健脾补肾法结合针刺治疗膝骨性关节炎的临床效果

董玉喜　陈艳明　王秋红

[摘要] 目的 觀察健脾补肾法结合膝部腧穴针刺治疗脾肾两虚、湿注骨节型膝骨性关节炎的临床效果。 方法 选择2015年1月～2016年12月在北京市昌平区中医医院门诊治疗的120例脾肾两虚、湿注骨节型膝骨性关节炎患者作为研究对象，采用区组随机化分组方法将其分为两组，每组60例。治疗组采用健脾补肾法（腹部腧穴中脘、下脘、气海、关元、大横穴）结合膝部腧穴（鹤顶、梁丘、血海、阴陵泉、阳陵泉穴）针刺治疗，对照组采用单纯膝部腧穴针刺治疗。治疗1个疗程后，比较两组治疗前后视觉模拟评分（VAS）、膝关节周径、西安大略与麦克马斯特大学骨性关节炎指数（WOMAC）评分（包括关节僵硬、日常关节活动和社会功能）；疗程结束3个月后对VAS、膝关节周径进行随访，并与治疗前后进行比较。 结果 两组治疗后关节僵硬、日常关节活动、社会功能评分均较治疗前显著降低，且治疗组均显著低于对照组，差异均有统计学意义（均P < 0.05）。与治疗前比较，两组治疗后、随访时VAS评分均明显降低，且治疗组均显著低于对照组（均P < 0.05）；与治疗后比较，治疗组随访时VAS评分明显降低（P < 0.05），对照组随访时VAS评分稍低，差异无统计学意义（P > 0.05）。治疗后两组膝关节周径均较治疗前显著降低（均P < 0.05），但组间比较差异无统计学意义（P > 0.05）；随访时两组膝关节周径均较治疗前显著降低（均P < 0.05），且治疗组明显低于对照组（P < 0.05）；与治疗后比较，治疗组随访时膝关节周径降低，对照组膝关节周径增加（均P < 0.05）。 结论 采用健脾补肾法结合膝部腧穴治疗脾肾两虚、湿注骨节型膝骨性关节炎，可明显减轻疼痛肿胀，改善日常关节功能，疗效稳定，且优于单纯膝部腧穴治疗。

[关键词] 膝骨性关节炎；针刺疗法；健脾补肾

[中图分类号] R684.3 [文献标识码] A [文章编号] 1673-7210（2017）08（a）-0089-04

[Abstract] Objective To observe the clinical effect of invigorating the spleen and tonifying the kidney combined with knee acupoints acupuncture in the treatment of knee osteoarthritis in the type of deficiency of both the spleen and the kidney， dampness infusion into bone and joints. Methods One hundred and twenty patients with knee osteoarthritis in the type of spleen and kidney deficiency， dampness infusion into bone and joints， who were treated in the Outpatient Department of Beijing Changping Hospital of Traditional Chinese Medicine from January 2015 to December 2016， were selected and randomly divided into two groups by block randomization method， each group had 60 cases. The treatment group was treated with acupuncture by invigorating the spleen and tonifying the kidney （taking the abdominal acupoints of Zhongwan， Xiawan， Qihai， Guanyuan， Daheng） combined with knee acupoints （Heding， Liangqiu， Xuehai， Yinlingquan， Yanglingquan）， the control group was taken the method of acupuncture treatment of simple knee acupoints. After 1 course of treatment， the visual analogue score （VAS）， knee circumference， the scores of Western Ontario McMaster University osteoarthritis index （WOMAC） （including joint stiffness， daily activities and social function） of the two groups before and after treatment were compared； 3 months after the end of treatment， the VAS scores and knee circumference were followed up and compared with the results before and after treatment. Results The scores of knee stiffness， joint daily activities and social function of the two groups after treatment were significantly lower than those before treatment， and the treatment group was lower than the control group， the differences were all statistically significant （all P < 0.05）. Compared with before treatment， the VAS scores of the two groups were decreased after treatment and follow-up， and the treatment group was lower than the control group， the differences were all statistically significant （all P < 0.05）. Compared with after treatment， the VAS scores in the treatment group at follow-up was decreased （P < 0.05）， and the VAS scores in the control group at follow-up was slightly decreased， but there was no statistically significant difference （P > 0.05）. The knee circumference of the two groups after treatment was decreased obviously compared with that before treatment （all P < 0.05）， there was no significant difference between the two groups （P > 0.05）. The knee circumference of the two groups at follow-up was lower than that before treatment （all P < 0.05）， and the treatment group was significantly lower than the control group （P < 0.05）； compared with after treatment， the knee circumference of the treatment group at follow-up was decreased， and the knee circumference of the control group was increased （all P < 0.05）. Conclusion The combination of acupuncture the abdominal acupoints with the knee acupoints to treat the knee osteoarthritis in the type of deficiency of both the spleen and the kidney， dampness infusion into bone and joints using the method of invigorating the spleen and tonifying the kidney can significantly reduce the pain and swelling， and improve daily joint function. The curative effect is stable， which is better than the treatment of simple knee acupoints.endprint

[Key words] Knee osteoarthritis； Acupuncture therapy； Invigorating the spleen and tonifying the kidney

膝骨性关节炎是指膝关节软骨出现原发性或继发性的一种退行性改变，并伴有髌骨软化和骨质增生，从而出现疼痛和功能障碍，甚至畸形的退行性疾病[1]。本病为临床常见病、多发病，在国内发病率有逐年升高的趋势，危害极其严重，给患者和社会带来极大的疾病负担[2]。……