中医专家谈风寒湿痹型膝骨关节炎的治疗

【摘要】 目的：对比温针灸联合蠲痹汤和普通针刺在治疗风寒湿痹型膝骨关节炎的临床疗效。方法：选取2019年7月至2019年12月期间在本院中医科接受治疗的膝骨关节炎患者60例，分为对照组（30例）和实验组（30例）。对照组给予常规普通针刺治疗，实验组给予温针灸联合蠲痹汤治疗，两组均连续治疗3周为一疗程。采用临床综合疗效评、疼痛视觉模拟评分（VAS）和膝关节功能评分法（HSS）评分估作为检验疗效的指标。结果实验组和对照组的患者在年龄、性别、病程、治疗前VAS和HSS评分差异均无统计学意义（P>0.05）。两组治疗方法均能有效地降低了VAS和HSS评分（P<0.05），缓解患者的病情变化。但与普通针刺对比，温针灸联合蠲痹汤疗法在缓解患者的疼痛、膝骨关节活动障碍方面更显著（P<0.05），在临床控制率和总有效率上明显高于普通针刺（P<0.05）。结论：温针灸联合蠲痹汤疗法在治疗膝骨关节炎的临床效果上优于常规针刺方法，值得推广。

     基金项目：浦东新区“国家中医药发展综合改革试验区”建设；项目编号：PDZY-2019-0219

    Objective: To compare the clinical effect of warm acupuncture and moxibustion combined with Jubi Decoction and common acupuncture in the treatment of wind-cold-dampness-bi osteoarthritis of the knee. Methods: 60 patients with knee osteoarthritis who received treatment in the Department of Traditional Chinese Medicine of our hospital from July to December 2019 were selected and divided into control group (30 cases) and experimental group (30 cases). The control group was treated with conventional acupuncture therapy, while the experimental group was treated with warm acupuncture therapy combined with Juanyi Decoction. The two groups were treated with one course of treatment for 3 weeks continuously. Comprehensive clinical efficacy evaluation, visual analogue scale (VAS) and knee joint function score (HSS) were used to evaluate the efficacy. Results there were no statistically significant differences between the experimental group and the control group in age, gender, course of disease, VAS and HSS scores before treatment (P>0.05). VAS and HSS scores were effectively reduced in both groups (P<0.05), and the changes of patients' condition were alleviated. However, compared with ordinary acupuncture and moxibustion, the combined therapy of warming and acupuncture combined with Jubi Decoction was more significant in alleviating patients' pain and knee joint mobility disorder (P<0.05), and its clinical control rate and total effective rate were significantly higher than those of ordinary acupuncture and moxibustion (P<0.05). Conclusion: The combined therapy of warming and acupuncture and Juanbi decoction is superior to conventional acupuncture in the treatment of knee osteoarthritis, and is worthy of promotion.

   膝骨关节炎(KOA)是由各种因素导致关节软骨磨损、破坏，软骨下骨及周围骨赘生的一种疾病，临床表现主要上以膝关节周围出现肿胀、疼痛、僵硬，甚至关节活动受限。西医目前对本病的治疗方法主要包括关节腔注射玻璃酸钠、口服镇痛药、对症治疗为主，疗效一般，并且有副作用，对患者重要脏器心脑、肝肾功能及胃肠道都有影响。手术治疗，价格昂贵，且不适用发病初期。因此，我们需要探索一种安全、有效，同时无明显副作用的治疗方法。根据相关研究，中医药在本病治疗上有着良好疗效。本研究即在此基础上采用温针灸联合蠲痹汤的方法治疗风寒湿痹型膝骨关节炎，疗效显著。

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   本文摘自（中国中医药现代远程教育  邬付骏，倪春燕,  邬美花   老港社区卫生服务中心中医科，上海201302）