刺絡(luò)拔罐加溫針灸治療膝關(guān)節(jié)內(nèi)側(cè)痛癥臨床觀察(1)

1、刺絡(luò)拔罐加溫針灸治療膝關(guān)節(jié)內(nèi)側(cè)痛癥臨床觀察(1)    【摘要】  目的  觀察針灸綜合療法治療膝關(guān)節(jié)內(nèi)側(cè)痛癥的臨床療效，尋找治療膝關(guān)節(jié)內(nèi)側(cè)痛癥的最佳方法。方法  將膝關(guān)節(jié)內(nèi)側(cè)痛癥患者按就診順序隨機(jī)分為治療組55例與對照組55例，治療組采用刺絡(luò)拔罐加溫針灸治療，對照組采用電針刺加TDP治療，兩組均治療20次后進(jìn)行療效對比。結(jié)果  治療組顯效42例，有效8例，無效5例，總有效率90.91%；對照組顯效24例，有效14例，無效17例，總有效率69.09%。經(jīng)統(tǒng)計(jì)學(xué)處理，兩組顯效和總有效率差異均有非常顯著性（P0.01）

2、。結(jié)論  刺絡(luò)拔罐加溫針灸對膝關(guān)節(jié)內(nèi)側(cè)病癥有較好療效。     【關(guān)鍵詞】  膝關(guān)節(jié)內(nèi)側(cè)痛癥；針灸療法；刺絡(luò)拔罐、溫針灸；電針刺+TDP     膝關(guān)節(jié)病是針灸科門診的常見病、多發(fā)病，其中膝關(guān)節(jié)內(nèi)側(cè)痛癥發(fā)病率較高，常見原因?yàn)橄リP(guān)節(jié)內(nèi)側(cè)副韌帶損傷、內(nèi)側(cè)半月板損傷，骨性關(guān)節(jié)炎、局限性滑膜炎、脛骨結(jié)節(jié)骨骺炎、臏骨軟化癥等。中醫(yī)屬痹證。筆者以刺絡(luò)拔罐加溫針灸治療55例(治療組)，電針刺加TDP治療55例(對照組)，治療組療效明顯優(yōu)于對照組，現(xiàn)報(bào)告如下。    1  臨床資料

3、    1.1  一般資料  110例均為針灸科門診病人，男37例，女73例；單膝發(fā)病56例，雙膝發(fā)病54例，共164膝；年齡最大79歲，最小17歲，平均年齡44歲；病程1個(gè)月內(nèi)23例，1個(gè)月2年43例，2年以上44例。按就診順序隨機(jī)分為治療組55例，對照組55例。治療組男19例，女36例；單膝33例，雙膝22例；病程1個(gè)月內(nèi)13例，1個(gè)月2年21例，2年以上21例。對照組男18例，女37例；單膝23例，雙膝32例；病程1個(gè)月內(nèi)10例，1個(gè)月2年22例，2年以上23例。兩組患者在性別、年齡、病程、病情及單雙膝關(guān)節(jié)發(fā)病方面，差異無顯著性（P0.0

4、5）。    1.2  診斷要點(diǎn)    1.2.1  病史  有外傷、勞損、病損史。    1.2.2  癥狀  膝關(guān)節(jié)痛以內(nèi)側(cè)為主，關(guān)節(jié)發(fā)軟無力，跳躍、上下樓梯、負(fù)重、屈膝及由蹲位驟然站起時(shí)疼痛加重，部分患者活動(dòng)膝關(guān)節(jié)時(shí)髕骨有一過性抖動(dòng)，伴膝關(guān)節(jié)彈響。    1.2.3  體征  膝關(guān)節(jié)內(nèi)側(cè)壓痛明顯，?？蓲屑巴葱詶l索，病程短者局部可見腫脹，病程長者膝關(guān)節(jié)內(nèi)側(cè)骨節(jié)突出，肌肉萎縮。膝關(guān)節(jié)功能受限制。 

5、;   1.2.4  X線片  在年輕或病程短患者可無明顯異常，年長及病程長患者可見膝關(guān)節(jié)骨性退變征象。查血尿酸、血沉、類風(fēng)濕因子，抗“O”等均正常而排除相關(guān)疾病。    2  治療方法    2.1  取穴  阿是穴、陰陵泉、膝關(guān)、曲泉、陰谷。    2.2  方法  治療組：在膝關(guān)節(jié)內(nèi)側(cè)按壓尋找最痛點(diǎn)，即阿是穴，梅花針叩刺，拔罐5min。叩刺拔罐隔日操作1次。取罐后在阿是穴三根針齊刺法刺入，針刺陰陵泉、膝關(guān)、曲泉

6、、陰谷穴，得氣后均施行針刺補(bǔ)法，留針時(shí)用艾條剪成長約2cm左右，插在針柄上，點(diǎn)燃施灸，燒盡后將針取出，每日1次，10天1個(gè)療程，休息1周后行第2個(gè)療程。對照組：阿是穴三根針齊刺法刺入，針刺陰陵泉、膝關(guān)、曲泉、陰谷穴，得氣后施行補(bǔ)法，留時(shí)用G6805-2A電針儀每膝2組輸出，并加TDP照射，時(shí)間30min，每日1次，10天1個(gè)療程，休息1周后行第2個(gè)療程。 1      operating system. The desktop configuration consisted of a P III processor, standard 24-b

7、it video-graphics card on it and a monitor with 85 Hz. horizontal frequencies and resolution of 800x600 pixels. The first image of the program is in a circular order of 30 round shapes, each having a different color (see Figure 1A). These colored circles are numbered on the screen and are separated

8、by equal distance in a circular fashion. These 30 different color hues were created using HLS color naming space with a programming algorithm derived from RGB system of Microsoft so as to have constant saturation and brightness but differing hue components. The hue component presents the changed par

9、ameters of each color. This avoids the possibility of color blinds to discriminate colors by saturation and/or brightness.    Application of the NCACVT All subjects were well informed by the tester about the test procedure. There is an introductory mini-test at the beginning of the pr

10、incipal testing program. This introductory phase there were 7 different color caps were showed, which are recognizable for both in normal and the color blinds. The subjects compared the sample test color with the circle colors by moving the mouse anticlockwise for matching until subject reaches the

11、corresponding color cap and clicks on the mouse (Figure 1A). After this mini-test illustration the principal test was started. The colored circles are numbered on the screen and are separated by equal distance in a circular fashion. The principal colors representing red, green and blue (RGB) are num

12、bered as 1, 11, and 21 respectively and they are shown with bold arrows. Numbers 6, 16 and 26 are the colors created by mixing two of the principal colors of the RGB system and they are shown with light arrows. In other words, these are the cyan-magenta-yellow (CMYK) systems principal colors. There

13、are 4 more intermediate hues in between these marked ones (Figure 1B). This presentation allows an even distribution of colors having close wavelengths in different quadrants. Consecutive presentations of the comparing test colors are also random and successive colors have distant wavelengths. Thirt

14、y colors are presented one after another and the subject moves the comparing test color anticlockwise until subject reaches the corresponding color cap and clicks on the mouse (Figure 1C). If the subject has color vision deficiency, subject may choose more than one colored circles which disappeared from view and saved (Figure 1D). Eve