摘要
目的:观察温针配合康复训练对髌骨软化症患者疼痛及治疗效果的影响,并与口服非甾体止痛剂配合康复训练后的治疗效果进行比较。方法:①选取2004-09/2006-06成都市第一人民医院疼痛专科收治的64例髌骨软化症患者,均符合国家中医药管理局1994年《中医病证诊断疗效标准》的髌骨软化症诊断,患者对本实验均签署知情同意书。随机数字表法分为针刺组34例,药物对照组30例,两组患者在年龄、性别、病程及病情程度差异均无显著性意义(P>0.05)。②针刺组患者给予温针治疗,1次/d,5次为1个疗程,疗程间隔2d,共治疗4个疗程。主穴:内膝眼、外膝眼、鹤顶。配穴:大腿软痛加扶兔;膝内侧痛加血海;膝外侧痛加梁丘;痰湿痹阻型加丰隆、三阴交;肝肾阴虚型加太溪。药物对照组患者口服非甾体止痛剂美洛昔康(商品名:赛可斯,四川三精升和制药有限公司生产,批号060701)7.5mg/d,疗程同针刺组。③两组患者每天针刺/给药后均进行康复训练,包括股四头肌等长收缩练习、蹲马步练习、夹球练习,各练习项目均重复10次为1组,5组/次,3次/d。④疼痛积分标准使用0～10分表示疼痛程度,分数越高疼痛越重。髌骨软化症疗效判定标准:治愈为膝部无疼痛,活动无不适,髌骨研磨试验阴性;好转为上下楼梯及半蹲时轻度疼痛,髌骨研磨试验(±);未愈为症状无改善,“软腿”及“假交锁”情况加重,X射线检查发现髌骨周围及软骨下有骨刺形成。结果:64例髌骨软化症患者均进入结果分析。①两组患者治疗后疼痛积分改善情况的比较:与治疗前比较,治疗后两组疼痛积分均明显降低[(8.0±1.0),(5.0±2.7)分;(8.0±3.0),(3.0±2.0)分;P<0.05或0.01];与药物对照组比较,治疗后针刺组疼痛积分降低幅度更为明显(P<0.05)。②两组患者临床疗效的比较:针刺组总有效率显著高于药物对照组(91.2%,50.0%,P<0.01)。结论:温针配合康复训练与口服非甾体止痛剂配合康复训练均可缓解疼痛,但温灸配合康复训练能更好的缓解疼痛,改善治疗效果。
AIM： To observe the curative effect of chondromalacia patellae （CP） patients treated by acupuncture with warmed needle combining with muscle strength training, and compare with oral administration of non-steroid antiinflammatory drugs （NSAIDs） combined with training. METHODS：①A total of 64 CP patients were enrolled from Department of Pain Management, Chengdu No.1 People＇s Hospital from September 2004 to June 2006. They were all d!agnosed as CP complying with the ＂TCM diagnostic efficacy standards＂ of State Administration of Traditional Chinese Medicine in 1994. All patients signed the informed consent and were divided into acupuncture group （n=34） and control group （n=30） by random number table method. There were no significant differences in age, sex, disease severity and course between the two groups （P 〉 0.05）.②The acupuncture group was treated with warmed needle once a day, 5. days a treatment, 2 days rest after one treatment and altogether 4 courses of treatment. The main points： Neixiyan （EX-LE4）, Waixiyan （EX-LE5）, Heding （EX-LE2）. The minor points： adding Futu （LI18） for pain of thigh; adding Xuehai （SP10） for pain in the medial side of the knee; adding Liangqiu （ST34） for pain in the lateral side of the knee; adding Fenglong （ST40） and Sanyinjiao （SP6） for the sputum and wet stagnation; adding Taixi （KI3） for the deficiency of kidney and liver ying. While control group orally took the NSAIDS Meloxicam （Sichuan Sanjing Shenghe Pharmaceutical Ltd. Product batches 060701） 7.5 mg a day, for the same treatment course as acupuncture group.③Each patient did strength training after acupuncture or taking medicine everyday, including musculus quadriceps fexoris isometric contraction training, bend standing training, musculus vastus medialis strength training. And each items repeated 10 times as a group, 5 groups every time, 3 times a day.④We indicated degree of pain by pain score, arranged from 0-10 points. The higher score showed the more severe pain. CP curative effect standardization： Recovery： No pain of knee, no complaint of activity, patella grinding test was negative; Improved： Light pain while stair activity and bend standing, patella grinding test was probably positive. Nulli-recovery： No improvement of symptom, aggravation of weakness of the knees and pseudo-interlocking. X-ray examination indicated spurring around the patellae and infer-cartilage. RESULTS： Totally 64 CP patients were analyzed in the resuh.①Comparison of the pain improvement after the treatment in two groups： After treatment, the pain scores of the two groups were significantly decreased [（8.0±1.0）, （5.0±2.7）; （8.0±3.0）, （3.0±2.0）; P 〈 0.05,0.01]; Compared with the control group, acupuncture group had a much more significantly decrease of the pain score after treatment （P 〈 0.05）.②Comparison of the clinical ef ficacy in two group： The total efficacy of acupuncture group was significantly higher than that of the control group （91.2%, 50.0%, P 〈 0.01）. CONCLUSION： Acupuncture with warmed needle combining with muscle strength training and oral administration of NSAIDS can both relieve pain, but acupuncture with warmed needle combining with muscle strength training has a better effect in relieving pain and improving curative efficacy.
出处
《中国临床康复》
CAS
CSCD
北大核心
2006年第47期170-171,共2页
Chinese Journal of Clinical Rehabilitation
