beijing 100078,China [2]Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China

出  处:《Journal of Acupuncture and Tuina Science》2024年第4期326-334,共9页针灸推拿医学(英文版)

基  金:2017年北京中医药大学青年教师专项计划课题,No.2017-JYB-JS-98;北京市中医药管理局中医药“3+3”薪火传承“杨甲三名家研究室”课题.

摘  要:目的:观察不同针刺深度治疗膝骨关节炎(KOA)的疗效及对超声成像下积液、软骨厚度与滑膜的影响。方法:将90例KOA患者随机分为常规针刺组、西药组与浅刺组,每组30例。常规针刺组针刺深度为15-30 mm,进针后捻转片刻,以有酸麻胀触电感为佳;浅刺组直刺2 mm,进针后不进行手法操作。以上两组取穴相同,均留针20 min,每周治疗3次。西药组给予硫酸氨基葡萄糖胶囊口服,一次2粒,每日3次。三组均治疗8周。分别在治疗前、治疗4周后和治疗8周后进行西安大略与麦克马斯特大学骨关节炎指数(WOMAC)和视觉模拟量表(VAS)评分,通过膝关节超声观察膝关节软骨、滑膜和关节积液的变化。治疗8周后进行临床疗效评价。结果:治疗8周后,常规针刺组和浅刺组积液和滑膜厚度均较治疗前显著改善(P<0.01),西药组积液较治疗前有改善(P<0.05),常规针刺组滑膜厚度改善优于西药组(P<0.05)。三组软骨厚度与治疗前比较差异均无统计学意义(P>0.05)。治疗4周和8周后,三组WOMAC(疼痛、僵硬、功能)和VAS评分均较治疗前下降(P<0.05);常规针刺组WOMAC疼痛评分均低于同时间点西药组和浅刺组(P<0.05);常规针刺组VAS评分均低于浅刺组(P<0.05)。治疗8周后,常规针刺组WOMAC中僵硬及功能评分均低于西药组(P<0.05)。结论:常规针刺、口服西药和浅刺均能缓解膝关节疼痛,改善膝关节僵硬及膝关节功能活动。常规针刺缓解膝关节疼痛疗效最佳,治疗8周后改善关节功能疗效最佳。常规针刺和浅刺均能明显减轻膝关节滑膜厚度;三种治疗方案均能改善关节积液,常规针刺和浅刺疗效更佳。Objective:To observe the efficacy of different needling depths for knee osteoarthritis(KOA)and the effects on effusion,cartilage thickness,and synovium under ultrasound imaging.Methods:A total of 90 patients with KOA were randomly divided into a conventional acupuncture group,a Western medication group,and a shallow acupuncture group,with 30 cases in each group.In the conventional acupuncture group,the needling depth was 15-30 mm,and the needle was twisted for a few moments after insertion so that a sore,numb,distending,and electrified sensation was obtained;in the shallow acupuncture group,the points were punctured perpendicularly by 2 mm,and no manipulation was performed after insertion.The same points were used in the two acupuncture groups,and the needles were retained for 20 min.The treatment was performed 3 times a week.The Western medication group was given glucosamine sulfate capsules for oral administration,2 capsules once,3 times a day.All three groups were treated for 8 weeks.The Western Ontario and McMaster Universities osteoarthritis index(WOMAC)and the visual analog scale(VAS)were scored before treatment,after 4 weeks and 8-week treatment,respectively;while the changes in knee cartilage,synovial membrane,and joint fluid were observed by knee ultrasound before and after 8-week treatment.The clinical efficacy was evaluated after 8-week treatment.Results:After 8-week treatment,the effusion and the synovial thickness improved significantly in both the conventional and shallow acupuncture groups compared with that before treatment(P<0.01);the effusion improved in the Western medication group compared with that before treatment(P<0.05);the synovial thickness improved better in the conventional acupuncture group than in the Western medication group(P<0.05).There was no statistically significant difference in the cartilage thickness among the three groups compared with that before treatment(P>0.05).The WOMAC(pain,stiffness,and function)and VAS scores decreased in all three groups after 4-and 8-week treatmen

关 键 词:针刺疗法 骨关节炎  针刺深度 超声评价 视觉模拟量表 

分 类 号:R246.2[医药卫生—针灸推拿学]

 

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