来源：风湿病与关节炎,2023,12（4）:10-14,61.

肌筋膜理论指导下的针刺股四头肌治疗膝骨关节炎寒湿痹阻证43例临床观察

（临床研究）

叶子丰¹，杨　惠²，匡浩铭¹，匡建军³，仇湘中³，戎　宽³

　　【摘　要】目的：观察肌筋膜理论指导下的针刺治法对膝骨关节炎寒湿痹阻证的临床疗效。方法：将86例膝骨关节炎寒湿痹阻证患者按照随机数字表法分为治疗组和对照组，每组43例。对照组给予足三里、内膝眼、鹤顶、悬钟、阴陵泉、阳陵泉、犊鼻、血海、梁丘等穴位常规针刺治疗，治疗组给予股四头肌针刺治疗。2组均隔日治疗1次，每周3次，疗程4周。观察2组临床疗效，以及治疗前后视觉模拟评分法（VAS）评分、麦克马斯特大学骨关节炎指数（WOMAC）评分、膝关节功能评分量表（Lysholm）评分、中医证候量化表评分，并监测不良反应。结果：治疗组痊愈7例，显效17例，好转14例，无效5例，总有效率为88.37%；对照组痊愈4例，显效13例，好转17例，无效9例，总有效率为79.07%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组VAS评分、WOMAC评分、中医证候评分较治疗前均降低，Lysholm评分较治疗前升高（P < 0.05）；且治疗组VAS评分、WOMAC评分水平均低于对照组（P < 0.05），Lysholm评分高于对照组（P < 0.05）。治疗后，2组中医证候单项积分较前均降低（P < 0.05）；且治疗组在改善疼痛重着、畏寒怕冷、关节僵硬、肢体肿胀症状方面优于对照组（P < 0.05）。２组均未出现明显不良反应。结论：针刺股四头肌可有效缓解膝骨关节炎寒湿痹阻证患者疼痛症状，改善患者活动障碍、精神状况，且疗效较常规针灸治疗更佳。

　　【关键词】　膝骨关节炎；肌筋膜理论；针刺；股四头肌；寒湿痹阻证

Clinical Observation on 43 Cases of Knee Osteoarthritis with Cold-dampness-bstruction Syndrome Treated by Acupuncture of Quadriceps Femoris Muscle under the Guidance of Myofascial Theory

YE Zi-feng,YANG Hui,KUANG Hao-ming,KUANG Jian-jun,QIU Xiang-zhong,RONG Kuan

　　【ABSTRACT】Objective:To observe the curative effect of acupuncture and moxibustion treatment under the guidance of Myofascial Theory on knee osteoarthritis with cold-dampness-obstruction syndrome.Methods:Eighty-six patients of knee osteoarthritis with cold-dampness-obstruction syndrome were randomly divided into a treatment group and a control group,with 43 cases in each group.Patients in the control group were treated with routine acupuncture at Zusanli（ST 36）,Neixiyan（EX-LE4）,Heding（EX-LE2）,Xuanzhong（GB 39）,Yinlingquan（SP 9）,Yanglingquan（GB 34）,Dubi（ST 35）,Xuehai（SP 10）,and Liangqiu（ST 34）.The treatment group received acupuncture at quadriceps femoris muscle.Both groups were treated once every other day,three times a week,for a course of 4 weeks.Observe the clinical efficacy of two groups,as well as VAS,WOMAC score,Lysholm score,and TCM Syndrome Quantification Scale scores（TCMSQSS）before and after treatment,and monitor adverse reactions.Results:In the treatment group,7 cases were cured,17 cases were significantly improved,14 cases were improved,and 5 cases were ineffective.The total effective rate was 88.37%.In the control group,4 cases were cured,13 cases were significantly improved,17 cases were improved,and 9 cases were ineffective.The total effective rate was 79.07%.The difference between the two groups was statistically significant（P < 0.05）.After treatment,the VAS,WOMAC score,and TCMSQSS of both groups decreased compared to before treatment,while the Lysholm score increased compared to before treatment（P < 0.05）;and the VAS score and WOMAC score levels in the treatment group were lower than those in the control group（P < 0.05）,while the Lysholm score was higher than that in the control group（P < 0.05）.After treatment,the TCM single point scores in both groups decreased compared to before（P < 0.05）;and the treatment group was superior to the control group in improving symptoms of severe pain,fear of cold,joint stiffness,and limb swelling（P < 0.05）.No significant adverse reactions were observed in both groups.Conclusion:Acupuncture of quadriceps femoris muscle can effectively relieve the pain symptoms of patients with knee osteoarthritis of cold-dampness-obstruction syndrome,improve their activity disorder and mental status,and the effect is better than that of conventional acupuncture and moxibustion.

　　【Keywords】 knee osteoarthritis;Myofascial Theory;acupuncture;quadriceps femoris muscle;cold-dampness-obstruction syndrome