[1]王智勇,郭珈宜,李峰,等.平乐正骨平衡理论指导下的刃针综合疗法治疗早中期膝骨关节炎气滞血瘀证的临床研究[J].中医正骨,2025,37(06):19-27.
　WANG Zhiyong,GUO Jiayi,LI Feng,et al.A clinical study of blade needle combined therapy under the guidance of Pingle Zhenggu(平乐正骨)balance theory for treatment of early- and mid-stage knee osteoarthritis with syndrome of qi stagnation and blood stasis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(06):19-27.
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平乐正骨平衡理论指导下的刃针综合疗法治疗早中期膝骨关节炎气滞血瘀证的临床研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年06期
页码:
19-27
栏目:
临床研究
出版日期:
2025-06-20

文章信息/Info

Title:
A clinical study of blade needle combined therapy under the guidance of Pingle Zhenggu(平乐正骨)balance theory for treatment of early- and mid-stage knee osteoarthritis with syndrome of qi stagnation and blood stasis
作者:
王智勇1; 郭珈宜1; 李峰1; 张云飞1; 杨孟孟1; 文永兵1; 付卓1; 耿丰勤1; 沈素红1; 丁永利2; 郑福增3; 杜进林4
1.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002; 2.河南中医药大学第一附属医院,河南 郑州 450000; 3.河南省中医院,河南 郑州 450002; 4.广东医科大学,广东 东莞 523808
Author(s):
WANG Zhiyong1; GUO Jiayi1; LI Feng1; ZHANG Yunfei1; YANG Mengmeng1; WEN Yongbing1; FU Zhuo1; GENG Fengqin1; SHEN Suhong1; DING Yongli2; ZHENG Fuzeng3; DU Jinlin4
1.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China 2.The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China 3.Henan Provincial Hospital of TCM,Zhengzhou 450002,Henan,China 4.Guangdong Medical University,Dongguan 523808,Guangdong,China
关键词:
骨关节炎; 膝;  血瘀气滞;  刃针;  针刺;  平衡理论;  随机对照试验专题
Keywords:
osteoarthritis; knee;  syndrome of blood stasis and qi stagnation;  blade needle;  acupuncture;  balance theory;  randomized controlled trials as topic
摘要:
目的:评价平乐正骨平衡理论指导下的刃针综合疗法治疗早中期膝骨关节炎(knee osteoarthritis,KOA)气滞血瘀证的临床疗效和安全性。方法:2022年2月至2023年3月,收治早中期KOA气滞血瘀证患者100例,随机分为2组,每组50例,均给予血府逐瘀汤口服、舒筋活血祛痛膏膝关节外敷、膝关节功能锻炼。在此基础上,一组根据患者的主要症状部位(髌上囊、髌下脂肪垫、内膝眼、犊鼻等部位),在平乐正骨平衡理论指导下采用刃针疗法治疗(刃针疗法组),每周治疗2～3次,共治疗2周; 另一组选用血海、内膝眼、犊鼻、阳陵泉、阴陵泉等穴位采用毫针针刺治疗(针刺疗法组),每日治疗1次,共治疗2周。分别于治疗前、治疗结束当天和治疗结束后1个月、3个月、6个月,比较2组患者的膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分、膝关节活动度。治疗和随访期间,观察和比较两组患者的不良反应和并发症发生情况。结果:①一般情况。治疗期间,刃针疗法组1例患者发生外伤骨折、1例患者因转科退出试验,刃针疗法组4例患者和针刺疗法组3例患者因未按方案接受治疗退出试验,最终刃针疗法组纳入44例患者、针刺疗法组纳入47例患者。②膝关节疼痛VAS评分。治疗前后2组膝关节疼痛VAS评分均随时间呈降低趋势(Wald χ2=371.079,P=0.000; Wald χ2=316.248,P=0.000); 治疗结束后1个月,2组膝关节疼痛VAS评分的差异有统计学意义(Z=-2.715,P=0.007),但组间差异较小,缺乏临床意义; 其余时间点2组间差异均无统计学意义。③WOMAC总分。治疗前后WOMAC总分总体上随时间呈先降低后轻度升高趋势(Wald χ2=179.547,P=0.000),2组间差异无统计学意义(Wald χ2=0.031,P=0.860)。④WOMAC疼痛评分和僵硬评分。治疗前后WOMAC疼痛评分、僵硬评分总体上随时间均呈先降低后轻度升高趋势(Wald χ2=231.809,P=0.000; Wald χ2=104.917,P=0.000),2组间差异均无统计学意义(Wald χ2=0.288,P=0.591; Wald χ2=0.004,P=0.947)。⑤WOMAC日常活动功能评分。治疗前后2组WOMAC日常活动功能评分随时间均呈先降低后轻度升高趋势(Wald χ2=125.244,P=0.000; Wald χ2=122.438,P=0.000),各时间点2组间差异均无统计学意义。⑥膝关节活动度。治疗前后,膝关节屈曲活动度、内旋活动度、外旋活动度总体上随时间均呈先增大后轻度减小趋势(Wald χ2=36.852,P=0.003; Wald χ2=12.997,P=0.011; Wald χ2=149.501,P=0.000),各时间点之间膝关节伸展活动度比较差异无统计学意义(Wald χ2=9.358,P=0.052)。2组患者膝关节屈曲活动度、伸展活动度、内旋活动度总体比较,组间差异均无统计学意义(Wald χ2=0.707,P=0.400; Wald χ2=0.273,P=0.601; Wald χ2=0.655,P=0.418); 刃针疗法组膝关节外旋活动度大于针刺疗法组(Wald χ2=4.552,P=0.033),但组间差异较小,缺乏临床意义。⑦不良反应和并发症发生情况。2组患者治疗和随访期间均未出现不良反应和并发症。结论:在平乐正骨平衡理论指导下采用刃针综合疗法治疗早中期KOA气滞血瘀证,能减轻患者的膝关节疼痛和僵硬症状、增加膝关节活动度、改善膝关节功能,其临床疗效和安全性与针刺疗法一致。
Abstract:
Objective:To evaluate the clinical curative effect and safety of blade needle combined therapy under the guidance of Pingle Zhenggu(平乐正骨,PLZG)balance theory for treatment of early- and mid-stage knee osteoarthritis(KOA)with syndrome of qi stagnation and blood stasis.Methods:One hundred early- and mid-stage KOA patients with syndrome of qi stagnation and blood stasis recruited from February 2022 to March 2023 were randomly divided into 2 groups,50 cases in each group.All patients in the 2 groups were treated with oral application of Xuefu Zhuyu Tang(血府逐瘀汤),external application of Shujin Huoxue Qutong Gao(舒筋活血祛痛膏)and knee functional exercises.In addition,50 patients(blade needle therapy group)were further treated with blade needle therapy under the guidance of PLZG balance theory according to the cardinal symptomatic sites(suprapatellar bursa,infrapatellar fat pad,Point Neixiyan(ST34),Point Dubi(ST35),etc.),2-3 times a week for consecutive 2 weeks.The other 50 patients(acupuncture therapy group)were treated with filiform needle acupuncture at Point Xuehai(SP10),Point Neixiyan(ST34),Point Dubi(ST35),Point Yanglingquan(GB34),Point Yinlingquan(SP9),etc.,once a day for consecutive 2 weeks.The knee pain visual analogue scale(VAS)scores,the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)scores and the range of motion(ROM)of knee were evaluated and compared between the two groups before the treatment and at post-treatment and 1-,3-,6-month-post-treatment.The adverse effects and complications were observed and compared between the 2 groups during the treatment and follow-up period.Results:①General condition.During the treatment period,2 patients in the blade needle therapy group withdrew from the trial due to traumatic fracture and transfer to another department,respectively; and 4 patients in the blade needle therapy group and 3 patients in the acupuncture therapy group withdrew from the trial due to failure to receive treatment according to the plan.Finally,44 patients in the blade needle therapy group and 47 patients in the acupuncture therapy group were included.②The knee pain VAS scores.The knee pain VAS scores presented a decreasing trend over time in the 2 groups before and after the treatment(Wald χ2=371.079,P=0.000; Wald χ2=316.248,P=0.000).There was statistical difference between the 2 groups at 1 month after the end of the treatment(Z=-2.715,P=0.007),but the difference was small and lack of clinical significance,and there was no statistical difference between the 2 groups at the remaining timepoints.③WOMAC total scores.In general,the WOMAC total scores presented a time-dependent trend of decreasing firstly and slightly increasing subsequently before and after the treatment(Wald χ2=179.547,P=0.000),and there was no statistical difference between the 2 groups(Wald χ2=0.031,P=0.860).④WOMAC pain scores and stiffness scores.In general,the WOMAC pain scores and stiffness scores presented a time-dependent trend of decreasing firstly and slightly increasing subsequently before and after the treatment(Wald χ2=231.809,P=0.000; Wald χ2=104.917,P=0.000),and there was no statistical difference between the 2 groups(Wald χ2=0.288,P=0.591; Wald χ2=0.004,P=0.947). ⑤WOMAC physical function scores.The WOMAC physical function scores presented a time-dependent trend of decreasing firstly and slightly increasing subsequently in the 2 groups before and after the treatment(Wald χ2=125.244,P=0.000; Wald χ2=122.438,P=0.000),and there was no statistical difference between the 2 groups at all timepoints.⑥The knee ROM.In general,the knee flexion ROM,inward rotation ROM and outward rotation ROM presented a time-dependent trend of increasing firstly and slightly decreasing subsequently before and after the treatment(Wald χ2=36.852,P=0.003; Wald χ2=12.997,P=0.011; Wald χ2=149.501,P=0.000).There was no statistical difference among the timepoints in knee extension ROM(Wald χ2=9.358,P=0.052).There was no statistical difference between the 2 groups in knee flexion ROM,extension ROM and inward rotation ROM(Wald χ2=0.707,P=0.400; Wald χ2=0.273,P=0.601; Wald χ2=0.655,P=0.418).The knee outward rotation ROM was greater in blade needle therapy group compared to acupuncture therapy group(Wald χ2=4.552,P=0.033),but the difference was small,and lack of clinical significance.⑦The adverse reactions and complications.No adverse reactions and complications were found in the 2 groups during the treatment and follow-up period.Conclusion:For treatment of early- and mid-stage KOA with syndrome of qi stagnation and blood stasis,the blade needle combined therapy under the guidance of PLZG balance theory can alleviate knee pain and stiffness,increase knee ROM and improve knee function,and it is comparable to the acupuncture therapy in the clinical curative effect and safety.

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备注/Memo

备注/Memo:
基金项目:河南省中医药科学研究专项课题(20-21ZY1005); 全国中医学术流派传承工作室建设项目(国中医药人教函〔2019〕62号)
通讯作者:王智勇 E-mail:473937511@qq.com
更新日期/Last Update: 1900-01-01