1. 浙江省温州市中西医结合医院康复医学科,浙江,温州,325000
2. 上海中医药大学康复医学院,上海,201203
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陈世宣, 计静, 冯伟, 等. 风寒湿痹型膝骨关节炎患者膝部筋结点分布特征及独活寄生汤联合手法松解对其影响的研究[J]. 上海中医药杂志, 2019,53(2):51-55.
CHEN Shixuan, JI Jing, FENG Wei, et al. Distribution characteristics of knee nodal points and effect of Duhuo Jisheng Decoction combined with manipulation in patients with knee osteoarthritis of anemofrigid-damp arthralgia type[J]. Shanghai Journal of Traditional Chinese Medicine, 2019,53(2):51-55.
陈世宣, 计静, 冯伟, 等. 风寒湿痹型膝骨关节炎患者膝部筋结点分布特征及独活寄生汤联合手法松解对其影响的研究[J]. 上海中医药杂志, 2019,53(2):51-55. DOI: 10.16305/j.1007-1334.2019.02.014.
CHEN Shixuan, JI Jing, FENG Wei, et al. Distribution characteristics of knee nodal points and effect of Duhuo Jisheng Decoction combined with manipulation in patients with knee osteoarthritis of anemofrigid-damp arthralgia type[J]. Shanghai Journal of Traditional Chinese Medicine, 2019,53(2):51-55. DOI: 10.16305/j.1007-1334.2019.02.014.
目的:观察风寒湿痹型膝骨关节炎(knee osteoarthritis, KOA)患者膝部筋结点分布特征及独活寄生汤联合手法松解对其的影响。 方法:将80例风寒湿痹型KOA患者随机分为治疗组和对照组,每组40例。对照组予常规西药,治疗组加用独活寄生汤口服联合筋结点手法松解。两组疗程均为4周、随访8周,触诊受试者治疗前筋结点分布情况并对筋结点的压痛程度进行评分,观察西安大略省和麦克马斯特大学膝骨关节炎量表(WOMAC)评分、5次坐立试验(FTSST)评分的变化情况。 结果:①最终完成试验者78例,治疗组38例,对照组40例。②触诊后发现,92.5%的风寒湿痹型KOA患者膝部周围存在筋结点,其主要分布在膝关节内侧,如内膝眼、鹅足部、收肌结节、内侧副韧带等;外侧主要于外膝眼处分布较多。总体而言,筋结点在膝内侧分布明显多于外侧,压痛程度内侧亦明显高于外侧。③治疗前后、治疗前与随访8周时组内比较,治疗组疼痛、僵硬、关节功能评分和总分均明显下降,对照组除僵硬评分外、其余评分均明显下降(P<0.05)。随访8周时与治疗后比较,治疗组疼痛评分存在下降趋势,其余评分有不同程度的上升趋势,但差异无统计学意义(P>0.05);对照组疼痛评分、关节功能评分及总分明显升高,出现显著反弹(P<0.05)。组间治疗后及随访8周时比较,疼痛评分、僵硬评分、关节功能评分及总分差异均有统计学意义,治疗组均明显低于对照组(P<0.05)。④治疗前后组内比较、治疗前与随访8周时比较,两组FTSST评分均明显下降(P<0.05);随访8周时与治疗后比较,对照组FTSST评分明显升高(P<0. 05)。组间治疗后和随访8周时比较,治疗组FTSST评分均明显低于对照组(P<0.05)。 结论:与常规西药相比,加用独活寄生汤联合筋结点手法松解治疗风寒湿痹型膝骨关节炎的疗效更佳,可明显改善膝关节疼痛、僵硬及关节功能,且疗效稳定、不易反弹。
Objective:To observe the distribution characteristics of knee nodal points in patients with knee osteoarthritis (KOA) of the anemofrigid-damp arthralgia type and the effect of Duhuo Jisheng Decoction combined with manipulation of the nodal points. Methods80 patients with KOA of the anemofrigid-damp arthralgia type were randomly assigned into the treatment group and the control group, 40 patients in each group. Patients in the control group were treated with western medicine, and those in the treatment group received Duhuo Jisheng Decoction combined with manipulation of the nodal points in addition. Patients in both groups were treated for 4 weeks and followed up for 8 weeks. The nodal points were examined by palpitation before treatment, and the degree of tenderness was scored. The changes in scores on the Western Ontario and McMaster Universities (WOMAC) osteoarthritis scale and scores in the five-times-sit-to-stand test (FTSST) were observed. Results:① 78 subjects completed the trial, including 38 in the treatment group and 40 in the control group. ② By palpation, it was found that 92.5% of patients with KOA of the anemofrigid-damp arthralgia type had nodal points around the knee, mainly distributed in the medial knee joint, such as medial depression of patellar ligament, pes anserinus, adductor tubercle and medial collateral ligament; and in the lateral knee joint, it is mainly distributed in the depression on the outside of the knee. Overall, there were obviously more nodal points in the medial knee than in the lateral knee, and the degree of tenderness in the medial knee was also significantly higher than that in the lateral knee. ③ The scores of pain, stiffness and joint function and the total score deceased significantly in the treatment group after treatment compared to those before treatment and at 8 weeks of follow up compared to those before treatment; and except for the stiffness score, the other scores decreased significantly in the control group (P<0.05). The pain score showed a tendency of decline in the treatment group, and the other scores showed a tendency of increase to varying degrees at 8 weeks of follow up compared to those after treatment, but there were no statistically significant differences (P>0.05); and the scores of pain and joint function and the total score increased significantly in the control group (P<0.05). There were significant differences in the scores of pain, stiffness and joint function and the total score between the groups after treatment and at 8 weeks of follow up, and the scores were significantly lower in the treatment group than in the control group (P<0.05). ④ The FTSST score decreased significantly in both groups after treatment compared to that before treatment and at 8 weeks of follow up compared to that before treatment (P<0.05); and the FTSST score increased significantly in the control group at 8 weeks of follow up compared to that after treatment (P<0.05). The FTSST score was significantly lower in the treatment group than in the control group after treatment and at 8 weeks of follow up (P<0.05). Conclusion:Compared to treatment with western medicine, treatment with western medicine plus manipulation of the nodal points and Duhuo Jisheng Decoction is more effective in treating KOA of the anemofrigid-damp arthralgia type and it significantly improves the pain, stiffness and function of the knee with stable treatment effect.
膝骨关节炎风寒湿痹证筋结点推拿手法独活寄生汤
knee osteoarthritisanemofrigid-damp arthralgia syndromenodal pointsmanipulation maneuverDuhuo Jisheng Decoction
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