針刀治骨性關節(jié)炎的臨床研究

1、針刀治療骨性關節(jié)炎的臨床研究,北京中醫(yī)藥大學Beijing Traditional Chinese Medicine University,Clinical Results in Treatment of Osteoarthritis with acupotome,朱漢章Zhu Hanzhang MD Professor,針 刀 醫(yī) 學 簡 介Brief Introduction Of Acupotomology,針刀醫(yī)學是將中

2、醫(yī)和西醫(yī)的部分基礎理論融合為一體,再創(chuàng)造而形成的一種新的醫(yī)學理論體系。 Acupotomology, a fusion of the basic theories of traditional Chinese and modern western medicine, has formed a complete system of medical science. This is a revolution in the

3、 medical field. Moreover, it symbolizes a new era in the medical science.,針刀醫(yī)學的四個基礎理論,閉合性手術理論 Closed surgery the theory concerning . 慢性軟組織組織損傷病因、病理學理論 The theory concerning the etiology and pathology of chronic

4、lesions to soft tissues.,Basic Theory,骨質增生新的病因學理論 The theory concerning the etiology and pathology of abnormal bony growths 關于經絡實質的一些新認識 The theory concerning the essence of channels and collaterals of trad

5、itional chinese medicine,六 大 組 成 部 分,Basic Contents,針刀醫(yī)學的病理生理學Physiopathology of Acupotomology,針刀醫(yī)學的手法學Manipulation of Acupotomology,針刀醫(yī)學的影像學Imageology of Acupotomology,針刀醫(yī)學的護理學Nursing science of Acupotomology,針刀醫(yī)學的

6、診斷學Diagnostics of Acupotomology,針刀醫(yī)學的治療學Therapeutics of Acupotomology,骨性關節(jié)炎是以關節(jié)面關節(jié)軟骨破壞、新骨增生為特征的慢性關節(jié)病。本病發(fā)病率隨年齡增長而增高。felson等報告,70歲以下和80歲以上人群的膝骨性關節(jié)炎患病率分別為7.0%和11.2% Butter等報告，44歲以下,45-59歲和60歲以上三組人群中，X線片骨性關節(jié)炎的患病率分別為6.2%、21

7、.6%和42.0%。,各年齡階段患膝骨性關節(jié)炎的概況,Osteoarthritis is characterized with the injury of joint soft bone and hyperplasia of new bone. The disease is more likely to happen with age increasing .Felson et al 7% in people under 70 year

8、s old and 11.2% over 80 years old. Butter etc 6.2%,21.6%,42% among people under 44 ,between 45-59 and over 60 years old respectively.,針刀醫(yī)學提出了“骨性關節(jié)炎的發(fā)病原因是關節(jié)內的力平衡被破壞,使關節(jié)周圍軟組織附著處應力增高所致”的理論。本實驗根據此理論應用針刀療法治療骨性關節(jié)炎,以進一步研究該病的病因和

9、機理,為臨床治療骨性關節(jié)炎提供新的思路.,Acupotomology raised the theory that the cause of osteoarthritis is the force unblance of joint and the increased stress in the attachment point of soft tissue around the joint. The increased stress

10、injured the ligament, and caused the edema and inflammation in the joint .on the other hand,it increased the osteogenesis metabolism and formed spurs.,136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

11、患者49例。,136 patients,43 male cases and 93 female cases with age between 41-72 years.Course of disease:2-5 years of 32 cases,over 11 years 50 cases. 87 patients suffered from two knees and 49 patients suffered from one k

12、nee.,將136例患者隨機分為針刀治療組（I組）和藥物治療組即對照組（II組）作 1 ：1 配對觀察。 136 patients were randomly devided into acupotome treatment group ( group I ) and drug Treatment group (Group II).,I組中男性23例，女性

13、45例,年齡41歲至69歲間,雙膝罹患者47例，單膝罹患者21例。 In group I:23 male,45 female cases aged between 41-69 years.47 cases suffered from two knees and 21 cases suffered from one knee. 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

14、罹患者28例。 In group II:20 male,48female cases aged between 45-72 years.40 cases suffered from two knees and 29 cases suffered from one knee.,關節(jié)疼痛 (Joint pain ) 早期可無癥狀或有輕度關節(jié)疼痛，晚期出現骨刺則疼痛明顯。關節(jié)僵直 (Joint rigidity

15、) 早期可有晨起關節(jié)僵直，或久坐起立時感覺關節(jié)僵直。晚期關節(jié)受限甚至強直。實驗室檢查( Laboratory test) 類風濕因子陰性、血沉、抗“O”正常。,X 線 檢 查（X-ray test）,中樞型（ Central Form ）可見脊柱小關節(jié)有骨贅形成，椎體前緣唇樣增生。There are

16、osteophyte formations of small joint of spine, the lip-like hyperplasia occurs in anterior margin of vertebral body.,外周型 （Peripheral form）早期可見骨端軟骨增生，后期骨質增生明顯，形成骨贅或骨刺。The cartilage hyperplasia of epiphysis may occur in

17、early stage, afterwards the cartilage hyperplasia occurs and osteophyte or spurs were formed.,針刀治療,患者仰臥屈膝，應用針刀對膝關節(jié)髕骨周圍、髕上囊、髂下囊、髕下脂肪墊、交叉韌帶、髁間嵴和內外側副韌帶及股二頭股、半腱肌、半膜肌、髂脛束等附著點處壓痛點及骨質增生處的變性、結疤、粘連及攣縮的軟組織進行切開松解。Patients were res

18、umed supine position and bent the joint knees. It was operated on the pain points of patella, suprapatellar bursa, infrapatellar bursa,infrapatellar fat pad, cruciate ligaments,intermal-leolar crest and medio-lateral acc

19、essory ligaments around the knee joint and attachment points of biceps muscle of thigh, semitendinous muscle,semimembronous muscle, iliotibial tract, and sites of hyperosteogeny.,外 手 法 治 療 External manipulat

20、ion treatment,所有患者均接受該輔助治療.患者仰臥,應用牽拉晃膝法、牽拉旋膝法、過屈和過伸膝關節(jié)和牽引狀態(tài)下的推彈等手法，將膝內翻或處翻畸形或屈伸功能障礙給予校正，使膝關節(jié)內外恢復正常的力學 狀態(tài)。Patients were adopted this treatment in two groups. Patient lies on own back and with applying of pull and rotati

21、on of the knee, and over flexion and over extension of knee joint,under the traction condition ,to correct the genu valgum and genu valgum abnormalities and functional disorders of flexion and extension.,康 復 療 法 Reha

22、bilitation Therapy,治療后三周內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個月內不可長途行走或負重行走。All patients were adopted this treatment.The discontinuous traction of the lower limbs and self-training of flexion a

23、nd extension of the limbs are the main method in 3 weeks after acupotomy.After three weeks the lower limbs carry a 1 Kg sandbag and raises the leg straightly upward and to exercise the contract funcion of quadriceps musc

24、le of the thigh .No less than 150 times everyday.Patients should not walk a long distance or carry a heavy load in 6 months.,統(tǒng) 計 學 處 理,數據用兩組比較X2檢驗進行處理。 All items were conducted by two-group X2 test.,評 價 標 準

25、 Criterion Of Efficacy,治愈：罹患膝關節(jié)疼痛完全消失，活動正常，X線證明骨關節(jié)增生變化停上，關節(jié)間隙基本正常。 Cured: pain of suffering knee joint disappears completely, the activity is normal,tth function is basically recovered X-ray proves that th

26、e hyperplastic change of the bone and joint stops. 顯效： 罹患膝關節(jié)疼痛減輕，活動有所進步，功能改善。 Singnificant efficacy: Pain of suffering knee joint lightens and the activity and the function is improved.,好轉：罹患膝關節(jié)疼痛有所減輕，活動功能無明顯

27、改善。 Improvement: Pain of suffering knee joint lightens to some extent, but the activity and function have no clear improvement. 無效：癥狀體征無好轉。 Inefficacy: All the symptoms and signs had not taken a turn for

28、the better.,針刀治療組68例中，臨床治愈33例（48.5%),顯效25例(36.8%),好轉10例(15%),總有效率為100%。In acupotome group,33 cases were cured (48.5%),with significant efficacy 25 cases(36.8%),improved 10 cases(15%).The total efficacy rate was 100%.對

29、照組68例中，臨床治愈0例,顯效10例（15%），好轉35例（51%），無效23例(34%),總有效率66%。In drug group,no cases were cured, with significant efficacy 10 cases (15%),improved 35 cases (51%), inefficacy 23 cases 934%),total efficacy rate was (66%).,經兩組比較X

30、2檢驗,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)。All items were siginificant difference conducted by x2 test (p<0.01).,討 論Discussion,骨性關節(jié)炎的病理學組織變化主要表現為關節(jié)軟骨壞死和軟骨增生，以及關節(jié)軟組織的一系列反應。The major pathologic cha

31、nges of osteoarthrit were necrosis and hyperplasis of joint soft bone.,目前臨床治療骨性關節(jié)炎主要采取藥物治療和手術治療。非甾體類抗炎藥物對軟骨基質的合成有抑制作用。糖皮質激素大劑量反復多次使用會阻礙軟骨修復過程.外科手段雖對患者的癥狀有所綬解,但創(chuàng)傷大,價格昂貴,患者不易接受。OA is treated with drug or surgery method in

32、 clinic. Non-steroid anti-inflammation drugs inhibited the synthesis of soft bone media.Glucocorticoids inhibit the recovery of soft bone. The surgery method caused serious trauma and is costly.,針刀醫(yī)學認為骨性關節(jié)炎的主要病因是人體內力平衡失調

33、所致,人體是一個封閉的力學系統(tǒng),在正常情況下,這個力學系統(tǒng)對于人體的生命和活動來說是相對平衡的,該力學平衡是建立在正常的“生命”和“活動”基礎上的.該力學系統(tǒng)失衡時,為保證人體的“生命”和“活動”不受損害而產生代償性病變。Acupotomology raised the theory that the cause of OA is the force unblance of joint.The body is a closed fo

34、rce system and maintain the balance at normal.The self-regulaton system would play a role to protect the normal function.,由于長期受風寒濕熱侵襲、外傷、慢性磨損等因素的影響，損傷關節(jié)周圍肌肉韌帶，使關節(jié)周圍軟組織反復充血、水腫、粘連攣縮，進而導致局部血液循環(huán)障礙組織乏氧，導致無氧代謝，產生大量酸性化學物質，引血管收縮

35、和肌損傷，導致疼痛和活動功能受限，肌組織變性和粘連攣縮加劇，致使膝關節(jié)生物力學平衡失調。Many factors,such as trauma,chronic wear and tear injured the muscles and ligaments around the joint,caused the repeatedly congestion,edema, adhesion and contracture.Disorder

36、 of local blood circulation caused the tissue hypoxia and anaerobic metabolism producing a lot of acid substances which stimulated vasoconstriction and damaged the muscular tissue, caused pain a

37、nd linited the joint activity. The result was the force unblance of knee joint.,關節(jié)在力學平衡失調的狀態(tài)下勉強繼續(xù)維持行走活動，勢必導致軟組織附著點處應力增高而使成骨代謝作用增強，鈣磷在骨端沉積增多而生成骨贅。It will certainly lead to the stress increase of the soft tissue at

38、tachment point,enhance osteogenic metabolism of calcium and phosphorus in bone termination.The osteophyte is formed.,本實驗結果證明，采用針刀治療輔以外手法及康復治療，使關節(jié)周圍的變性、粘連和攣縮的軟組織得到松解，從而使關節(jié)生物力學趨于平衡，有效改善和緩解癥狀.配合康復鍛煉,使關節(jié)周圍的肌力加強,關節(jié)力學的穩(wěn)定性得以鞏固,

39、效果更為明顯,這為針刀醫(yī)學認為骨性關節(jié)炎是“力學平衡失調”的理論提供了有力證據。Acupotomy relaxed peripheral soft tissue of around the joint,reduced the degeneration,adhesion and contracture.It recovered the force blance and alleviated the symptoms.The effe