針刀治療骨性關(guān)節(jié)炎的臨床研究

針刀治療骨性關(guān)節(jié)炎的臨床研究ClinicalResultsinTreatmentofOsteoarthritiswithacupotome2021/4/271

針刀醫(yī)學簡介

BriefIntroductionOfAcupotomology

針刀醫(yī)學是將中醫(yī)和西醫(yī)的部分基礎(chǔ)理論融合為一體,再創(chuàng)造而形成的一種新的醫(yī)學理論體系。

Acupotomology,afusionofthebasictheoriesoftraditionalChineseandmodernwesternmedicine,hasformedacompletesystemofmedicalscience.Thisisarevolutioninthemedicalfield.Moreover,itsymbolizesanewerainthemedicalscience.2021/4/272

針刀醫(yī)學的四個基礎(chǔ)理論

閉合性手術(shù)理論

Closedsurgerythetheoryconcerning.

慢性軟組織組織損傷病因、病理學理論

Thetheoryconcerningtheetiologyandpathologyofchroniclesionstosofttissues.BasicTheory2021/4/273

骨質(zhì)增生新的病因?qū)W理論

Thetheoryconcerningtheetiologyandpathologyofabnormalbonygrowths

關(guān)于經(jīng)絡(luò)實質(zhì)的一些新認識

Thetheoryconcerningtheessenceofchannelsandcollateralsoftraditionalchinesemedicine2021/4/274

六大組成部分

BasicContents針刀醫(yī)學的病理生理學PhysiopathologyofAcupotomology針刀醫(yī)學的手法學ManipulationofAcupotomology針刀醫(yī)學的影像學ImageologyofAcupotomology2021/4/275針刀醫(yī)學的護理學NursingscienceofAcupotomology針刀醫(yī)學的診斷學DiagnosticsofAcupotomology針刀醫(yī)學的治療學TherapeuticsofAcupotomology2021/4/276

骨性關(guān)節(jié)炎是以關(guān)節(jié)面關(guān)節(jié)軟骨破壞、新骨增生為特征的慢性關(guān)節(jié)病。本病發(fā)病率隨年齡增長而增高。felson等報告,70歲以下和80歲以上人群的膝骨性關(guān)節(jié)炎患病率分別為7.0%和11.2%Butter等報告，44歲以下,45-59歲和60歲以上三組人群中，X線片骨性關(guān)節(jié)炎的患病率分別為6.2%、21.6%和42.0%。

各年齡階段患膝骨性關(guān)節(jié)炎的概況Osteoarthritisischaracterizedwiththeinjuryofjointsoftboneandhyperplasiaofnewbone.Thediseaseismorelikelytohappenwithageincreasing.Felsonetal7%inpeopleunder70yearsoldand11.2%over80yearsold.Butteretc6.2%,21.6%,42%amongpeopleunder44,between45-59andover60yearsoldrespectively.2021/4/277

針刀醫(yī)學提出了“骨性關(guān)節(jié)炎的發(fā)病原因是關(guān)節(jié)內(nèi)的力平衡被破壞,使關(guān)節(jié)周圍軟組織附著處應(yīng)力增高所致”的理論。本實驗根據(jù)此理論應(yīng)用針刀療法治療骨性關(guān)節(jié)炎,以進一步研究該病的病因和機理,為臨床治療骨性關(guān)節(jié)炎提供新的思路.Acupotomologyraisedthetheorythatthecauseofosteoarthritisistheforceunblanceofjointandtheincreasedstressintheattachmentpointofsofttissuearoundthejoint.Theincreasedstressinjuredtheligament,andcausedtheedemaandinflammationinthejoint.ontheotherhand,itincreasedtheosteogenesismetabolismandformedspurs.2021/4/278136例患者中,男性43例,女性93例,年齡41-72歲。病程2-5年54例,6-10年32例。11年以上50例。雙膝罹患者87例,單膝罹患者49例。

136patients,43malecasesand93femalecaseswithagebetween41-72years.Courseofdisease:2-5yearsof32cases,over11years50cases.87patientssufferedfromtwokneesand49patientssufferedfromoneknee.2021/4/279

將136例患者隨機分為針刀治療組（I組）和藥物治療組即對照組（II組）作1：1配對觀察。

136patientswererandomlydevidedintoacupotometreatmentgroup(groupI)anddrugTreatmentgroup(GroupII).

2021/4/27109、人的價值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20235:00:43PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一個人炫耀什么，說明他內(nèi)心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、業(yè)余生活要有意義，不要越軌。2023/2/32023/2/303February202317、一個人即使已登上頂峰，也仍要自強不息。2023/2/32023/2/32023/2/32023/2/3I組中男性23例，女性45例,年齡41歲至69歲間,雙膝罹患者47例，單膝罹患者21例。

IngroupI:23male,45femalecasesagedbetween41-69years.47casessufferedfromtwokneesand21casessufferedfromoneknee.

II組中男性20例,女性48例,年齡在45至72歲之間雙膝罹患者40例，單膝罹患者28例。

IngroupII:20male,48femalecasesagedbetween45-72years.40casessufferedfromtwokneesand29casessufferedfromoneknee.

2021/4/2712關(guān)節(jié)疼痛(Jointpain)

早期可無癥狀或有輕度關(guān)節(jié)疼痛，晚期出現(xiàn)骨刺則疼痛明顯。關(guān)節(jié)僵直(Jointrigidity)早期可有晨起關(guān)節(jié)僵直，或久坐起立時感覺關(guān)節(jié)僵直。晚期關(guān)節(jié)受限甚至強直。實驗室檢查(Laboratorytest)類風濕因子陰性、血沉、抗“O”正常。2021/4/2713X線檢查

（X-raytest）中樞型（CentralForm）可見脊柱小關(guān)節(jié)有骨贅形成，椎體前緣唇樣增生。Thereareosteophyteformationsofsmalljointofspine,thelip-likehyperplasiaoccursinanteriormarginofvertebralbody.外周型（Peripheralform）早期可見骨端軟骨增生，后期骨質(zhì)增生明顯，形成骨贅或骨刺。Thecartilagehyperplasiaofepiphysismayoccurinearlystage,afterwardsthecartilagehyperplasiaoccursandosteophyteorspurswereformed.2021/4/2714針刀治療患者仰臥屈膝，應(yīng)用針刀對膝關(guān)節(jié)髕骨周圍、髕上囊、髂下囊、髕下脂肪墊、交叉韌帶、髁間嵴和內(nèi)外側(cè)副韌帶及股二頭股、半腱肌、半膜肌、髂脛束等附著點處壓痛點及骨質(zhì)增生處的變性、結(jié)疤、粘連及攣縮的軟組織進行切開松解。Patientswereresumedsupinepositionandbentthejointknees.Itwasoperatedonthepainpointsofpatella,suprapatellarbursa,infrapatellarbursa,infrapatellarfatpad,cruciateligaments,intermal-leolarcrestandmedio-lateralaccessoryligamentsaroundthekneejointandattachmentpointsofbicepsmuscleofthigh,semitendinousmuscle,semimembronousmuscle,iliotibialtract,andsitesofhyperosteogeny.2021/4/2715

外手法治療

Externalmanipulationtreatment

所有患者均接受該輔助治療.患者仰臥,應(yīng)用牽拉晃膝法、牽拉旋膝法、過屈和過伸膝關(guān)節(jié)和牽引狀態(tài)下的推彈等手法，將膝內(nèi)翻或處翻畸形或屈伸功能障礙給予校正，使膝關(guān)節(jié)內(nèi)外恢復正常的力學狀態(tài)。Patientswereadoptedthistreatmentintwogroups.Patientliesonownbackandwithapplyingofpullandrotationoftheknee,andoverflexionandoverextensionofkneejoint,underthetractioncondition,tocorrectthegenuvalgumandgenuvalgumabnormalitiesandfunctionaldisordersofflexionandextension.2021/4/2716康復療法

RehabilitationTherapy

治療后三周內(nèi)以間斷性下肢牽引和自我鍛練患肢屈伸功能為主。三周后下肢負重（1公斤沙袋）直腿抬高鍛煉股四頭肌收縮功能，每日不少于150次。6個月內(nèi)不可長途行走或負重行走。Allpatientswereadoptedthistreatment.Thediscontinuoustractionofthelowerlimbsandself-trainingofflexionandextensionofthelimbsarethemainmethodin3weeksafteracupotomy.Afterthreeweeksthelowerlimbscarrya1Kgsandbagandraisesthelegstraightlyupwardandtoexercisethecontractfuncionofquadricepsmuscleofthethigh.Nolessthan150timeseveryday.Patientsshouldnotwalkalongdistanceorcarryaheavyloadin6months.2021/4/2717

統(tǒng)計學處理

數(shù)據(jù)用兩組比較X2檢驗進行處理。

Allitemswereconductedbytwo-groupX2test.2021/4/2718

評價標準

CriterionOfEfficacy

治愈：罹患膝關(guān)節(jié)疼痛完全消失，活動正常，X線證明骨關(guān)節(jié)增生變化停上，關(guān)節(jié)間隙基本正常。

Cured:painofsufferingkneejointdisappearscompletely,theactivityisnormal,tthfunctionisbasicallyrecoveredX-rayprovesthatthehyperplasticchangeoftheboneandjointstops.

顯效：罹患膝關(guān)節(jié)疼痛減輕，活動有所進步，功能改善。

Singnificantefficacy:Painofsufferingkneejointlightensandtheactivityandthefunctionisimproved.2021/4/2719

好轉(zhuǎn)：罹患膝關(guān)節(jié)疼痛有所減輕，活動功能無明顯改善。

Improvement:

Painofsufferingkneejointlightenstosomeextent,buttheactivityandfunctionhavenoclearimprovement.

無效：癥狀體征無好轉(zhuǎn)。

Inefficacy:Allthesymptomsandsignshadnottakenaturnforthebetter.2021/4/2720針刀治療組68例中，臨床治愈33例（48.5%),顯效25例(36.8%),好轉(zhuǎn)10例(15%),總有效率為100%。Inacupotomegroup,33caseswerecured(48.5%),withsignificantefficacy25cases(36.8%),improved10cases(15%).Thetotalefficacyratewas100%.對照組68例中，臨床治愈0例,顯效10例（15%），好轉(zhuǎn)35例（51%），無效23例(34%),總有效率66%。Indruggroup,nocaseswerecured,withsignificantefficacy10cases(15%),improved35cases(51%),inefficacy23cases934%),totalefficacyratewas(66%).2021/4/2721經(jīng)兩組比較X2檢驗,針刀治療組的治愈率和顯效率均明顯高于藥物治療組,有顯著治療組,有顯差異(P<0.01)。Allitemsweresiginificantdifferenceconductedbyx2test(p<0.01).2021/4/2722討論

Discussion2021/4/2723骨性關(guān)節(jié)炎的病理學組織變化主要表現(xiàn)為關(guān)節(jié)軟骨壞死和軟骨增生，以及關(guān)節(jié)軟組織的一系列反應(yīng)。Themajorpathologicchangesofosteoarthritwerenecrosisandhyperplasisofjointsoftbone.2021/4/2724目前臨床治療骨性關(guān)節(jié)炎主要采取藥物治療和手術(shù)治療。非甾體類抗炎藥物對軟骨基質(zhì)的合成有抑制作用。糖皮質(zhì)激素大劑量反復多次使用會阻礙軟骨修復過程.外科手段雖對患者的癥狀有所綬解,但創(chuàng)傷大,價格昂貴,患者不易接受。OAistreatedwithdrugorsurgerymethodinclinic.Non-steroidanti-inflammationdrugsinhibitedthesynthesisofsoftbonemedia.Glucocorticoidsinhibittherecoveryofsoftbone.Thesurgerymethodcausedserioustraumaandiscostly.2021/4/2725針刀醫(yī)學認為骨性關(guān)節(jié)炎的主要病因是人體內(nèi)力平衡失調(diào)所致,人體是一個封閉的力學系統(tǒng),在正常情況下,這個力學系統(tǒng)對于人體的生命和活動來說是相對平衡的,該力學平衡是建立在正常的“生命”和“活動”基礎(chǔ)上的.該力學系統(tǒng)失衡時,為保證人體的“生命”和“活動”不受損害而產(chǎn)生代償性病變。AcupotomologyraisedthetheorythatthecauseofOAistheforceunblanceofjoint.Thebodyisaclosedforcesystemandmaintainthebalanceatnormal.Theself-regulatonsystemwouldplayaroletoprotectthenormalfunction.2021/4/2726由于長期受風寒濕熱侵襲、外傷、慢性磨損等因素的影響，損傷關(guān)節(jié)周圍肌肉韌帶，使關(guān)節(jié)周圍軟組織反復充血、水腫、粘連攣縮，進而導致局部血液循環(huán)障礙組織乏氧，導致無氧代謝，產(chǎn)生大量酸性化學物質(zhì)，引血管收縮和肌損傷，導致疼痛和活動功能受限，肌組織變性和粘連攣縮加劇，致使膝關(guān)節(jié)生物力學平衡失調(diào)。Manyfactors,suchastrauma,chronicwearandtearinjuredthemusclesandligamentsaroundthejoint,causedtherepeatedlycongestion,edema,adhesionandcontracture.Disorderoflocalbloodcirculationcausedthetissuehypoxiaandanaerobicmetabolismproducingalotofacidsubstanceswhichstimulatedvasoconstrictionanddamagedthemusculartissue,causedpainandlinitedthejointactivity.Theresultwastheforceunblanceofkneejoint.2021/4/2727關(guān)節(jié)在力學平衡失調(diào)的狀態(tài)下勉強繼續(xù)維持行走活動，勢必導致軟組織附著點處應(yīng)力增高而使成骨代謝作用增強，鈣磷在骨端沉積增多而生成骨贅。Itwillcertainlyleadtothestressincreaseofthesofttissueattachmentpoint,enhanceosteogenicmetabolismofcalciumandphosphorusinbonetermination.Theosteophyteisformed.2021/4/2728本實驗結(jié)果證明，采用針刀治療輔以外手法及康復治療，使關(guān)節(jié)周圍的變性、粘連和攣縮的軟組織得到松解，從而使關(guān)節(jié)生物力學趨于平衡，有效改善和緩解癥狀.配合康復鍛煉,使關(guān)節(jié)周圍的肌力加