余红超　孙菊　董博

[摘要] 目的 观察针刀整体松解术配合蠲痹汤治疗肝肾亏虚型膝骨性关节炎的临床效果。 方法 应用随机数字法将2013年9月～2015年6月在陕西中医药大学附属医院门诊和住院部治疗的120例肝肾亏虚型膝骨性关节炎患者分成治疗组和对照组，每组60例。治疗组给予针刀整体松解术配合蠲痹汤治疗，对照组单纯给予中药蠲痹汤内服， 15 d为1个疗程。1个疗程后观察两组临床疗效，并评价治疗前后两组患者视觉模拟评分（VAS）和Lysholm膝关节评分。 结果 治疗组总有效率为95.0%，对照组总有效率为81.7%，差异有统计学意义（P < 0.05）。两组治疗后VAS评分和Lysholm评分均较治疗前明显改善（P < 0.05），且治疗组改善更明显（P < 0.05）。 结论 针刀整体松解术配合蠲痹汤治疗肝肾亏虚型膝骨性关节炎效果显著，能明显减轻患者疼痛，提高患者膝关节功能活动度。

[关键词] 针刀整体松解术；蠲痹汤；肝肾亏虚；膝骨性关节炎；疼痛；膝关节功能活动度

[中图分类号] R684.3 [文献标识码] A [文章编号] 1673-7210（2017）01（c）-0169-04

[Abstract] Objective To observe the clinical curative effect of overall acupotome lysis cooperated with Juanbi Decoction in the treatment of deficiency of liver and kidney type of knee osteoarthritis. Methods According to the method of random number table， 120 cases of patients with deficiency of liver and kidney type of knee osteoarthritis treated in Outpatient and Inpatient Department of the Affiliated Hospital of Shaanxi University of Chinese Medicine from September 2013 to June 2015 were divided into treatment group and control group， with 60 cases in each group. The treatment group was given overall acupotome lysis cooperated with Juanbi Decoction， the control group was only given Juanbi Decoction orally， 15 d was as a course. After a course of treatment， the clinical efficacy of the two groups was observed， and the scores of visual analogue scale （VAS） and Lysholm knee score of the two groups before and after treatment were evaluated. Results The total effective rate of treatment group was 95.0%， which of control group was 81.7%， with statistically significant difference （P < 0.05）； after treatment， the VAS scores and Lysholm knee scores of the two groups were significantly improved compared with those before treatment （P < 0.05）， and the treatment group was improved more significantly （P < 0.05）. Conclusion The curative effect of overall acupotome lysis cooperated with Juanbi Decoction in the treatment of deficiency of liver and kidney type of knee osteoarthritis is remarkable， which can significantly relieve the pain of patients and improve the activity of knee joint function.

[Key words] Overall acupotome lysis； Juanbi Decoction； Deficiency of liver and kidney； Knee osteoarthritis； Pain； Activity of knee joint function

膝骨性關节炎（KOA）又称为增生性关节炎、退行性骨关节病等，多发生于中老年女性，主要临床症状为膝关节疼痛、肿胀、僵硬、活动受限，严重者关节畸形，并由此引起走路、起立和上下楼梯困难，重者影响患者生活。KOA属于中医学“痹证”“骨痹”范畴，肝肾亏虚、筋骨虚弱是其主要发病原因。《张氏医通》指出：“膝为筋之府，膝痛无不因肝肾虚者，虚则风寒湿气袭之。”肝主筋，主束骨而利关节。肾主骨，藏精气而充髓壮筋骨。绝大多数患者为年老体弱，肝肾亏虚，筋脉凝滞，筋骨失养，又复感寒湿之邪，流注关节而发为本病。目前对KOA发病机制的阐述尚未完全清楚，临床仍无特效治疗方法，目前的治疗方法大多采取综合治疗。本研究应用针刀整体松解……