不同中医证型的前交叉韧带损伤与继发性软骨损伤相关性研究
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摘要
【目的】基于"筋骨并重"理论探讨不同中医证型的膝关节前交叉韧带(ACL)损伤继发软骨损伤的临床研究。【方法】选取60例膝关节ACL断裂且行关节镜手术治疗的患者,由2名高级职称医师对患者进行中医辨证分型,分别辨证为气滞血瘀型、筋脉失养型、湿阻筋络型3型,每型各20例;对不同中医证型患者ACL断裂的关节镜下关节软骨损伤程度进行Outerbridge分级,并对数据进行统计学分析处理。【结果】(1)病程方面,气滞血瘀型ACL损伤的平均病程较湿阻筋络型和筋脉失养型短,差异有统计学意义(P<0.01);而湿阻筋络型的平均病程较筋脉失养型略长,但差异无统计学意义(P>0.05)。(2)软骨损伤程度方面:根据Outerbridge分级,气滞血瘀型患者以Ⅰ级和Ⅱ级为主,占95.0%;筋脉失养型患者以Ⅱ级和Ⅲ级为主,占80.0%;湿阻筋络型患者以Ⅲ级和Ⅳ级为主,占85.0%;3种证型患者的软骨损伤程度比较(非参数秩和检验),差异有统计学意义(P<0.01)。(3)LSD检验结果:湿阻筋络型患者的ACL断裂继发软骨损伤程度较气滞血瘀型和筋脉失养型均严重,差异均有统计学意义(P<0.01)。【结论】不同中医证型的ACL继发软骨损伤程度不同,可在一定程度上为ACL断裂的中医辨证及早期重建ACL的必要性提供客观依据;同时也阐明了"伤筋"对"伤骨"的影响,从而引起对"筋伤"早期治疗的重视,进而丰富了"筋骨并重"理论的内涵。
Objective To investigate the secondary articular cartilage injury in the anterior cruciate ligament(ACL) injury patients with various traditional Chinese medicine(TCM) syndromes based on the theory of"treatment of both tendons and bones". Methods Sixty patients with ACL break and having taken the arthroscopic surgery were differentiated into various TCM syndrome types by two senior physicians. The patients were differentiated into the types of Qi stagnation and blood stasis,malnutrition of tends and vessels,and dampness blocking tendons and collaterals,20 cases in each syndrome type. ACL break patients with various TCM syndrome types were classified into various grades of Outerbridge and then the data was statistically analyzed. Results(1)The mean course of the disease of ACL injury patients with Qi stagnation and blood stasis was shorter than that of the patients with other two syndrome types,the difference being significant(P<0.01). The mean course of the disease of ACL injury patients with dampness blocking tendons and collaterals only showed an increasing trend compared with that of the patients with malnutrition of tends and vessels,the difference being insignificant(P>0.05).(2)and grade Ⅱ(accounting for95.0%)in patients with Qi stagnation and blood stasis,characterized as Outerbridge grade Ⅱ and Ⅲ(accounting for 80.0%)in patients with malnutrition of tends and vessels,and characterized as Outerbridge grade Ⅲ and Ⅳ(accounting for 85.0%)in patients with dampness blocking tendons and collaterals. The results of nonparametric Wilcoxon rank-sum test showed that the difference among the three groups was statistically significant(P<0.01).(3)The results of least significant difference(LSD)test showed that the degree of articular cartilage injury in the patients with dampness blocking tendons and collaterals was severer than that in the patients with syndrome types of Qi stagnation and blood stasis and malnutrition of tends and vessels,the difference being significant(P<0.01).Conclusion The degree of secondary cartilage damage varies in ACL injury patients with different TCM syndrome types,which can provide an objective basis for TCM syndrome differentiation of ACL injury and the necessity of early reconstruction of the broken ACL. The results clarify the effect of "injured tendons"on"bone injury",and indict the importance to the early treatment of tendon injury,enriching the connotation of the theory of"treatment of both tendons and bones".
Objective To investigate the secondary articular cartilage injury in the anterior cruciate ligament(ACL) injury patients with various traditional Chinese medicine(TCM) syndromes based on the theory of"treatment of both tendons and bones". Methods Sixty patients with ACL break and having taken the arthroscopic surgery were differentiated into various TCM syndrome types by two senior physicians. The patients were differentiated into the types of Qi stagnation and blood stasis,malnutrition of tends and vessels,and dampness blocking tendons and collaterals,20 cases in each syndrome type. ACL break patients with various TCM syndrome types were classified into various grades of Outerbridge and then the data was statistically analyzed. Results(1)The mean course of the disease of ACL injury patients with Qi stagnation and blood stasis was shorter than that of the patients with other two syndrome types,the difference being significant(P<0.01). The mean course of the disease of ACL injury patients with dampness blocking tendons and collaterals only showed an increasing trend compared with that of the patients with malnutrition of tends and vessels,the difference being insignificant(P>0.05).(2)and grade Ⅱ(accounting for95.0%)in patients with Qi stagnation and blood stasis,characterized as Outerbridge grade Ⅱ and Ⅲ(accounting for 80.0%)in patients with malnutrition of tends and vessels,and characterized as Outerbridge grade Ⅲ and Ⅳ(accounting for 85.0%)in patients with dampness blocking tendons and collaterals. The results of nonparametric Wilcoxon rank-sum test showed that the difference among the three groups was statistically significant(P<0.01).(3)The results of least significant difference(LSD)test showed that the degree of articular cartilage injury in the patients with dampness blocking tendons and collaterals was severer than that in the patients with syndrome types of Qi stagnation and blood stasis and malnutrition of tends and vessels,the difference being significant(P<0.01).Conclusion The degree of secondary cartilage damage varies in ACL injury patients with different TCM syndrome types,which can provide an objective basis for TCM syndrome differentiation of ACL injury and the necessity of early reconstruction of the broken ACL. The results clarify the effect of "injured tendons"on"bone injury",and indict the importance to the early treatment of tendon injury,enriching the connotation of the theory of"treatment of both tendons and bones".
引文
[1]敖英芳.关节镜外科学[M].北京:北京大学医学出版社,2012:239.
[2]张世明.中西医结合运动创伤学[M].北京:北京大学出版社,2008:395.
[3]Outerbridge R E.The etiology of chondromalacia patellae[J].JBone Joint Surg Br,1961,43B:752.
[4]孙树椿,孙之镐.中医筋伤学[M].北京:人民卫生出版社,2008:132.
[5]黄枫,郑晓辉,周琦石.陈基长治骨疗伤中“筋骨并重”治疗原则浅析[J].中医药学刊,2005,23(4):599.
[6]叶树森,金鸿宾,王志彬.筋骨并重的临床理念[J].辽宁中医药大学学报,2008,10(3):54.
[7]徐雁,敖英芳.前交叉韧带断裂继发软骨损伤的临床研究[J].中国运动医学杂志,2002,21(1):7.
[8]Andriacchi T,Dyrby C.Interactions between kinematics and loading during walking for the normal and ACL deficient knee[J].J Biomech,2005,38(2):293.
[9]Georgoulis A D,Papadonikolakis A,Papageorgiou C D,et al.Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking[J].Am J Sports Med,2003,31(1):75.
[10]刘锋.龙鳖胶囊治疗绝经后妇女膝骨性关节炎的临床研究[D].广州:广州中医药大学,2005.
[11]郑素明,关俊辉.膝骨性关节炎中医证型与其关节镜下表现关系的临床研究[J].广州中医药大学学报,2012,29(4):377.
[2]张世明.中西医结合运动创伤学[M].北京:北京大学出版社,2008:395.
[3]Outerbridge R E.The etiology of chondromalacia patellae[J].JBone Joint Surg Br,1961,43B:752.
[4]孙树椿,孙之镐.中医筋伤学[M].北京:人民卫生出版社,2008:132.
[5]黄枫,郑晓辉,周琦石.陈基长治骨疗伤中“筋骨并重”治疗原则浅析[J].中医药学刊,2005,23(4):599.
[6]叶树森,金鸿宾,王志彬.筋骨并重的临床理念[J].辽宁中医药大学学报,2008,10(3):54.
[7]徐雁,敖英芳.前交叉韧带断裂继发软骨损伤的临床研究[J].中国运动医学杂志,2002,21(1):7.
[8]Andriacchi T,Dyrby C.Interactions between kinematics and loading during walking for the normal and ACL deficient knee[J].J Biomech,2005,38(2):293.
[9]Georgoulis A D,Papadonikolakis A,Papageorgiou C D,et al.Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking[J].Am J Sports Med,2003,31(1):75.
[10]刘锋.龙鳖胶囊治疗绝经后妇女膝骨性关节炎的临床研究[D].广州:广州中医药大学,2005.
[11]郑素明,关俊辉.膝骨性关节炎中医证型与其关节镜下表现关系的临床研究[J].广州中医药大学学报,2012,29(4):377.