目的 利用核磁共振观察宫廷理筋振髌法治疗膝关节骨关节炎(knee osteoarthritis,KOA)的临床疗效.方法 回顾东直门医院收治的膝关节骨关节炎患者44例,其中按摩组22例,用宫廷理筋振髌法治疗,中药组22例,用东直门医院骨科洗药治疗,2组患者治疗前均进行核磁共振检查,3～6个月治疗期间复查核磁共振,观察前交叉韧带、后交叉韧带、髌韧带、内侧副韧带、外侧副韧带、髌下脂肪垫、内侧支持带、外侧支持带、半月板损伤、关节积液、髌骨软化等部位治疗前后变化情况.结果 按摩和中药治疗膝关节骨关节炎均有效,按摩组患者临床疗效优于中药组(P<0.05).结论 宫廷理筋振髌法治疗膝关节骨关节炎患者临床疗效理想,患者易于接受,同时核磁共振检查(magnetic resonance imaging,MRI)在膝关节骨关节炎的诊断分期、治疗、疗效评价等方面有明显的优势.

Based on the resutls of literature review and interviews of experts, two rounds of Delphi surveys were conducted. The mean, importance ratio, coefficient of variation and coordination coefficient were used for assessment of survey from multiple perspectives, and finally form a framework model of factors affecting the efficacy of Tuina therapy. A total of 37 experts were selected for questionnaire surveys, the positive coefficients of experts' participatation in the first round and second round were 92.5% and 80.0%, respectively. The overall coordination coefficient in the second round is 0.68. The items were included into the consensus meeting if the importance ratio of items were equal to and more than 80%. After the expert consensus meeting, 22 items were included to form a framework model of factors affecting the efficacy of Tuina therapy, and summarized as 5 major influencing factors, including diagnostic factors, treatment factors, prognostic factors, patient factors, and doctor-patient communication. This framework can guide and help young Tuina practitioners to improve clinical efficacy. It is also clearly pointed out that the effect of Tuina for pain is not only related to disease diagnosis or manipulation, but also related to home exercise, health care, and doctor-patient communication.

Background Non-alcoholic fatty liver disease（NAFLD） is a common disease of the digestive system. With the improvements of living standards and breakthroughs in viral hepatitis research,NAFLD has replaced viral hepatitis as the most common chronic liver disease. Guidance documents can provide clinical staff with standard and reliable diagnosis and treatment approaches. The screening and development of high-quality guidance documents is of great importance to standardise the clinical practice of NAFLD. Objective To analyze the methodological quality and reporting quality of guidance documents for NAFLD,summarize and compare the recommendations,so as to provide a reference for the development and report of future guidelines for NAFLD. Methods Pub Med,CNKI,CBM,Wanfang Data Knowledge Service Platform,VIP Database were searched for clinical guidelines and consensuses on NAFLD supplemented by WHO,GIN,NICE,SIGN and Medlive from 2012-01-01 to 2022-01-01. Two researchers in the field of liver disease screened the literature,extracted the data and independently evaluated the methodological quality and reporting quality of the included guideline documents using AGREE Ⅱ and RIGHT,respectively. The recommendations of the higher quality guideline documents were collated and compared by the two researchers. Results A total of 19 publications were enrolled,including 12 guidelines and 7 consensuses;6 in Chinese and 13 in English;10 of which were developed using an evidence-based approach. The average scores for each domain of AGREE Ⅱ were 42.84% for scope and purpose,31.43% for participants,31.25% for rigour,60.67% for clarity,32.68% for application and 37.50% for independence. The average scores of RIGHT in each area were 59.65% for basic information,66.12% for background,42.11% for evidence,39.85% for recommendations,17.11% for review and quality assurance,18.42% for funding and conflict of interest statement and management,47.37% for other aspects. The average scores in AGREE Ⅱ and reporting qualities in RIGHT of evidence-based guidance documents were both higher than non-evidence-based guidance documents. The average scores in AGREE Ⅱ and reporting qualities in RIGHT of foreign guidance documents were higher than domestic guidance documents. The main recommendations relate to screening and diagnosis,assessment,management（non-pharmacologic and pharmacologic treatment） and surgical treatment. Conclusion The methodological quality and reporting quality of the published guidance documents for NAFLD still need to be improved,and there are still gaps between domestic guidance documents and international guidance documents. The development of TCM guidance documents should follow an evidence-based approach. Further reference should be made to international standards such as AGREE Ⅱ and RIGHT in the development and reporting of guidelines. Clinical screening awareness for high-risk population of NAFLD and a comprehensive system for early non-invasive diagnosis and assessment should be established. Multidimensional treatment plans for lifestyle,liver function and metabolic disorders should be provided for patients with NAFLD.

BackgroundLumbar spinal stenosis (LSS) is the main cause of severe pain and disability. The long-term prognosis of surgical intervention for LSS is still controversial, and the reoperation rate is high. In 2002, the United States carried out a nearly 10-year multi-center spine patient effectiveness research trial (Spine Patient Outcomes Research Trial, SPORT) , which provided information on the suitability of surgery for lumbar disc herniation, LSS, and degenerative lumbar spondylolisthesis, in order to compare and analyze the clinical efficacy, cost-effectiveness, and prognostic factors of surgery and conservative treatment (non-surgical treatment) .ObjectiveTo summarize the results of the Spine Patient Outcome Research Trial (SPORT) on LSS, in order to provide ideas and methods for traditional Chinese medicine to intervene in LSS.MethodsPubMed, EMBase, The Cochrane Library, Web of Science database were retrieved by computer. The SPORT studies on surgical versus non-surgical for LSS or LSS subgroup analysis were included and the data was extracted and merged. The methodological quality of randomized controlled trials was evaluated using the Cochrane Collaboration "risk of bias" evaluation tool, and cohort studies or subgroup analysis were evaluated using the NOS scale.ResultsA total of 16 studies were included. In the 4-year follow-up, the efficacy of surgical intervention for LSS was significantly better than that of non-surgical therapy (P<0.05) . The difference in efficacy between surgery and non-surgical treatment was gradually reduced during the 8-year follow-up (P>0.05) . The total cost of surgery was more than twice that of non-surgical patients. Baseline ODI score greater than 56 points, elderly patients, and disease duration> 1 year are risk factors for surgical intervention for LSS were therisk factors for surgical intervention in LSS (P<0.05) .ConclusionSurgical therapy can significantly improve the symptoms of patients with LSS within 4 years, but there is no significant difference between surgical and non-surgical therapy in the long-term effect. As an important part of non-surgical therapy, Chinese medicine can refer to the methodology of the SPORT to establish a clinical research paradigm that conforms to the characteristics of clinical practice of Chinese medicine.

The standardization of pediatric Tuina is beneficial to pediatric Tuina practitioners in a norm practices. The paper collects the content from teaching textbooks, TCM ancient books and database literature, and tries to develop the technical specifications of pediatric Tuina by four rounds Delphi surveys and expert consensus. This specification covers the manipulation of pediatric Tuina, the position of acupoints, the effects of acupoints and the diagnosis and treatment of pediatric Tuina, including indications, contraindications, cautious use, operation steps and methods.

退行性腰椎管狭窄症是一种老年多发疾病,在指南中,中重度退行性腰椎管狭窄症保守治疗被推荐为第一治疗策略,但没有给出具体高质量证据推荐的中医保守方案.本文以"以筋代骨"中医理论探求出中重度腰椎管狭窄症"杂合而治"中医保守诊疗方案的新思路.在刺络放血和药罐拔罐的基础上,结合针刀、膏摩、内服中药等构成综合疗法,以内服中药调理患者形神,以针刀增加治疗强度,以膏摩促进组织修复,形成"以罐为主、以刀助攻、以膏修复、以药调身"的四维一体疗法.

目的 观察九步八分推拿法治疗女性膝关节骨性关节炎的临床疗效,并分析其可能作用机制.方法 纳入20例女性膝关节骨性关节炎患者,选取疼痛程度重的单侧患膝进行为期2周6次的推拿治疗,推拿方案按照九步八分法方案进行.在第1次治疗前、第1次治疗后及第6次治疗后分别使用疼痛数字评分法(NRS)及西部安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分以评价疼痛改善情况,采用股直肌超声灌注成像检测增强达峰时间(TTP)、造影峰值强度(PI).结果 20例受试者脱落1例,最终19例患者纳入统计分析.NRS评分治疗前后三个时间点比较差异均有统计学意义(P=0.001).WOMAC总分治疗前后三个时间点比较差异均有统计学意义(P=0.007),WOMAC疼痛维度评分(P=0.027)、功能维度评分(P=0.010)治疗前后三个时间点比较差异均有统计学意义,僵硬维度评分治疗前后三个时间点比较差异均无统计学意义(P=O.378).治疗前后三个时间点TTP比较差异均无统计学意义(P=0.449).治疗前后三个时间点PI比较差异均有统计学意义(P=O.039).各时间点两两比较,第1次治疗后较第1次治疗前PI增加(P=0.02),第6次治疗后PI与第1次治疗前比较差异无统计学意义(P=1.000),第6次治疗后PI与第1次治疗后比较差异亦无统计学意义(P=0.200).结论 九步八分推拿法可显著改善女性膝关节骨性患者的关节疼痛和关节功能,其作用机制可能与改善股直肌微循环、调整关节代谢状态有关.

患者报告结局测量工具(PROMs)是评价与量化患者报告结局的工具,而良好的测量性能是应用PROMs的基本前提条件,但PROMs数量众多,测量性能评价欠规范、不全面,因此如何选择合适的PROMs成为临床研究中亟待解决的问题之一.基于共识健康测量工具的选择标准(COSMIN)旨在帮助临床研究人员和医务工作者选择最合适的PROMs,本研究参考COSMIN并以中国腰痛患者日常生活活动能力量表的选择为例,探讨PROMs选择路径,发现PROMs选择路径主要包含以下5项主要内容:全面检索判断是否已有工具、研制/译制工具、工具测量性能研究、系统评价、改编工具,其中系统评价是PROMs选择路径中的关键;同时,PROMs的选择并非"一蹴而就",而是一个循环向前的过程.