1.北京中医药大学附属护国寺中医医院针灸科,北京 100035
2.北京中医药大学附属护国寺中医医院骨科,北京 100035
王骐,男,37岁,博士,主治医师。研究方向:针刺临床及机制研究。
纸质出版日期:2024-07-25,
收稿日期:2023-10-31,
扫 描 看 全 文
王骐,吕晖,孙兆天,等.针刺联合骨科熥药对膝骨关节炎寒湿痹阻证患者步态特征的影响[J].北京中医药,2024,43(7):766-771.
WANG Qi,LYU Hui,SUN Zhaotian,et al.Effect of acupuncture combined with orthopedics formentation on gait characteristics in knee osteoarthritis of cold-dampness obstruction syndrome[J]. Beijing Journal of Traditional Chinese Medicine,2024,43(07):766-771.
王骐,吕晖,孙兆天,等.针刺联合骨科熥药对膝骨关节炎寒湿痹阻证患者步态特征的影响[J].北京中医药,2024,43(7):766-771. DOI: 10.16025/j.1674-1307.2024.07.010.
WANG Qi,LYU Hui,SUN Zhaotian,et al.Effect of acupuncture combined with orthopedics formentation on gait characteristics in knee osteoarthritis of cold-dampness obstruction syndrome[J]. Beijing Journal of Traditional Chinese Medicine,2024,43(07):766-771. DOI: 10.16025/j.1674-1307.2024.07.010.
目的
2
探讨针刺联合骨科熥药对膝骨关节炎寒湿痹阻证患者步态特征的影响。
方法
2
选取2021年1月—2023年5月北京中医药大学附属护国寺中医医院针灸科和骨科门诊收治的126例膝骨关节炎患者为研究对象,采用区组随机化方法(区组长度为9)产生的随机数字将患者分为3组,剔除失访患者后,针刺组纳入36例、骨科熥药组纳入35例、联合治疗组纳入38例。针刺组采用局部扬刺联合常规取穴针刺方案治疗,骨科熥药组外用骨科熥药治疗,联合治疗组采用局部扬刺联合常规取穴针刺和骨科熥药治疗,3组每隔1~2 d治疗1次,1周治疗3次,共治疗8周。分别于治疗前、治疗结束时(治疗后)及16周随访时采用IDEEA3便捷式步态分析仪检测患者步态参数,包括单腿支撑时间、双腿支撑时间、周期时间、单双腿支撑时间比(SLS/DLS)、肢体摆动时间、步速、步长、步幅和抬腿强度、摆腿强度、蹬地强度、跖屈强度。记录治疗期间3组发生的不良反应。
结果
2
治疗后及16周随访时,3组单腿支撑时间、双腿支撑时间、SLS/DLS、步速、步长、步幅和抬腿强度、摆腿强度、蹬地强度、跖屈强度均较治疗前改善(
P
<
0.05);与针刺组、骨科熥药组比较,治疗后及16周随访时,联合治疗组单腿支撑时间、双腿支撑时间、SLS/DLS、步速、步长、步幅和抬腿强度、摆腿强度、蹬地强度、跖屈强度改善明显(
P
<
0.05);针刺组、骨科熥药组各步态参数比较差异无统计学意义(
P
>
0.05)。3组均无晕针、滞针、断针、疼痛加剧、严重针具过敏、熥药烫伤或熥药过敏等不良反应发生。针刺过后出现轻度皮下血肿8例(针刺组3例、联合治疗组5例),数小时内自行消退。
结论
2
针刺联合骨科熥药可显著提高膝骨关节炎寒湿痹阻证患者步态稳定性,增强各屈伸肌群力量,延长步行距离,提高步频,效果优于针刺、骨科熥药单独治疗。
Objective
2
To discuss the effect of acupuncture combined with orthopedic formentation on the gait characteristics of patients with knee osteoarthritis of cold-dampness obstruction syndrome.
Methods
2
A total of 126 cases with knee osteoarthritis who were admitted by the Department of Acupuncture and Moxibustion and Department of Orthopedics, Huguosi Hospital of Traditional Chinese Medicine Affiliated to the Beijing University of Chinese Medicine from January 2021 to May 2023 were collected as the research subjects, and divided into three groups by using random numbers generated by block randomization method (block length is 9). After excluding the lost patients, 36 cases were included in acupuncture group, 35 cases in orthopedic formentation group and 38 cases in combined treatment group. The acupuncture group was treated with a combination of local Yang needling and conventional acupoint selection acupuncture scheme, the orthopedic formentation group was treated with external orthopedic formentation, and the acupuncture combined with orthopedic formentation group was treated with a combination of local Yang needling and conventional acupoint selection acupuncture and orthopedic formentation. The three groups were treated once every 1 or 2 d and three times a week for 8 weeks. The gait characteristics before treatment, at the end of treatment and at the 16th week in follow up was evaluated by adopting IDEEA3 portable gait analyzer. Observation indicators included single leg support time, double leg support time, cycle time, ratio of single leg support time to double leg support time (SLS/DLS), limb swing time, stride speed, stride length, stride length and leg lifting strength, leg swinging strength, ground pushing strength, and plantar flexion strength. The adverse reactions of the three groups during the treatment were counted.
Results
2
After treatment and at 16 weeks follow-up, the three groups showed improvements in single leg support time, double leg support time, SLS/DLS, stride speed, stride length, stride length and leg lifting strength, leg swinging strength, ground pushing strength, and plantar flex
ion strength compared to those before treatment (
P
<
0.05). Compared with the acupuncture group and orthopedic formentation group, the acupuncture combined with orthopedic formentation group showed significant improvement in single leg support time, double leg support time, SLS/DLS, stride speed, stride length, stride length, leg lifting strength, leg swinging strength, ground pushing strength, and plantar bending strength after treatment and 16 weeks of follow-up (
P
<
0.05), while the orthopedic formentation group showed no significant improvement (
P
>
0.05). There were no adverse reactions such as needle fainting, needle stagnation, needle breakage, aggravated pain, severe needle allergy, scald or allergic reaction in the three groups. Throughout the experiment, 8 subjects experienced mild subcutaneous hematoma (3 cases in acupuncture group and 5 cases in combined treatment group), which subsided spontaneously within a few hours.
Conclusion
2
Acupuncture combined with orthopedic drugs can significantly improve the gait stability of patients with cold-dampness obstruction syndrome of knee osteoarthritis, enhance the strength of various flexors and extensors, prolong the walking distance and increase the gait frequency, and the effect is better than acupuncture and orthopedic drugs alone.
膝骨关节炎针刺骨科熥药步态特征寒湿痹阻证
Knee osteoarthritisacupunctureorthopedic formentationgait characteristicscold-dampness obstruction syndrome
SHARMA L. Osteoarthritis of the knee [J]. The New Engl J Med, 2021,384(1):51-59.
WANG Q, LV H, SUN ZT, et al. Effect of electroacupuncture versus sham electroacupuncture in patients with knee osteoarthritis: a pilot randomized controlled trial[J]. Evid Based Complement Alternat Med, 2020:1686952.
黄泽灵, 施珊妮, 何俊君,等. 温针灸治疗阳虚寒凝型膝骨关节炎疗效Meta分析及选穴规律研究[J]. 康复学报,2021,31(4):341-350.
周萌, 曹光磊, 张宽,等. 便携式步态分析仪量化评价全膝关节置换病人的步态特征[J]. 中国矫形外科杂志,2015,23(7):615-619.
HOCHBERG MC, AlTMAN RD, BRANDT KD, et al. Guidelines for the medical management of osteoarthritis. Part Ⅱ. Osteoarthritis of the knee. American College of Rheumatology[J]. Arthritis Rheum, 1995,38(11):1541-1546.
KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis[J]. Ann Rheum Dis, 1957,16(4):494-502.
陈卫衡.膝骨关节炎中医诊疗指南(2020年版)[J].中医正骨,2020,32(10):1-14.
宋越, 马良宵, 王俊翔,等. 针刺角度、方向、深度与针效关系探讨[J]. 针灸临床杂志,2020,36(2):5-8.
王琪, 张艳芝, 孙实,等. 宫廷正骨特色治疗膝关节骨性关节炎的临床观察[J]. 中国中医急症,2016,25(5):907-909.
甄朋超,王倩倩.骨科熥药配合经皮激光汽化减压治疗腰椎间盘突出症的临床观察[J].中国中医骨伤科杂志,2013,21(1):38-39,42.
张昊华,闫松华,方沉,等.用便携式步态分析仪评估全髋关节置换术手术效果[J].医用生物力学,2015,30(4):361-366.
刘艳成, 夏群, 胡永成,等. 便携步态分析量化评价脊髓型颈椎病患者的步态特征[J]. 中国组织工程研究,2014(11):1774-1779.
霍乐乐,陈磊,高文香.中医药治疗膝骨关节炎的现状[J].风湿病与关节炎,2016,5(6):77-80.
谢天宇.针灸治疗膝骨关节炎智能辨证选穴的算法模型研究[D].成都:成都中医药大学,2019.
李永婷, 石广霞, 屠建锋,等. 针灸治疗膝骨关节炎选穴规律分析[J]. 辽宁中医杂志,2017,44(10):2179-2182.
张琥, 张旻, 邢磊,等. 平衡针法治疗膝骨关节炎的即时步态分析研究[J]. 上海中医药大学学报,2018,32(5):33-35,40.
黎蔚欣, 郭玮, 宗姝琪,等. 《灵枢经》合谷刺治疗膝骨关节炎临床疗效[J]. 北京中医药,2022,41(4):452-455.
孙颂歌,张艳珍,孙莹,等.补肾强督方联合双氯芬酸二乙胺乳胶剂治疗肾虚督寒型膝骨关节炎临床观察[J].北京中医药,2022,41(8):921-924.
寇龙威, 郭珈宜, 李峰,等. 针药结合治疗膝骨关节炎临床研究进展[J]. 亚太传统医药,2021,17(2):174-177.
孙小波,刘玉婷,邱祖财.铍针结合中药药熨治疗膝骨关节炎21例:雷仲民教授学术经验[J].光明中医,2017,32(21):3147-3148.
0
浏览量
0
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构