中醫傷科手法對骨性膝關節炎療效之評估; The Effects of Traditional Chinese Traumatologic Manipulation on Knee Joint Osteoarthritis

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Title:	中醫傷科手法對骨性膝關節炎療效之評估;The Effects of Traditional Chinese Traumatologic Manipulation on Knee Joint Osteoarthritis
Authors:	盧樹森;Shu-Shen Lu
Contributors:	中國醫藥學院中西醫結合研究所
Keywords:	骨性膝關節炎;傷科手法;Osteoarthritis;Traumatologic Manipulation
Date:	1990
Issue Date:	2009-12-01 18:58:23 (UTC+8)
Abstract:	骨性膝關節炎是由於膝關節軟骨的退行性病變，連帶引起軟骨下骨、關節邊緣、滑液膜和關節周圍結構相關變化的疾病，是中老年人最常見的關節炎。本病常引起膝關節疼痛和功能障礙，一般治療目標是減少疼痛、不適，和改善關節活動功能。臨床用藥以水楊酸鹽和非類固醇類消炎藥為主，但長期使用可能引起副作用，目前多以選擇性第二代環氧化酶 (COX-2) 抑制劑治療，然而其長期使用效果如何，仍不清楚，副作用亦可能出現。以往初步之臨床觀察顯示：中醫傷科手法能直接、快速減緩關節的疼痛、不適，改善膝關節活動功能，本研究採用 VAS和LFI量表以評估傷科手法對骨性膝關節炎之療效。在長庚紀念醫院中醫門診篩選骨性膝關節炎患者54名為實驗組，接受傷科手法治療，每週兩次，連續六週；另於彰化基督教醫院風濕科門診篩選同類病患44名為對照組，接受西藥Mobic及Viartril-S之治療，連續給藥六週。兩組患者治療前均接受X光檢查、問卷、VAS和LFI量表之評估，並於治療後一、四、六週重複VAS和LFI量表之評估。研究結果顯示：VAS方面，兩組並無顯著差異 (p=0.18)。LFI評估結果，實驗組與對照組有顯著差異 (p<0.0001)，尤以X光K/L第二級患者為然，且其療效與治療時間呈正相關。; Osteoarthritis（OA） is characterized by defects in articular cartilage and related changes in subchondral bone, joint margins, synovium, and para-articular structures. OA is one of the most common forms of arthritis and a major cause of pain and disability particularly among the elderly. The goals of management for OA are to decrease pain and to improve function. Clinically, choices of drug for OA are salicylates, nonsteroid anti-inflammatory drugs and selective COX-2 inhibitors. However, the related side effects are associated with prolonged use. In the previous observation, traditional Chinese traumatologic manipulation may rapidly relieve pain and restore function. In this study, the effects on OA of the knee was measured with the visual analogue scale（VAS）and the Lequesne’s fuctional index（LFI）. Fifty-four patients with OA of the knee were enrolled in the study group from the out-patient-department in Chang Gung Memorial Hospital. They received manipulative therapy twice a week and treatment continued for six weeks. Another 44 patients entered the control group via out-patient-department in Changhua Christian Hospital, they were given Mobic and Viartril-S orally for six weeks. The difference between groups was measured with VAS and LFI. For the VAS, there was no significant difference between groups（p=0.18）. For the LFI, there was significant difference in favor of traumatologic manipulation（p<0.0001）. The K/L grade 2 patients were significantly improved by traumatologic manipulation with prolonged treatment.
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