摘要
目的:观察推拿和鹿衔草为主组方治疗老年性膝关节骨关节炎的干预效果。方法:选择2002-03/2004-06在上海交通大学附属第一人民医院推拿科、中医科门诊就诊的老年性膝关节骨关节炎患者86例,均自愿参加观察。按随机分组表分成4组,即推拿+鹿衔草组、推拿组、鹿衔草组及自我锻炼组,分别为22,22,22及20例。①推拿组患者取俯卧位,以滚法作用于患肢后侧5min,重点在部委中(、委阳(;取仰卧位,用滚法作用于患者患侧大腿股四头肌,着重于膝关节髌骨上部5min;继而以按揉与弹拨法交替作用于患肢,配合点按犊鼻、内外膝眼、阳陵泉、鹤顶、膝阳关、梁丘等(位;作屈膝法,配合膝关节伸屈、旋内、旋外被动运动;最后以擦法擦热患膝。3次/周,共治疗4周。②鹿衔草组患者服用汤药(鹿衔草为主的基础方),辩证加减。1剂/d,分2次口服,共服用4周。③推拿+鹿衔草组治疗方法:在推拿治疗同时服用鹿衔草为主组方的汤药,共治疗4周,方法同上。④自我锻炼组:进行知识教育,并嘱患者自行进行功能锻炼,包括牵张训练、主动和被动活动度训练及增力训练等,锻炼时间为4周。采用WOMAC评分(包括疼痛、僵硬、日常生活3大类,用0～100mm视觉量表评分法,分数越高患者的机体功能越差,对生活的影响程度也越大)和20m步行时间对治疗前及治疗4周后的膝关节功能进行评估,并在治疗4周后评估疗效,疗效评定标准:①有效:关节疼痛、肿胀消失,活动功能恢复正常,理化检查正常。②好转:关节疼痛、肿胀减退,活动功能好转。结果:86例患者均进入结果分析,无脱落。①各组患者治疗4周后的WOMAC评分和20m步行时间均较治疗前显著降低(P<0.05)。治疗4周后推拿+鹿衔草组的WOMAC评分显著低于自我锻炼组(P<0.05);推拿+鹿衔草组和推拿组的20m步行时间显著短于自我锻炼组(P<0.05)。②经过4周的治疗和锻炼,推拿+鹿衔草组、推拿组、鹿衔草组及自我锻炼组患者的治疗有效率分别为86%,82%,82%和60%,各组比较差异均无显著性意义(P>0.05)。结论:单纯推拿、单纯服用鹿衔草及自我功能锻炼均能有效治疗老年性膝关节骨关节炎,明显改善患者膝关节运动功能,但推拿加鹿衔草综合治疗的疗效更优。
AIM： To evaluate the effect of manipulation and pyrola compound traditional Chinese medicine on senile osteoarthritis of knee.
METHODS： Eighty-six outpatients with knee osteoarthritis were selected from Department of Massage and Department of Traditional Chinese Medicine, First People＇s Hospital Affiliated to Shanghai Jiaotong University from March 2002 to June 2004. All patients were willing to join the observation. They were randomly assigned to 4 groups： manipulation plus pyrola group （a=22）, manipulation group （a=22）, pyrola compound traditional Chinese medicine group （n=22）, and self-exercise group （n=20）. ①The manipulation group： Prone position, rolling manipulation to the affected thigh for 5 minutes, mainly the Weizhong and Weiyang of the fossa poplitea and the posterelateral part of the leg; Supine position, rolling manipulation for 5 minutes to affected side of quadriceps femoris and superior part of the whirbone; Alternately manipulation of pressing-kneading, flicking-poking and digital：pressing to Dubi, xiyan, Yanglingquan, Healing, Xiyangguan and Liangqiu; Rotating of the knee joint cooperated by the passive stretch, flexion, inward and lateral rotation; At last, spreading some ointment of Chinese holly leaf on the affected knee joint and scrubbing until give the patient a warm sensation. The treatment was done three times weekly for 4 weeks. ②Pyrola group： The patients were treated with Chinese herbs orally （modified Pyrola compound traditional Chinese medicine） twice a day with water for weeks.③Manipulation plus pyrola group： Patients were treated by Chinese herb orally besides the manipulation with the same processes as the manipulation group for 4 weeks. ④Self-exercise group： Patients were told to do exercise themselves such as stretching exercises, active and passive range-of-motion exercises, strengthening exercises and so on for 4 weeks. Western Ontario and McMaster universities osteoarthritis index （WOMAC） score （including pain, stiffness and daily life, 0-100 mm visual scale was used, the more the scores, the worse the function, so the greater effect to life） and 20 m walking time test were used for evaluation of the function of knee joint before and 4 weeks after treatment. The standard for evaluation： ①effective： Arthralgia and swelling disappeared, motor function recovered with normal physiochemical detection.②improved： Arthralgia and swelling lessened, and the motor function was improved.
RESULTS： All the 86 patients were involved in the result analysis without any loss. ①The time in the 20 m walking and scores in WOMAC of each group were decreased after 4 weeks of treatment （P 〈 0.05）. The average WOMAC scores of the manipulation plus pyrola group were obviously lower than the self-exercise group （P 〈 0.05）; and the time in 20 m walking of the manipulation group and manipulation plus pyrola group was shorter than the self-exercise group （P 〈 0.05）. ②After 4 weeks of treatment and exercise, the effective rates of the manipulation plus pyrola group, manipulation group, pyrola group and self-exercise group were 86%, 82%, 82% and 60%, respectively, which had no significant difference （P 〉 0.05）.
CONCLUSION： Simple manipulation, pyrola and self-exercise can all markedly improve the knee osteoarthritis, but the therapeutic effect of combined therapy of manipulation and pyrola is better.
出处
《中国临床康复》
CSCD
北大核心
2006年第23期30-32,共3页
Chinese Journal of Clinical Rehabilitation
