付雯琴 宓轶群 薛美 山萍

摘 要 目的：观察“筋穴”导气针法结合电针对肝肾亏虚型早、中期膝骨关节炎（KOA）的临床疗效。方法：收集2018年6月1日至2019年1月30日就诊于上海市徐汇区长桥街道社区卫生服务中心的肝肾亏虚型KOA患者40例，随机分为治疗组和对照组各20例。治疗组采用“筋穴”导气针法结合电针，对照组采用针刺假穴法结合电针。两组留针时间为20 min，隔日1次，10次为1个疗程，共2个疗程。比较治疗前、治疗后45 d及治疗后6个月的骨性关节炎指数（WOMAC）评分，并用8公尺行走试验及5次坐立试验评价膝关节运动功能。结果：两组治疗后45 d的WOMAC评分均下降（P均<0.01），膝部疼痛评分、进行日常活動评分的组间差异有统计学意义（P<0.01）。治疗后45 d治疗组的8公尺行走试验及5次坐立试验所用时间均较治疗前缩短（P均<0.01），而对照组仅5次坐立试验所用时间缩短（P<0.01）。6个月随访，两组间WOMAC评分差异有统计学意义（P均<0.01）；两组5次坐立试验所用时间与治疗后45 d比较均有下降（P<0.01），且组间差异有统计学意义（P<0.05）。结论：“筋穴”导气针法结合电针治疗肝肾亏虚型早、中期KOA，患者WOMAC评分、膝关节运动功能均有明显改善。

关键词 膝骨关节炎；肝肾亏虚；筋穴；导气针法；六步健膝法

中图分类号：R246.9 文献标志码：A 文章编号：1006-1533（2020）16-0030-03

Observation of clinical therapeutic effect of qi-guiding acupuncture method at “tendon acupoint” combined with electro-acupuncture in the treatment of early and middle knee osteoarthritis

FU Wenqin1， MI Yiqun2， XUE Mei1， SHAN Ping1（1. Traditional Chinese Medicine Department of Changqiao Community Health Service Center of Xuhui District， Shanghai 200231， China； 2. Acupuncture Department of Traumatology of Sixth Peoples Hospital affiliated to Shanghai Jiao Tong University， Shanghai 200233， China）

ABSTRACT Objective： To observe the clinical effect of qi-guiding acupuncture method at “tendon acupoint” combined with electro-acupuncture in the treatment of knee osteoarthritis（KOA） in early and middle stage of deficiency of liver and kidney. Methods： From June 1， 2018 to January 30， 2019， 40 KOA patients with deficiency of liver and kidney were collected from Changqiao Community Health Service Center of Xuhui District， Shanghai， and randomly divided into a treatment group and a control group with 20 cases in each group. The treatment group was treated with qi-guiding acupuncture method at “tendon acupoint” combined with electro-acupuncture， and the control group was treated with acupuncture at false points combined with electro-acupuncture. The needle retention time of the two groups was 20 minutes， once every other day， 10 times as a course of treatment， and a total of 2 courses. The WOMAC scores were compared between the two groups before treatment， after treatment of 45 days， and after 6 months of follow-up， and the movement function of knee joints was evaluated by 8-meter walking test and 5-time sit-to-stand test. Results： After 45-day treatment， WOMAC scores all decreased in two groups（all P <0.01）， the difference of the knee pain score and daily activity score was statistically significant between the two groups（P<0.01）. The time for the 8-meter walking test and the 5-time sit-to-stand test in the treatment group at 45 days after treatment was shorter than before treatment（all P<0.01）， and the control group only shortened the time taken for 5-time sit-to-stand test（P<0.01）. After 6 months of follow-up， the difference of WOMAC score between the two groups was statistically significant（P<0.01）； the time taken for the 5-time sit-to-stand test in both groups decreased compared with that 45 days after treatment（P<0.01）， and the difference between the groups was statistically significant（P<0.05）. Conclusion： In the treatment of KOA at the early and middle stage of deficiency of liver and kidney with qi-guiding acupuncture method at “tendon acupoint” combined with electro-acupuncture， the WOMAC score and knee joint motor function of the patients are significantly improved.

KEY WORDS knee osteoarthritis； deficiency of liver and kidney； tendon acupoint； qi-guiding acupuncture method； six step knee strengthening method

膝关节骨性关节炎（knee osteoarthritis，KOA）是一种慢性、退行性和进行性疾病，以膝关节软骨变性和丢失及关节边缘和软骨下骨骨质再生为特征[1]，以疼痛、肿胀、僵硬、活动受限和局部肌肉无力等為主要临床表现。目前研究表明KOA的患病率高达33.6%[2]，并有逐年上升趋势，严重者可致膝关节畸形，甚至致残，造成患者生活质量下降、治疗成本增加，这也给患者造成极大的心理负担。在治疗方面，早、中期KOA以消炎镇痛等对症处理，晚期则需手术治疗等补救措施[3]。本研究探讨“筋穴”导气针法结合电针治疗肝肾亏虚型早、中期KOA的临床效果，旨在寻找早、中期KOA临床较佳的治疗策略，缓解疾病进展。

1 资料与方法

1.1 一般资料

收集2018年6月1日至2019年1月30日就诊于上海市徐汇区长桥街道社……