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(xué)簡(jiǎn)介

BriefIntroductionOfAcupotomology

針刀醫(yī)學(xué)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(xué)理論體系。

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

針刀醫(yī)學(xué)的四個(gè)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(xué)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(shí)質(zhì)的一些新認(rèn)識(shí)

Thetheoryconcerningtheessenceofchannelsandcollateralsoftraditionalchinesemedicine2021/4/274

六大組成部分

BasicContents針刀醫(yī)學(xué)的病理生理學(xué)PhysiopathologyofAcupotomology針刀醫(yī)學(xué)的手法學(xué)ManipulationofAcupotomology針刀醫(yī)學(xué)的影像學(xué)ImageologyofAcupotomology2021/4/275針刀醫(yī)學(xué)的護(hù)理學(xué)NursingscienceofAcupotomology針刀醫(yī)學(xué)的診斷學(xué)DiagnosticsofAcupotomology針刀醫(yī)學(xué)的治療學(xué)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(zhǎng)而增高。felson等報(bào)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(bào)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(xué)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(shí)驗(yàn)根據(jù)此理論應(yīng)用針刀療法治療骨性關(guān)節(jié)炎,以進(jìn)一步研究該病的病因和機(jī)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(jī)分為針刀治療組（I組）和藥物治療組即對(duì)照組（II組）作1：1配對(duì)觀察。

136patientswererandomlydevidedintoacupotometreatmentgroup(groupI)anddrugTreatmentgroup(GroupII).

2021/4/27109、人的價(jià)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(qǐng)。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯(cuò)的事來(lái)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(gè)人炫耀什么，說(shuō)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(gè)人即使已登上頂峰，也仍要自強(qiáng)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(wú)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(shí)感覺關(guān)節(jié)僵直。晚期關(guān)節(jié)受限甚至強(qiáng)直。實(shí)驗(yàn)室檢查(Laboratorytest)類風(fēng)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(duì)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(diǎn)處壓痛點(diǎn)及骨質(zhì)增生處的變性、結(jié)疤、粘連及攣縮的軟組織進(jìn)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(fù)正常的力學(xué)狀態(tài)。Patientswereadoptedthistreatmentintwogroups.Patientliesonownbackandwithapplyingofpullandrotationoftheknee,andoverflexionandoverextensionofkneejoint,underthetractioncondition,tocorrectthegenuvalgumandgenuvalgumabnormalitiesandfunctionaldisordersofflexionandextension.2021/4/2716康復(fù)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(fù)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(gè)月內(nèi)不可長(zhǎng)途行走或負(fù)重行走。Allpatientswereadoptedthistreatment.Thediscontinuoustractionofthelowerlimbsandself-trainingofflexionandextensionofthelimbsarethemainmethodin3weeksafteracupotomy.Afterthreeweeksthelowerlimbscarrya1Kgsandbagandraisesthelegstraightlyupwardandtoexercisethecontractfuncionofquadricepsmuscleofthethigh.Nolessthan150timeseveryday.Patientsshouldnotwalkalongdistanceorcarryaheavyloadin6months.2021/4/2717

統(tǒng)計(jì)學(xué)處理

數(shù)據(jù)用兩組比較X2檢驗(yàn)進(jìn)行處理。

Allitemswereconductedbytwo-groupX2test.2021/4/2718

評(píng)價(jià)標(biāo)準(zhǔn)

CriterionOfEfficacy

治愈：罹患膝關(guān)節(jié)疼痛完全消失，活動(dòng)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(dòng)有所進(jìn)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(dòng)功能無(wú)明顯改善。

Improvement:

Painofsufferingkneejointlightenstosomeextent,buttheactivityandfunctionhavenoclearimprovement.

無(wú)效：癥狀體征無(wú)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(duì)照組68例中，臨床治愈0例,顯效10例（15%），好轉(zhuǎn)35例（51%），無(wú)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(yàn),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(xué)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(duì)軟骨基質(zhì)的合成有抑制作用。糖皮質(zhì)激素大劑量反復(fù)多次使用會(huì)阻礙軟骨修復(fù)過程.外科手段雖對(duì)患者的癥狀有所綬解,但創(chuàng)傷大,價(jià)格昂貴,患者不易接受。OAistreatedwithdrugorsurgerymethodinclinic.Non-steroidanti-inflammationdrugsinhibitedthesynthesisofsoftbonemedia.Glucocorticoidsinhibittherecoveryofsoftbone.Thesurgerymethodcausedserioustraumaandiscostly.2021/4/2725針刀醫(yī)學(xué)認(rèn)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(gè)封閉的力學(xué)系統(tǒng),在正常情況下,這個(gè)力學(xué)系統(tǒng)對(duì)于人體的生命和活動(dòng)來(lái)說(shuō)是相對(duì)平衡的,該力學(xué)平衡是建立在正常的“生命”和“活動(dòng)”基礎(chǔ)上的.該力學(xué)系統(tǒng)失衡時(shí),為保證人體的“生命”和“活動(dòng)”不受損害而產(chǎn)生代償性病變。AcupotomologyraisedthetheorythatthecauseofOAistheforceunblanceofjoint.Thebodyisaclosedforcesystemandmaintainthebalanceatnormal.Theself-regulatonsystemwouldplayaroletoprotectthenormalfunction.2021/4/2726由于長(zhǎng)期受風(fēng)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(fù)充血、水腫、粘連攣縮，進(jìn)而導(dǎo)致局部血液循環(huán)障礙組織乏氧，導(dǎo)致無(wú)氧代謝，產(chǎn)生大量酸性化學(xué)物質(zhì)，引血管收縮和肌損傷，導(dǎo)致疼痛和活動(dòng)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(xué)平衡失調(diào)。Manyfactors,suchastrauma,chronicwearandtearinjuredthemusclesandligamentsaroundthejoint,causedtherepeatedlycongestion,edema,adhesionandcontracture.Disorderoflocalbloodcirculationcausedthetissuehypoxiaandanaerobicmetabolismproducingalotofacidsubstanceswhichstimulatedvasoconstrictionanddamagedthemusculartissue,causedpainandlinitedthejointactivity.Theresultwastheforceunblanceofkneejoint.2021/4/2727關(guān)節(jié)在力學(xué)平衡失調(diào)的狀態(tài)下勉強(qiáng)繼續(xù)維持行走活動(dòng)，勢(shì)必導(dǎo)致軟組織附著點(diǎn)處應(yīng)力增高而使成骨代謝作用增強(qiáng)，鈣磷在骨端沉積增多而生成骨贅。Itwillcertainlyleadtothestressincreaseofthesofttissueattachmentpoint,enhanceosteogenicmetabolismofcalciumandphosphorusinbonetermination.Theosteophyteisformed.2021/4/2728本實(shí)驗(yàn)結(jié)果證明，采用針刀治療輔以外手法及康復(fù)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(xué)趨于平衡，有效改善和緩解癥狀.配合康復(fù)鍛煉,使關(guān)節(jié)周圍的肌力加