针刀治疗骨性关节炎的临床研究

针刀治疗骨性关节炎的临床研究ClinicalResultsinTreatmentofOsteoarthritiswithacupotome2021/4/271

针刀医学简介

BriefIntroductionOfAcupotomology

针刀医学是将中医和西医的部分基础理论融合为一体,再创造而形成的一种新的医学理论体系。

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

针刀医学的四个基础理论

闭合性手术理论

Closedsurgerythetheoryconcerning.

慢性软组织组织损伤病因、病理学理论

Thetheoryconcerningtheetiologyandpathologyofchroniclesionstosofttissues.BasicTheory2021/4/273

骨质增生新的病因学理论

Thetheoryconcerningtheetiologyandpathologyofabnormalbonygrowths

关于经络实质的一些新认识

Thetheoryconcerningtheessenceofchannelsandcollateralsoftraditionalchinesemedicine2021/4/274

六大组成部分

BasicContents针刀医学的病理生理学PhysiopathologyofAcupotomology针刀医学的手法学ManipulationofAcupotomology针刀医学的影像学ImageologyofAcupotomology2021/4/275针刀医学的护理学NursingscienceofAcupotomology针刀医学的诊断学DiagnosticsofAcupotomology针刀医学的治疗学TherapeuticsofAcupotomology2021/4/276

骨性关节炎是以关节面关节软骨破坏、新骨增生为特征的慢性关节病。本病发病率随年龄增长而增高。felson等报告,70岁以下和80岁以上人群的膝骨性关节炎患病率分别为7.0%和11.2%Butter等报告，44岁以下,45-59岁和60岁以上三组人群中，X线片骨性关节炎的患病率分别为6.2%、21.6%和42.0%。

各年龄阶段患膝骨性关节炎的概况Osteoarthritisischaracterizedwiththeinjuryofjointsoftboneandhyperplasiaofnewbone.Thediseaseismorelikelytohappenwithageincreasing.Felsonetal7%inpeopleunder70yearsoldand11.2%over80yearsold.Butteretc6.2%,21.6%,42%amongpeopleunder44,between45-59andover60yearsoldrespectively.2021/4/277

针刀医学提出了“骨性关节炎的发病原因是关节内的力平衡被破坏,使关节周围软组织附着处应力增高所致”的理论。本实验根据此理论应用针刀疗法治疗骨性关节炎,以进一步研究该病的病因和机理,为临床治疗骨性关节炎提供新的思路.Acupotomologyraisedthetheorythatthecauseofosteoarthritisistheforceunblanceofjointandtheincreasedstressintheattachmentpointofsofttissuearoundthejoint.Theincreasedstressinjuredtheligament,andcausedtheedemaandinflammationinthejoint.ontheotherhand,itincreasedtheosteogenesismetabolismandformedspurs.2021/4/278136例患者中,男性43例,女性93例,年龄41-72岁。病程2-5年54例,6-10年32例。11年以上50例。双膝罹患者87例,单膝罹患者49例。

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

将136例患者随机分为针刀治疗组（I组）和药物治疗组即对照组（II组）作1：1配对观察。

136patientswererandomlydevidedintoacupotometreatmentgroup(groupI)anddrugTreatmentgroup(GroupII).

2021/4/27109、人的价值，在招收诱惑的一瞬间被决定。2023/2/32023/2/3Friday,February3,202310、低头要有勇气，抬头要有低气。2023/2/32023/2/32023/2/32/3/20235:00:43PM11、人总是珍惜为得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人乱于心，不宽余请。2023/2/32023/2/32023/2/3Friday,February3,202313、生气是拿别人做错的事来惩罚自己。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、一个人炫耀什么，说明他内心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、业余生活要有意义，不要越轨。2023/2/32023/2/303February202317、一个人即使已登上顶峰，也仍要自强不息。2023/2/32023/2/32023/2/32023/2/3I组中男性23例，女性45例,年龄41岁至69岁间,双膝罹患者47例，单膝罹患者21例。

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

II组中男性20例,女性48例,年龄在45至72岁之间双膝罹患者40例，单膝罹患者28例。

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

2021/4/2712关节疼痛(Jointpain)

早期可无症状或有轻度关节疼痛，晚期出现骨刺则疼痛明显。关节僵直(Jointrigidity)早期可有晨起关节僵直，或久坐起立时感觉关节僵直。晚期关节受限甚至强直。实验室检查(Laboratorytest)类风湿因子阴性、血沉、抗“O”正常。2021/4/2713X线检查

（X-raytest）中枢型（CentralForm）可见脊柱小关节有骨赘形成，椎体前缘唇样增生。Thereareosteophyteformationsofsmalljointofspine,thelip-likehyperplasiaoccursinanteriormarginofvertebralbody.外周型（Peripheralform）早期可见骨端软骨增生，后期骨质增生明显，形成骨赘或骨刺。Thecartilagehyperplasiaofepiphysismayoccurinearlystage,afterwardsthecartilagehyperplasiaoccursandosteophyteorspurswereformed.2021/4/2714针刀治疗患者仰卧屈膝，应用针刀对膝关节髌骨周围、髌上囊、髂下囊、髌下脂肪垫、交叉韧带、髁间嵴和内外侧副韧带及股二头股、半腱肌、半膜肌、髂胫束等附着点处压痛点及骨质增生处的变性、结疤、粘连及挛缩的软组织进行切开松解。Patientswereresumedsupinepositionandbentthejointknees.Itwasoperatedonthepainpointsofpatella,suprapatellarbursa,infrapatellarbursa,infrapatellarfatpad,cruciateligaments,intermal-leolarcrestandmedio-lateralaccessoryligamentsaroundthekneejointandattachmentpointsofbicepsmuscleofthigh,semitendinousmuscle,semimembronousmuscle,iliotibialtract,andsitesofhyperosteogeny.2021/4/2715

外手法治疗

Externalmanipulationtreatment

所有患者均接受该辅助治疗.患者仰卧,应用牵拉晃膝法、牵拉旋膝法、过屈和过伸膝关节和牵引状态下的推弹等手法，将膝内翻或处翻畸形或屈伸功能障碍给予校正，使膝关节内外恢复正常的力学状态。Patientswereadoptedthistreatmentintwogroups.Patientliesonownbackandwithapplyingofpullandrotationoftheknee,andoverflexionandoverextensionofkneejoint,underthetractioncondition,tocorrectthegenuvalgumandgenuvalgumabnormalitiesandfunctionaldisordersofflexionandextension.2021/4/2716康复疗法

RehabilitationTherapy

治疗后三周内以间断性下肢牵引和自我锻练患肢屈伸功能为主。三周后下肢负重（1公斤沙袋）直腿抬高锻炼股四头肌收缩功能，每日不少于150次。6个月内不可长途行走或负重行走。Allpatientswereadoptedthistreatment.Thediscontinuoustractionofthelowerlimbsandself-trainingofflexionandextensionofthelimbsarethemainmethodin3weeksafteracupotomy.Afterthreeweeksthelowerlimbscarrya1Kgsandbagandraisesthelegstraightlyupwardandtoexercisethecontractfuncionofquadricepsmuscleofthethigh.Nolessthan150timeseveryday.Patientsshouldnotwalkalongdistanceorcarryaheavyloadin6months.2021/4/2717

统计学处理

数据用两组比较X2检验进行处理。

Allitemswereconductedbytwo-groupX2test.2021/4/2718

评价标准

CriterionOfEfficacy

治愈：罹患膝关节疼痛完全消失，活动正常，X线证明骨关节增生变化停上，关节间隙基本正常。

Cured:painofsufferingkneejointdisappearscompletely,theactivityisnormal,tthfunctionisbasicallyrecoveredX-rayprovesthatthehyperplasticchangeoftheboneandjointstops.

显效：罹患膝关节疼痛减轻，活动有所进步，功能改善。

Singnificantefficacy:Painofsufferingkneejointlightensandtheactivityandthefunctionisimproved.2021/4/2719

好转：罹患膝关节疼痛有所减轻，活动功能无明显改善。

Improvement:

Painofsufferingkneejointlightenstosomeextent,buttheactivityandfunctionhavenoclearimprovement.

无效：症状体征无好转。

Inefficacy:Allthesymptomsandsignshadnottakenaturnforthebetter.2021/4/2720针刀治疗组68例中，临床治愈33例（48.5%),显效25例(36.8%),好转10例(15%),总有效率为100%。Inacupotomegroup,33caseswerecured(48.5%),withsignificantefficacy25cases(36.8%),improved10cases(15%).Thetotalefficacyratewas100%.对照组68例中，临床治愈0例,显效10例（15%），好转35例（51%），无效23例(34%),总有效率66%。Indruggroup,nocaseswerecured,withsignificantefficacy10cases(15%),improved35cases(51%),inefficacy23cases934%),totalefficacyratewas(66%).2021/4/2721经两组比较X2检验,针刀治疗组的治愈率和显效率均明显高于药物治疗组,有显著治疗组,有显差异(P<0.01)。Allitemsweresiginificantdifferenceconductedbyx2test(p<0.01).2021/4/2722讨论

Discussion2021/4/2723骨性关节炎的病理学组织变化主要表现为关节软骨坏死和软骨增生，以及关节软组织的一系列反应。Themajorpathologicchangesofosteoarthritwerenecrosisandhyperplasisofjointsoftbone.2021/4/2724目前临床治疗骨性关节炎主要采取药物治疗和手术治疗。非甾体类抗炎药物对软骨基质的合成有抑制作用。糖皮质激素大剂量反复多次使用会阻碍软骨修复过程.外科手段虽对患者的症状有所绶解,但创伤大,价格昂贵,患者不易接受。OAistreatedwithdrugorsurgerymethodinclinic.Non-steroidanti-inflammationdrugsinhibitedthesynthesisofsoftbonemedia.Glucocorticoidsinhibittherecoveryofsoftbone.Thesurgerymethodcausedserioustraumaandiscostly.2021/4/2725针刀医学认为骨性关节炎的主要病因是人体内力平衡失调所致,人体是一个封闭的力学系统,在正常情况下,这个力学系统对于人体的生命和活动来说是相对平衡的,该力学平衡是建立在正常的“生命”和“活动”基础上的.该力学系统失衡时,为保证人体的“生命”和“活动”不受损害而产生代偿性病变。AcupotomologyraisedthetheorythatthecauseofOAistheforceunblanceofjoint.Thebodyisaclosedforcesystemandmaintainthebalanceatnormal.Theself-regulatonsystemwouldplayaroletoprotectthenormalfunction.2021/4/2726由于长期受风寒湿热侵袭、外伤、慢性磨损等因素的影响，损伤关节周围肌肉韧带，使关节周围软组织反复充血、水肿、粘连挛缩，进而导致局部血液循环障碍组织乏氧，导致无氧代谢，产生大量酸性化学物质，引血管收缩和肌损伤，导致疼痛和活动功能受限，肌组织变性和粘连挛缩加剧，致使膝关节生物力学平衡失调。Manyfactors,suchastrauma,chronicwearandtearinjuredthemusclesandligamentsaroundthejoint,causedtherepeatedlycongestion,edema,adhesionandcontracture.Disorderoflocalbloodcirculationcausedthetissuehypoxiaandanaerobicmetabolismproducingalotofacidsubstanceswhichstimulatedvasoconstrictionanddamagedthemusculartissue,causedpainandlinitedthejointactivity.Theresultwastheforceunblanceofkneejoint.2021/4/2727关节在力学平衡失调的状态下勉强继续维持行走活动，势必导致软组织附着点处应力增高而使成骨代谢作用增强，钙磷在骨端沉积增多而生成骨赘。Itwillcertainlyleadtothestressincreaseofthesofttissueattachmentpoint,enhanceosteogenicmetabolismofcalciumandphosphorusinbonetermination.Theosteophyteisformed.2021/4/2728本实验结果证明，采用针刀治疗辅以外手法及康复治疗，使关节周围的变性、粘连和挛缩的软组织得到松解，从而使关节生物力学趋于平衡，有效改善和缓解症状.配合康复锻炼,使关节周围的肌力加