手法联合盐酸氨基葡萄糖治疗膝骨关节炎临床观察

目的 基于红外热成像技术评价手法治疗膝骨关节炎(knee osteoarthritis，KOA)的临床疗效，探讨手法作用机制，形成手法治疗KOA规范化诊疗评估方案。方法 通过简单随机方法将40例KOA患者分为对照组和治疗组，每组20例（治疗组和对照组分别被剔除1例和2例）。治疗组采用手法治疗联合盐酸氨基葡萄糖胶囊口服，对照组采用自我按摩联合盐酸氨基葡萄糖胶囊口服。治疗2周后，以膝关节区域温度、督脉温度、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（the Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC）、连续5次坐立时间、15 m直线连续行走时间为指标，评价两组疗效。结果 两组治疗后VAS评分均显著降低（P＜0.05）；治疗组治疗前后VAS评分差值显著大于对照组（P＜0.05）。两组治疗后WOMAC的疼痛、僵硬、生活功能评分和总分显著降低（P＜0.05）；其中治疗组治疗前后WOMAC总分和僵硬评分差值显著大于对照组（P＜0.05）。两组治疗后连续5次坐立时间、15 m直线连续行走时间均显著降低（P＜0.05)；治疗组治疗后连续5次坐立时间、15 m直线连续行走时间降低值显著大于对照组（P＜0.05）。两组治疗后膝关节区域温度显著降低（P＜0.05），督脉区域温度显著升高(P＜0.05)；治疗组治疗后膝关节区域温度降低值和督脉区域温度升高值显著大于对照组（P＜0.05)。两组基于WOMAC总分的临床疗效比较，差异有统计学意义（P＜0.05），治疗组临床疗效明显优于对照组。结论 中医手法治疗可减轻KOA患者膝关节疼痛、僵硬症状，改善日常生活功能，疗效优于自我按摩。

Clinical Effect of Manipulation Combined with Glucosamine Hydrochloride in Treatment of Knee Osteoarthritis

Objective To investigate the clinical effect and mechanism of action of manipulation in the treatment of knee osteoarthritis (KOA) using infrared thermal imaging, and to develop a standardized diagnosis and treatment regimen based on manipulation for KOA. Methods A total of 40 patients with KOA were randomly divided into control group and treatment group, with 20 patients in each group. One patient in the treatment group and two in the control group were removed. The patients in the treatment group were given manipulation combined with oral glucosamine hydrochloride capsules, and those in the control group were given self-massage combined with oral glucosamine hydrochloride capsules. After two weeks of treatment, the two groups were evaluated and compared in terms of the caloric value of knee joint, the caloric value of the governor vessel, Visual Analogue Scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), time of Five-Times Sit-to-Stand Test, and time of 15-m continuous straight walking. Results Both groups had a significant reduction in VAS score after treatment (P<0.05), and the treatment group had a significantly greater reduction in VAS score than the control group (P<0.05). After treatment, both groups had significant reductions in total WOMAC score and the scores of pain, stiffness, and activities of daily living, and the treatment group had significantly greater reductions in total WOMAC score and the score of stiffness than the control group (P<0.05). After treatment, both groups had significant reductions in time of Five-Times Sit-to-Stand Test and time of 15-m continuous straight walking, and the treatment group had significantly greater reductions than the control group (P<0.05). After treatment, both groups had a significant reduction in the local temperature of the knee joint and a significant increase in the local temperature of the governor vessel (P<0.05), and the treatment group had a significantly greater reduction and a significantly greater increase than the control group (P<0.05). There was a significant difference in clinical outcome based on total WOMAC score between the two groups (P<0.05), and the treatment group had a significantly better clinical outcome than the control group. Conclusion Traditional Chinese medicine manipulation can alleviate knee joint pain and stiffness and improve activities of daily living in KOA patients and has a better clinical effect than self-massage.