摘要
目的:以推拿治疗膝骨关节炎(KOA)为例,标准化、规范化不同推拿手法并提出推拿手法治疗KOA的共性核心技术。方法:系统检索2019年以前推拿手法治疗KOA的随机对照试验,并建立文献数据库,提取手法的操作内容。采用内容分析法,通过选择和定义分析单元不同推拿内容的操作目的、作用部位、手法分类、刺激强度,由小组成员独立编码并达成归类共识汇总分类,最后形成推拿手法治疗KOA的概念框架。结果:共纳入24个研究,包含21类手法,手法治疗的有效率63.3%~96.25%,手法每次治疗时间8~30min/次,治疗8~30次,疗程6~35d。内容分析法结果示操作目的主要包括诱导软组织放松、减少软组织肿胀或炎症、提高软组织伸展性、改变肌肉功能、增加关节活动度、改变关节温度、点穴、提高关节稳定性,作用在膝周围、大腿及小腿的肌群和关节。理论框架结果示推拿手法治疗KOA的共性核心技术主要包括放松软组织,主要作用肌肉为大腿前群肌肉(股四头肌为主),手法多采用中度摩擦类手法;其次为小腿肌后群(腓肠肌、腘绳肌为主),手法多采用中重度的摩擦类手法;再次是通过中重按拿类手法放松髌周组织。膝关节是推拿干预KOA的另一个关键环节,采用中重度的运动关节类手法(被动活动)增加膝关节的活动度。结论:不同推拿手法治疗KOA的操作目的及部位高度重合,通过内容分析和理论框架可以将不同手法求同存异,进而提出手法治疗KOA的核心技术,提高推拿手法临床研究的一致性。
Objective:Tuina treatment for knee osteoarthritis (KOA) was used as an example to discuss the standardization of different schools of tuina in the clinical trials.Methods:A systematic review has been conducted on the tuina treatment for KOA until 2019,and the content and process of tuina operation were extracted.The content analysis method was used to define and code in 4 categories as the treatment purpose,targeted tissues,manipulation classification and stimulus intensity of different massage contents.The whole process has been independently identified and coded by two members,and the consensus was reached through discussion.Finally,the conceptual framework of tuina therapy for KOA was formed based on the categories.Results:A total of 24 studies were included,including 21 types of tuina.The effective rates were 63.3%-96.25%.The duration of each treatment was 8-30min per time,a total of 8-30 times with the course of treatment 6-35 days.The results of content analysis showed that the purpose category included relaxing soft tissue,reducing swelling or inflammation of soft tissue,improving soft tissue extensibility,changing muscle function,increasing joint range of motion,changing joint temperature,improving joint stability,and acting on the muscle groups and joints around the knee.The results of the conceptual framework showed that it was the core process that the friction manipulation with moderate intensity was used to relax the soft tissues mainly including the anterior thigh muscles (eg.quadriceps femoris),and then the posterior calf muscle (e.g.gastrocnemius muscle).Next,the pressure manipulation with high intensity was to relax the popliteal fossa and peripatellar tissues.Finally,the knee joint was another key in the tuina treatment for KOA that the moderate to severe motion-like manipulation (passive activity) was adopted to increase the range of motion of knee.Conclusion:The systematic review has confirmed the different types of Tuina in KOA clinical trials,but the main purpose of treatment and the manipulation-targeted tissues are almost same and overlapped among trials.The methods of content analysis and conceptual framework can be used to standardize and normalize the different types of tuina among trials,which help to put forward the core technique in tuina treatment for KOA,and to increase the intervention consistency among trials.
作者
李思娜
王锡友
唐镜全
李多多
刘长信
于长禾
LI Si-na;WANG Xi-you;TANG Jing-quan;LI Duo-duo;LIU Chang-xin;YU Chang-he(Master Degree Candidate,The First Clinical Medical College,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Tuina and Pain Management,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Shenzhen Hospital of Beijing University of Chinese Medicine,Shenzhen 518172,China)
出处
《中华中医药杂志》
CAS
CSCD
北大核心
2020年第3期1422-1427,共6页
China Journal of Traditional Chinese Medicine and Pharmacy
基金
国家自然科学基金项目(No.81803956)
北京市科学技术委员会“首都临床特色应用研究”专项课题(No.Z18110000171816500)
中央高校基本科研业务专项资金(No.2019-JYB-XS-153,No.2018-JYBZZJS092,No.2017-JYB-JS-161)。
关键词
膝骨关节炎
推拿
规范化
临床试验
内容分析法
框架分析法
Knee osteoarthritis
Tuina
Normalization
Clinical trials
Content analysis
Conceptual framework
