针刺治疗膝骨关节炎随机对照观察

摘要

目的：比较拔河针法与常规电针疗法治疗膝骨关节炎的疗效，探寻治疗本病较优疗法，并冀佐证刺灸手法的重要性。方法将符合标准的100例膝骨关节炎患者按就诊顺序随机分为电针组50例和拔河针组50例。拔河针组主穴取足三里和鹤顶两穴，于针刺得气后做相向顶或反向抽，作拔河状，如此反复操作使针感时强时消；电针组按常规取局部穴为主，得气后接G6805-1型电针治疗仪，用疏密波。记录两组患者治疗2个疗程后反应情况，并采用VAS评分及美国西部Ontario与McMaster大学骨关节炎指数(WOMAC)评分评定关节功能。结果两组患者均获6个月后随访。两组治疗后VAS评分、WOMAC量表各项评分及总分与治疗前比较差异均有统计学意义(P＜0.01)；拔河针组患者在治疗后降低VAS评分、WOMAC量表各项评分及总分方面优于电针组(P＜0.01)；拔河针组及电针组治疗后总有效率分别为92.0%和90.0%，随访期总有效率分别为94.0%、92.0%，两组间及两组随访期与治疗后相比均无明显差异(P＞0.05)，而两组患者治疗后及随访期的愈显率分别为68.0%、52.0%和68.0%、54.0%，拔河针组明显优于电针组(P＜0.05)。结论拔河针组与电针组治疗膝骨关节炎均有良好效果，且稳定性强；拔河针组在改善临床症状方面优于电针组。%Objective To compare the therapeutic effects of tug-of-war needling method versus conventional electroacupuncture on knee osteoarthritis, seek a better method for treating this disease and prove the importance of needling and moxibustion techniques. Method One hundred patients meeting the criteria of knee osteoarthritis were allocated, in order of visits, to an electroacupuncture group of 50 cases and a tug-of-war needling group of 50 cases. In the tug-of-war needling group of patients, points Zusanli(ST36) and Heding(EX-LE2) were mainly selected and after the arrival of qi following needle insertion, forward pushing or backward pulling was repeatedly made like tug of war to strengthen or eliminate the needling sensation. In the electroacupuncture group, local points were mainly selected according to the routine, and after the arrival of qi, a G6805-1 type electric acupuncture therapeutic instrument was connected and sparse-dense waves were used. Reactions were recorded in the two groups of patients after two courses of treatment. Joint function was assessed using the VAS and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Result Both groups of patients were followed up at six months after the end of treatment. There were statistically significant pre-/post-treatment differences in the VAS score and the WOMAC sub-scores and total score in the two groups (P<0.01). The VAS score and the WOMAC sub-scores and total score decreased more in the tug-of-war needling group of patients than in the electroacupuncture group (P<0.01). The total efficacy rates in the tug-of-war needling and electroacupuncture groups were 92.0% and 90.0%, respectively, at the end of treatment and 94.0% and 92.0%, respectively, at the follow-up;there was no statistically significant difference between the two groups and between at the end of treatment and at the follow-up in the two groups (P>0.05). However, the cure and marked efficacy rates in the two groups of patients were 68.0%and 52.0%, respectively, at the end of treatment and 68.0%and 54.0%, respectively, at the follow-up. It was statistically higher in the tug-of-war needling group than in the electroacupuncture group (P<0.05). Conclusion Both tug-of-war needling and electroacupuncture have a good and very stable therapeutic effect on knee osteoarthritis. Tug-of-war needling is better than electroacupuncture in improving the clinical symptoms.