电针对膝骨性关节炎患者登梯时空参数变异性的影响
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摘要
目的观察电针对膝骨性关节炎(KOA)患者登梯能力的影响。方法将36例KOA患者随机分成电针组和对照组,每组18例。电针组取穴为阳陵泉、阴陵泉、血海、梁丘、足三里、内膝眼、犊鼻,采用电针频率为2Hz的连续方波,电流强度以患者能耐受为度,治疗30 min;对照组选取电针组各穴位旁开约2 cm处浅刺,接电针仪但无电流输出,留针30 min。两组患者均治疗3周,共计11次。于治疗前后进行登梯步态检测,分析上梯及下梯步速及其他时间-空间学参数的变异系数。结果治疗后电针组上、下梯步速比治疗前增加(P <0. 05或P <0. 01),下梯左侧步行周期变异系数较治疗前减小(P <0. 05),上梯左侧步长变异系数、初始双支撑时间变异系数减小(P <0. 05或P <0. 01);对照组下梯右侧初始双支撑时间变异系数、步频变异系数较治疗前减小(P <0. 05或P <0. 01)。治疗后电针组较对照组下梯右侧摆动时间变异系数减小(P <0. 05),其余指标比较差异均无统计学意义(P> 0. 05)。结论电针可以改善KOA患者上梯及下梯的步行速度,减小时间-空间学参数的变异系数,增加上下梯时的步态稳定性,从而提高患者登梯能力。
Objective To observe the effects of electroacupuncture on stair climbing ability in patients with knee osteoarthritis(KOA). Methods A total of 36 KOA patients were randomly divided into electroacupuncture group and control group,with 18 cases in each group. Acupoints adopted in the electroacupuncture group were Yanglingquan(GB 34),Yinlingquan(SP 9),Xuehai(SP 10),Liangqiu(ST 34),Zusanli(ST 36),Neixiyan(EXLE 4),Dubi(ST 35). The electroacupuncture group accepted electroacupuncture with a continuous square wave with a frequency of 2 Hz,and the current intensity depends on patient tolerance,for 30 min. The control group received shallow acupuncture about 2 cm next to the acupoints in the electroacupuncture group. They were connected with electroacupuncture instrument,but without current,and needle retention for 30 min. Both groups were treated for 3 weeks,totally 11 times. Stair climbing gait was measured before and after treatment. Velocities and other spatial-temporal parameters variability during ascending and descending stairs were analyzed. Results After treatment,velocities during both ascending and descending stairs in the electroacupuncture group were increased than those before treatment(P < 0. 01,P < 0. 05). The coeffeicient of variation of gait cycle during stair descending on left limb decreased than those before treatment(P < 0. 05). The coeffeicient of variation of step length and the initial double support time during stair ascending was decreased(P < 0. 05,P < 0. 01). In the control group,the coeffeicient of variation of initial double support time and gait frequency during stair descending on right limb decreased significantly(P < 0. 01,P < 0. 05). After treatment,the variation of swing time of stair descend on right lower limb in the electroacupuncture group was decreased compared with those of the control group(P < 0. 05). There were no significant differences in the comparison of other indicators(P > 0. 05). Conclusion Electroacupuncture may increase the velocities of stair ascending and descending in patients with KOA,also reduce the coeffeicient of variation of spatial-temporal parameters,improve the gait stability of stair ascending and descending,thus improving the ability of stair climbing.
Objective To observe the effects of electroacupuncture on stair climbing ability in patients with knee osteoarthritis(KOA). Methods A total of 36 KOA patients were randomly divided into electroacupuncture group and control group,with 18 cases in each group. Acupoints adopted in the electroacupuncture group were Yanglingquan(GB 34),Yinlingquan(SP 9),Xuehai(SP 10),Liangqiu(ST 34),Zusanli(ST 36),Neixiyan(EXLE 4),Dubi(ST 35). The electroacupuncture group accepted electroacupuncture with a continuous square wave with a frequency of 2 Hz,and the current intensity depends on patient tolerance,for 30 min. The control group received shallow acupuncture about 2 cm next to the acupoints in the electroacupuncture group. They were connected with electroacupuncture instrument,but without current,and needle retention for 30 min. Both groups were treated for 3 weeks,totally 11 times. Stair climbing gait was measured before and after treatment. Velocities and other spatial-temporal parameters variability during ascending and descending stairs were analyzed. Results After treatment,velocities during both ascending and descending stairs in the electroacupuncture group were increased than those before treatment(P < 0. 01,P < 0. 05). The coeffeicient of variation of gait cycle during stair descending on left limb decreased than those before treatment(P < 0. 05). The coeffeicient of variation of step length and the initial double support time during stair ascending was decreased(P < 0. 05,P < 0. 01). In the control group,the coeffeicient of variation of initial double support time and gait frequency during stair descending on right limb decreased significantly(P < 0. 01,P < 0. 05). After treatment,the variation of swing time of stair descend on right lower limb in the electroacupuncture group was decreased compared with those of the control group(P < 0. 05). There were no significant differences in the comparison of other indicators(P > 0. 05). Conclusion Electroacupuncture may increase the velocities of stair ascending and descending in patients with KOA,also reduce the coeffeicient of variation of spatial-temporal parameters,improve the gait stability of stair ascending and descending,thus improving the ability of stair climbing.
引文
[1]王斌,邢丹,董圣杰,等.中国膝骨关节炎流行病学和疾病负担的系统评价[J].中国循证医学杂志,2018,18(2):134-142.
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[7]BEAUCHET O,ALLALI G,BERRUT G,et al. Is lowlower-limb kinematic variability always an index of stabili-ty?[J]. Gait Posture,2007,26(2):327-328.
[8]HAUSDORFF JM. Gait variability:methods,modelingand meaning[J]. J Neuroeng Rehabil,2005,2(1):19.
[9]BRACH JS,STUDENSKI SA,PERERA S,et al. GaitVariability and the risk of incident mobility disability incommunity-dwelling older adults[J]. J Gerontol A Biol SciMed Sci,2007,62(9):983-988.
[10]SCHAAFSMA JD,GILADI N,BALASH Y,et al. Gaitdynamics in Parkinson's disease:relationship to Parkinso-nian features, falls and response to levodopa[J]. JNeurol Sci,2003,212(1):47-53.
[11]MONTEROODASSO M,VERGHESE J,BEAUCHET O,et al. Gait and cognition:a complementary approach tounderstanding brain function and the risk of falling[J]. JAm Geriatr Soc,2012,60(11):2127-2136.
[12]KISS RM. Effect of severity of knee osteoarthritis on thevariability of gait parameters[J]. J Electromyogr Kinesiol,2011,21(5):695-703.
[13]付慕勇.电针配合辨证取穴治疗膝关节骨性关节炎的随机对照试验[J].天津中医药,2013,30(10):597-600.
[14]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[15]KELLGREN JH,LAWREN JS. Radiological Assessmentof Osteo-Arthrosis[J]. Ann Rheum Dis,1957,4(16):494-502.
[16]LIU YH,WEI IP,WANG TM,et al. Immediate effects ofacupuncture treatment on intra-and inter-limb contribu-tions to body support during gait in patients with bilateralmedial knee osteoarthritis[J]. Am J Chin Med,2017,45(1):23-35.
[17]CAPPOZZO A,CATANI F,CROCE UD,et al. Positionand orientation in space of bones during movement:ana-tomical frame definition and determination[J]. ClinBiomech,1995,10(4):171-178.
[18]彭时雨,谢雁鸣,黎元元,等.基于文献计量学方法对中医药治疗膝关节骨性关节炎主要流派的研究[J].中国中医骨伤科杂志,2016,24(9):36-41.
[19]LIN X,HUANG K,ZHU G,et al. The effects of acu-puncture on chronic knee pain due to osteoarthritis:ameta-analysis[J]. J Bone Joint Surg Am,2016,98(18):1578-1585.
[20]陈桥桥,杨红亚,余波,等.膝骨关节炎的针灸治疗及其作用机制探讨[J].辽宁中医杂志,2018,45(2):369-372.
[21]陈菁华,王芗斌,林颖,等.膝骨性关节炎患者平地行走的下肢生物力学分析[J].按摩与康复医学,2015,6(10):16-18.
[22]GABELL A,NAYAK US. The effect of age on variabilityin gait[J]. J Gerontol,1984,39(6):662-666.
[23]王芗斌,谢雪榕,侯美金,等.电针对膝关节骨性关节炎患者登梯活动时下肢动力学影响的临床研究[J].中国针灸,2017,37(10):1027-1034.
[24]STERGIOU N,MORAITI CG,RISTANIS S,et al. Theeffect of the walking speed on the stability of the anteriorcruciate ligament deficient knee[J]. Clin Biomech,2004,19(9):957-963.
[25]SUTHERLAND DH,OLSHEN R,COOPER L,et al.The development of mature gait[J]. J Bone Joint SurgAm,1980,62(3):336-353.
[26]SADEGHI H,ALLARD P,PRINCE F,et al. Symmetryand limb dominance in able-bodied gait:a review[J].Gait Posture,2000,12(1):34-45.
[27]GROTLE M. Traditional Chinese acupuncture was not su-perior to sham acupuncture for knee osteoarthritis but de-livering treatment with high expectations of improvementwas superior to delivering treatment with neutral expecta-tions[J]. J Physiother,2011,57(1):56.
[28]王芗斌,侯美金,陈剑,等.电针对膝骨性关节炎患者功能活动及登梯时空参数的影响[J].中国中医基础医学杂志,2017,23(8):1139-1144.
[29]AJISAFE T,WU J,GEIL M. Toe spatiotemporal differ-ences between transition steps when ascending shorterflight stairways of different heights[J]. Appl Ergon,2017,59(Pt A):203-208.
[2]GUCCIONE AA. The effects of specific medical conditionson the functional limitations of elders in the FraminghamStudy[J]. Am J Public Health,1994,84(3):351-358.
[3]HINMAN RS,BENNELL KL,METCALF BR,et al. Bal-ance impairments in individuals with symptomatic knee os-teoarthritis:a comparison with matched controls using clin-ical tests[J]. Rheumatology,2002,41(12):1388-1394.
[4]HESTER AL,WEI F. Falls in the community:state of thescience[J]. Clin Interv Aging,2013,2013(8):675-679.
[5]BARBOUR KE,STEVENS JA,HELMICK CG,et al.Falls and fall injuries among adults with arthritis:UnitedStates,2012[J]. MMWR Morb Mortal Wkly Rep,2014,63(17):379-383.
[6]MAT S,NG CT,TAN MP. Influence of hip and knee os-teoarthritis on dynamic postural control parameters amongolder fallers[J]. J Rehabil Med,2017,49(3):258-263.
[7]BEAUCHET O,ALLALI G,BERRUT G,et al. Is lowlower-limb kinematic variability always an index of stabili-ty?[J]. Gait Posture,2007,26(2):327-328.
[8]HAUSDORFF JM. Gait variability:methods,modelingand meaning[J]. J Neuroeng Rehabil,2005,2(1):19.
[9]BRACH JS,STUDENSKI SA,PERERA S,et al. GaitVariability and the risk of incident mobility disability incommunity-dwelling older adults[J]. J Gerontol A Biol SciMed Sci,2007,62(9):983-988.
[10]SCHAAFSMA JD,GILADI N,BALASH Y,et al. Gaitdynamics in Parkinson's disease:relationship to Parkinso-nian features, falls and response to levodopa[J]. JNeurol Sci,2003,212(1):47-53.
[11]MONTEROODASSO M,VERGHESE J,BEAUCHET O,et al. Gait and cognition:a complementary approach tounderstanding brain function and the risk of falling[J]. JAm Geriatr Soc,2012,60(11):2127-2136.
[12]KISS RM. Effect of severity of knee osteoarthritis on thevariability of gait parameters[J]. J Electromyogr Kinesiol,2011,21(5):695-703.
[13]付慕勇.电针配合辨证取穴治疗膝关节骨性关节炎的随机对照试验[J].天津中医药,2013,30(10):597-600.
[14]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[15]KELLGREN JH,LAWREN JS. Radiological Assessmentof Osteo-Arthrosis[J]. Ann Rheum Dis,1957,4(16):494-502.
[16]LIU YH,WEI IP,WANG TM,et al. Immediate effects ofacupuncture treatment on intra-and inter-limb contribu-tions to body support during gait in patients with bilateralmedial knee osteoarthritis[J]. Am J Chin Med,2017,45(1):23-35.
[17]CAPPOZZO A,CATANI F,CROCE UD,et al. Positionand orientation in space of bones during movement:ana-tomical frame definition and determination[J]. ClinBiomech,1995,10(4):171-178.
[18]彭时雨,谢雁鸣,黎元元,等.基于文献计量学方法对中医药治疗膝关节骨性关节炎主要流派的研究[J].中国中医骨伤科杂志,2016,24(9):36-41.
[19]LIN X,HUANG K,ZHU G,et al. The effects of acu-puncture on chronic knee pain due to osteoarthritis:ameta-analysis[J]. J Bone Joint Surg Am,2016,98(18):1578-1585.
[20]陈桥桥,杨红亚,余波,等.膝骨关节炎的针灸治疗及其作用机制探讨[J].辽宁中医杂志,2018,45(2):369-372.
[21]陈菁华,王芗斌,林颖,等.膝骨性关节炎患者平地行走的下肢生物力学分析[J].按摩与康复医学,2015,6(10):16-18.
[22]GABELL A,NAYAK US. The effect of age on variabilityin gait[J]. J Gerontol,1984,39(6):662-666.
[23]王芗斌,谢雪榕,侯美金,等.电针对膝关节骨性关节炎患者登梯活动时下肢动力学影响的临床研究[J].中国针灸,2017,37(10):1027-1034.
[24]STERGIOU N,MORAITI CG,RISTANIS S,et al. Theeffect of the walking speed on the stability of the anteriorcruciate ligament deficient knee[J]. Clin Biomech,2004,19(9):957-963.
[25]SUTHERLAND DH,OLSHEN R,COOPER L,et al.The development of mature gait[J]. J Bone Joint SurgAm,1980,62(3):336-353.
[26]SADEGHI H,ALLARD P,PRINCE F,et al. Symmetryand limb dominance in able-bodied gait:a review[J].Gait Posture,2000,12(1):34-45.
[27]GROTLE M. Traditional Chinese acupuncture was not su-perior to sham acupuncture for knee osteoarthritis but de-livering treatment with high expectations of improvementwas superior to delivering treatment with neutral expecta-tions[J]. J Physiother,2011,57(1):56.
[28]王芗斌,侯美金,陈剑,等.电针对膝骨性关节炎患者功能活动及登梯时空参数的影响[J].中国中医基础医学杂志,2017,23(8):1139-1144.
[29]AJISAFE T,WU J,GEIL M. Toe spatiotemporal differ-ences between transition steps when ascending shorterflight stairways of different heights[J]. Appl Ergon,2017,59(Pt A):203-208.
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