“以筋代骨”六步手法联合针刺治疗膝关节骨关节炎的临床研究

Clinical study on the six-step technique of “replacing bone with tendons” combined with acupuncture in the treatment of knee osteoarthritis

关键词:  膝关节骨关节炎  手法  针刺  以筋代骨  董氏奇穴  临床疗效

Key words:  knee osteoarthritis  technique  acupuncture  tendons instead of bones  Dong’s extraordinary acupoints  clinical effect

摘要:

[目的] 探讨“以筋代骨”六步手法联合针刺治疗膝关节骨关节炎的临床疗效。[方法] 选取2021年1月—2024年5月北京中医药大学深圳医院（龙岗）疼痛推拿中心收治的84例膝关节骨关节炎患者，随机分为两组，对照组（42例）接受“以筋代骨”六步手法6周，观察组（42例）接受“以筋代骨”六步手法联合董氏奇穴针刺治疗6周。比较两组疗效、膝关节疼痛、功能、超声影像学参数、实验室指标以及两组不良反应比较。[结果] 观察组治疗总有效率高于对照组（92.86% vs. 69.05%，P＜0.05）。两组治疗后视觉模拟评分法（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、髌上囊滑膜厚度、髌上囊液体厚度、血清前列腺素E2（PGE2）、透明质酸（HA）、软骨寡聚基质蛋白（COMP）、肿瘤坏死因子-α（TNF-α）水平较治疗前降低（P＜0.05）；膝关节运动功能Lysholm量表（LKSS）评分、髌上囊滑膜血流信号检出率较治疗前增高（P＜0.05）；观察组治疗后VAS、WOMAC评分、髌上囊滑膜厚度、髌上囊液体厚度、血清PGE2、HA、COMP、TNF-α低于对照组（P＜0.05）；LKSS评分、髌上囊滑膜血流信号检出率高于对照组（P＜0.05）。两组不良反应比较差异无统计学意义（P>0.05）。[结论] “以筋代骨”六步手法联合董氏奇穴针刺可有效缓解膝关节疼痛，改善膝关节功能，在膝关节骨关节炎治疗中具有较高的临床疗效。

Abstract:

[Objective] To explore the clinical effect of “replacing bone with tendons” six-step technique combined with acupuncture in the treatment of knee osteoarthritis. [Methods] A total of 84 patients with knee osteoarthritis admitted to Tuina Therapy Center for Pain Management Shenzhen Hospital of Beijing University of Chinese Medicine（Longgang） from May 2020 to May 2024 were randomly divided into the two groups. The control group（42 cases） received the six-step manipulation of “replacing bone with tendon” for 6 weeks，and the observation group（42 cases） received the six-step manipulation of “replacing bone with tendon” combined with Dong’s extraordinary acupoints acupuncture for 6 weeks. The therapeutic effect，knee pain，function，ultrasound imaging parameters，laboratory indicators，and comparison of adverse reactions were compared between the two groups. [Results] The total effective rate of the observation group was higher than that of the control group（92.86% vs. 69.05%，P＜0.05）. Post-treatment visual analog scale（VAS），Western Ontario and McMaster University osteoarthritis index（WOMAC） scores，the synovial membrane thickness and fluid thickness of suprapatellar bursa，serum prostaglandin E2（PGE2），hyaluronic acid（HA），cartilage oligomer matrix protein（COMP） and tumor necrosis factor-α（TNF-α） levels were decreased compared with those before treatment（P＜0.05）. Lysholm knee scoring scale（LKSS） for motor function of the knee，the detection rate of synovial blood flow signal of suprapatellar bursae was higher than that before treatment（P＜0.05）. VAS，WOMAC scores，synovial thickness of suprapatellar bursae，fluid thickness of suprapatellar bursae after treatment in the observation group；serum PGE2，HA，COMP and TNF-α were lower than those of control group（P＜0.05）；LKSS score and the detection rate of synovial blood flow signal of suprapatellar bursae were higher than those of control group（P＜0.05）. There was no significant difference in adverse reactions between the two groups（P>0.05）. [Conclusion] The six-step technique of “replacing bone with tendons” combined with Dong’s Qi point acupuncture can effectively relieve knee pain and improve knee function，and has a high clinical effect in the treatment of knee osteoarthritis.