1、针刀治疗骨性关节炎的临床研究,北京中医药大学Beijing Traditional Chinese Medicine University,Clinical Results in Treatment of Osteoarthritis with acupotome,朱汉章Zhu Hanzhang MD Professor,针 刀 医 学 简 介Brief Introduction Of Acupotomology,针刀医学是将中医和西医的部分基础理论融合为一体,再创造而形成的一种新的医学理论体系。 Acupotomology, a fusion of the basic theories of
2、 traditional Chinese and modern western medicine, has formed a complete system of medical science. This is a revolution in the medical field. Moreover, it symbolizes a new era in the medical science.,针刀医学的四个基础理论,闭合性手术理论 Closed surgery the theory concerning . 慢性软组织组织损伤病因、病理学理论 The theory concerning t
3、he etiology and pathology of chronic lesions to soft tissues.,Basic Theory,骨质增生新的病因学理论 The theory concerning the etiology and pathology of abnormal bony growths 关于经络实质的一些新认识 The theory concerning the essence of channels and collaterals of traditional chinese medicine,六 大 组 成 部 分,Basic Contents,针刀医学的
4、病理生理学Physiopathology of Acupotomology,针刀医学的手法学Manipulation of Acupotomology,针刀医学的影像学Imageology of Acupotomology,针刀医学的护理学Nursing science of Acupotomology,针刀医学的诊断学Diagnostics of Acupotomology,针刀医学的治疗学Therapeutics of Acupotomology,骨性关节炎是以关节面关节软骨破坏、新骨增生为特征的慢性关节病。本病发病率随年龄增长而增高。felson等报告,70岁以下和80岁以上人群的膝骨性
5、关节炎患病率分别为7.0%和11.2% Butter等报告，44岁以下,45-59岁和60岁以上三组人群中，X线片骨性关节炎的患病率分别为6.2%、21.6%和42.0%。,各年龄阶段患膝骨性关节炎的概况,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 years ol
6、d 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.,针刀医学提出了“骨性关节炎的发病原因是关节内的力平衡被破坏,使关节周围软组织附着处应力增高所致”的理论。本实验根据此理论应用针刀疗法治疗骨性关节炎,以进一步研究该病的病因和机理,为临床治疗骨性关节炎提供新的思路.,Acupotomology raised the theory that the cause of osteoarthriti
7、s is the force unblance of joint and the increased stress in the attachment point of soft tissue around the joint. The increased stress 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
8、,女性93例,年龄41-72岁。病程2-5年54例,6-10年32例。11年以上50例。双膝罹患者87例,单膝罹患者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 knee.,将136例患者随机分为针刀治疗组（I组）和
9、药物治疗组即对照组（II组）作 1 ：1 配对观察。 136 patients were randomly devided into acupotome treatment group ( group I ) and drug Treatment group (Group II).,I组中男性23例，女性45例,年龄41岁至69岁间,双膝罹患者47例，单膝罹患者21例。 In group I:23 male,45 female cases aged between 41-69 years.47 cases suffered from two knees and 21 cases suffere
10、d from one knee. II组中男性20例,女性48例,年龄在45至72岁之间双膝罹患者40例，单膝罹患者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.,关节疼痛 (Joint pain ) 早期可无症状或有轻度关节疼痛，晚期出现骨刺则疼痛明显。关节僵直 (Joint rigidity) 早期可有晨起关节僵直，或久坐起立时感觉关节僵直。晚期关节受限甚至强直。实验室检
11、查( Laboratory test) 类风湿因子阴性、血沉、抗“O”正常。,X 线 检 查（X-ray test）,中枢型（ Central Form ）可见脊柱小关节有骨赘形成，椎体前缘唇样增生。There are osteophyte formations of small joint of spine, the lip-like hyperplasia occurs in anterior margin of vertebral body.,外周型 （Peripheral form）早期可见骨端软骨增生，后期骨质增生明显，形成骨赘或骨刺。The cartilage hyperplasi
12、a of epiphysis may occur in early stage, afterwards the cartilage hyperplasia occurs and osteophyte or spurs were formed.,针刀治疗,患者仰卧屈膝，应用针刀对膝关节髌骨周围、髌上囊、髂下囊、髌下脂肪垫、交叉韧带、髁间嵴和内外侧副韧带及股二头股、半腱肌、半膜肌、髂胫束等附着点处压痛点及骨质增生处的变性、结疤、粘连及挛缩的软组织进行切开松解。Patients were resumed supine position and bent the joint knees. It was
13、 operated on the pain points of patella, suprapatellar bursa, infrapatellar bursa,infrapatellar fat pad, cruciate ligaments,intermal-leolar crest and medio-lateral accessory ligaments around the knee joint and attachment points of biceps muscle of thigh, semitendinous muscle,semimembronous muscle, i
14、liotibial tract, and sites of hyperosteogeny.,外 手 法 治 疗 External manipulation treatment,所有患者均接受该辅助治疗.患者仰卧,应用牵拉晃膝法、牵拉旋膝法、过屈和过伸膝关节和牵引状态下的推弹等手法，将膝内翻或处翻畸形或屈伸功能障碍给予校正，使膝关节内外恢复正常的力学 状态。Patients were adopted this treatment in two groups. Patient lies on own back and with applying of pull and rotation of th
15、e 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 复 疗 法 Rehabilitation Therapy,治疗后三周内以间断性下肢牵引和自我锻练患肢屈伸功能为主。三周后下肢负重（1公斤沙袋）直腿抬高锻炼股四头肌收缩功能，每日不少于150次。6个月内不可
16、长途行走或负重行走。All patients were adopted this treatment.The discontinuous traction of the lower limbs and self-training of flexion and 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 e
17、xercise the contract funcion of quadriceps muscle of the thigh .No less than 150 times everyday.Patients should not walk a long distance or carry a heavy load in 6 months.,统 计 学 处 理,数据用两组比较X2检验进行处理。 All items were conducted by two-group X2 test.,评 价 标 准 Criterion Of Efficacy,治愈：罹患膝关节疼痛完全消失，活动正常，X线证明
18、骨关节增生变化停上，关节间隙基本正常。 Cured: pain of suffering knee joint disappears completely, the activity is normal,tth function is basically recovered X-ray proves that the hyperplastic change of the bone and joint stops. 显效： 罹患膝关节疼痛减轻，活动有所进步，功能改善。 Singnificant efficacy: Pain of suffering knee joint lightens and
19、 the activity and the function is improved.,好转：罹患膝关节疼痛有所减轻，活动功能无明显改善。 Improvement: Pain of suffering knee joint lightens to some extent, but the activity and function have no clear improvement. 无效：症状体征无好转。 Inefficacy: All the symptoms and signs had not taken a turn for the better.,针刀治疗组68例中，临床治愈33例（
20、48.5%),显效25例(36.8%),好转10例(15%),总有效率为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%.对照组68例中，临床治愈0例,显效10例（15%），好转35例（51%），无效23例(34%),总有效率66%。In drug group,no cases were cured, with significant effica
21、cy 10 cases (15%),improved 35 cases (51%), inefficacy 23 cases 934%),total efficacy rate was (66%).,经两组比较X2检验,针刀治疗组的治愈率和显效率均明显高于药物治疗组,有显著治疗组,有显差异(P0.01)。All items were siginificant difference conducted by x2 test (p0.01).,讨 论Discussion,骨性关节炎的病理学组织变化主要表现为关节软骨坏死和软骨增生，以及关节软组织的一系列反应。The major pathologic
22、 changes of osteoarthrit were necrosis and hyperplasis of joint soft bone.,目前临床治疗骨性关节炎主要采取药物治疗和手术治疗。非甾体类抗炎药物对软骨基质的合成有抑制作用。糖皮质激素大剂量反复多次使用会阻碍软骨修复过程.外科手段虽对患者的症状有所绶解,但创伤大,价格昂贵,患者不易接受。OA is treated with drug or surgery method in clinic. Non-steroid anti-inflammation drugs inhibited the synthesis of soft
23、bone media.Glucocorticoids inhibit the recovery of soft bone. The surgery method caused serious trauma and is costly.,针刀医学认为骨性关节炎的主要病因是人体内力平衡失调所致,人体是一个封闭的力学系统,在正常情况下,这个力学系统对于人体的生命和活动来说是相对平衡的,该力学平衡是建立在正常的“生命”和“活动”基础上的.该力学系统失衡时,为保证人体的“生命”和“活动”不受损害而产生代偿性病变。Acupotomology raised the theory that the cause
24、 of OA is the force unblance of joint.The body is a closed force system and maintain the balance at normal.The self-regulaton system would play a role to protect the normal function.,由于长期受风寒湿热侵袭、外伤、慢性磨损等因素的影响，损伤关节周围肌肉韧带，使关节周围软组织反复充血、水肿、粘连挛缩，进而导致局部血液循环障碍组织乏氧，导致无氧代谢，产生大量酸性化学物质，引血管收缩和肌损伤，导致疼痛和活动功能受限，肌组
25、织变性和粘连挛缩加剧，致使膝关节生物力学平衡失调。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 of local blood circulation caused the tissue hypoxia and anaerobic metabolism producing a lot of aci
26、d substances which stimulated vasoconstriction and damaged the muscular tissue, caused pain and linited the joint activity. The result was the force unblance of knee joint.,关节在力学平衡失调的状态下勉强继续维持行走活动，势必导致软组织附着点处应力增高而使成骨代谢作用增强，钙磷在骨端沉积增多而生成骨赘。It will certainly lead to the stress increase of the soft tiss
27、ue attachment point,enhance osteogenic metabolism of calcium and phosphorus in bone termination.The osteophyte is formed.,本实验结果证明，采用针刀治疗辅以外手法及康复治疗，使关节周围的变性、粘连和挛缩的软组织得到松解，从而使关节生物力学趋于平衡，有效改善和缓解症状.配合康复锻炼,使关节周围的肌力加强,关节力学的稳定性得以巩固,效果更为明显,这为针刀医学认为骨性关节炎是“力学平衡失调”的理论提供了有力证据。Acupotomy relaxed peripheral soft t
28、issue of around the joint,reduced the degeneration,adhesion and contracture.It recovered the force blance and alleviated the symptoms.The effect was more obvious assisted with rehabilitation therapy.This result provided the evidence for the theory that osteoarthritis is resulted from the force unbalance of knee joint.,谢 谢 ！Thanks for your attending,
