热敏灸联合功能训练在膝骨性关节炎康复治疗中的应用及对患者关节功能的影响
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摘要
目的探讨热敏灸联合功能训练在膝骨性关节炎康复治疗中的应用效果及对患者关节功能的影响。方法选择宁波大学医学院附属医院2017年6月—2018年3月治疗的膝骨性关节炎患者64例,采用随机数字表分为对照组和观察组,各32例。对照组给予热敏灸治疗,观察组在对照组基础上联合功能训练,治疗3个月后评估患者治疗效果,采用JOA膝关节功能评分分别从疼痛及步行能力、肿胀、疼痛及上下楼梯能力和屈角度及强直、高度挛缩4个方面对患者关节功能进行评估;采用膝骨关节炎生活质量量表从社会、躯体、工作、症状及影响5个维度评估患者效果,比较2组患者临床效果、关节功能及生活质量。结果观察组治疗3个月总有效率为93.75%,高于对照组的71.88%(P<0.05);2组治疗3个月后疼痛及步行能力、肿胀、疼痛上下楼梯能力、屈角度及强直、高度挛缩评分,均高于治疗前(均P<0.05);观察组治疗3个月后疼痛及步行能力、肿胀、疼痛及上下楼梯能力、屈角度及强直、高度挛缩评分,均高于对照组(均P<0.05);2组治疗3个月后社会、躯体、工作、症状及影响评分,均高于治疗前(均P<0.05);且观察组均高于对照组(均P<0.05)。结论热敏灸联合功能训练用于膝骨性关节炎康复治疗中能获得较高的近期疗效,有助于改善患者关节功能,促进膝关节功能恢复,改善临床症状,从而提高患者生活质量,值得推广应用。
Objective To explore the effect of heat-induced moxibustion combined with functional training on rehabilitation of knee osteoarthritis and its effect on joint function. Methods Sixty-four patients with knee osteoarthritis treated from June 2017 to March 2018 were selected as subjects and divided into the control group(n=32) and the observation group(n=32) using a random number table. Control group was given thermal moxibustion treatment, and the observation group was provided with joint function training on the basis of the control group. Three months after treatment, the treatment effect was evaluated via the JOA knee function score respectively from pain and walking ability of pain, swelling, up and down the stairs and flexion angle and the rigidity, highly evaluating contracture of joint function in patients with four aspects. The knee osteoarthritis quality of life scale was used to evaluate the effect of patients from five dimensions of society, body, work, symptoms and influence, and to compare the clinical effect, joint function and quality of life of the two groups. Results The total effective rate of thermal moxibustion combined with functional exercise for 3 months in the observation group was 93.75%, significantly higher than 71.88% in the control group(P<0.05). The scores of pain, walking ability, swelling, ability of walking up and down stairs, flexion Angle, rigidity and height contracture were all higher in the two groups 3 months after treatment than before treatment(all P<0.05). The scores of pain, walking ability, swelling, ability of walking up and down stairs, flexion Angle, rigidity and height contracture in the observation group were all higher than those in the control group(all P<0.05). After 3 months of treatment, the scores of social, physical, work, symptom and influence in both groups were higher than those before treatment(all P<0.05) while the scores in the observation group were all higher than those in the control group(all P<0.05). Conclusion The application of thermal moxibustion combined with functional training in the rehabilitation treatment of knee osteoarthritis can achieve a relatively high short-term efficacy, which is helpful to improve the joint function of patients, promote the recovery of knee joint function, improve the clinical symptoms of patients, and thus improve the quality of life of patients.
Objective To explore the effect of heat-induced moxibustion combined with functional training on rehabilitation of knee osteoarthritis and its effect on joint function. Methods Sixty-four patients with knee osteoarthritis treated from June 2017 to March 2018 were selected as subjects and divided into the control group(n=32) and the observation group(n=32) using a random number table. Control group was given thermal moxibustion treatment, and the observation group was provided with joint function training on the basis of the control group. Three months after treatment, the treatment effect was evaluated via the JOA knee function score respectively from pain and walking ability of pain, swelling, up and down the stairs and flexion angle and the rigidity, highly evaluating contracture of joint function in patients with four aspects. The knee osteoarthritis quality of life scale was used to evaluate the effect of patients from five dimensions of society, body, work, symptoms and influence, and to compare the clinical effect, joint function and quality of life of the two groups. Results The total effective rate of thermal moxibustion combined with functional exercise for 3 months in the observation group was 93.75%, significantly higher than 71.88% in the control group(P<0.05). The scores of pain, walking ability, swelling, ability of walking up and down stairs, flexion Angle, rigidity and height contracture were all higher in the two groups 3 months after treatment than before treatment(all P<0.05). The scores of pain, walking ability, swelling, ability of walking up and down stairs, flexion Angle, rigidity and height contracture in the observation group were all higher than those in the control group(all P<0.05). After 3 months of treatment, the scores of social, physical, work, symptom and influence in both groups were higher than those before treatment(all P<0.05) while the scores in the observation group were all higher than those in the control group(all P<0.05). Conclusion The application of thermal moxibustion combined with functional training in the rehabilitation treatment of knee osteoarthritis can achieve a relatively high short-term efficacy, which is helpful to improve the joint function of patients, promote the recovery of knee joint function, improve the clinical symptoms of patients, and thus improve the quality of life of patients.
引文
[1] 于泉,赵云飞,王玉玲.迈之灵治疗膝关节骨性关节炎合并滑膜炎疗效分析[J].中国医药,2013,8(8):1132-1133.
[2] 廖化敏,何增义.红外线照射联合穴位贴敷及功能锻炼治疗老年膝骨性关节炎的临床疗效及护理[J].激光杂志,2016,37(1):152-154.
[3] 潘化平,冯慧,陈攻,等.运动方式对膝关节骨性关节炎患者运动功能及关节液中NO、MMPs-9水平影响的研究[J].中国康复医学杂志,2016,31(9):960-963.
[4] LOREDO-PéREZ A A,MONTALVO-BLANCO C E,HERNáNDEZ-GONZáLEZ L I,et al.High-fat diet exacerbates pain-like behaviors and periarticular bone loss in mice with CFA-induced knee arthritis[J].Obesity,2016,24(5):1106-1115.
[5] 佚名.温针灸阳陵泉联合等速肌力训练治疗膝关节骨性关节炎的疗效观察[J].中国中西医结合杂志,2018,38(6):655-657.
[6] ?IESTAD B E,WHITE D K,BOOTON R,et al.Longitudinal course of physical function in people with symptomatic knee osteoarthritis:data from the multicenter osteoarthritis study and the osteoarthritis initiative[J].Arthritis Care Res (Hoboken),2016,68(3):325-331.
[7] 王晓敏,赖震,包晓萍,等.中药熏蒸联合玻璃酸钠关节注射治疗老年膝骨性关节炎的疗效观察[J].中华物理医学与康复杂志,2017,39(2):152-153.
[8] 高明霞,林强,陈安亮,等.低强度脉冲超声联合药物治疗创伤性膝关节骨性关节炎的临床研究[J].中国康复医学杂志,2016,31(8):862-867.
[9] 兰纯娜,王如蜜,周罗治非,等.有氧运动在预防兔膝骨关节炎发生中的作用及其机制研究[J].中华物理医学与康复杂志,2016,38(8):561-565.
[10] SONG G M,TIAN X,JIN Y H,et al.Moxibustion is an alternative in treating knee osteoarthritis:the evidence from systematic review and meta-analysis[J].Medicine,2016,95(6):e2790.
[11] 杨静怡,何红晨,宗慧燕,等.步态分析在膝关节骨性关节炎中的应用进展[J].中国康复医学杂志,2016,31(10):1168-1170.
[12] 刘扬.白细胞介素-24基因在膝关节骨性关节炎发病中的作用及意义[J].中国现代医学杂志,2016,26(13):63-67.
[13] 王敏,刘绍凡,赵蓉,等.高频超声在膝骨性关节炎药物治疗疗效评价中的应用价值[J].重庆医学,2017,46(26):3709-3711.
[14] HOCHBERG M C,MARTEL-PELLETIER J,MONFORT J,et al.Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis:a multicentre,randomised,double-blind,non-inferiority trial versus celecoxib[J].Ann Rheum Dis,2016,75(1):37-44.
[15] 田少奇,王斌,刘江俊,等.微创单髁置换治疗膝关节骨性关节炎及骨坏死的中期临床疗效[J].中华创伤杂志,2016,32(7):632-637.
[16] 冯激波,吴恙,倪东亮,等.唑来膦酸联合透明质酸钠治疗绝经后骨质疏松合并膝骨关节炎的临床效果分析[J].中华全科医学,2016,14(6):928-930.
[17] 岳萍,高亮,陈默,等.温针灸对膝骨性关节炎兔行为学及关节软骨肿瘤坏死因子-α、基质金属蛋白酶-3含量的影响[J].针刺研究,2016,41(3):235-239.
[18] DE ROOIJ M,VAN DER LEEDEN M,HEYMANS M W,et al.Course and predictors of pain and physical functioning in patients with hip osteoarthritis:systematic review and meta-analysis[J].J Rehabil Med,2016,48(3):245-252.
[19] 罗学辉,谢学文,曾文磊,等.关节镜下有限清理术配合伤科黄水外敷治疗膝骨性关节炎的效果[J].广东医学,2016,37(7):1078-1081.
[20] 韩艳,周文芳,吴云刚,等.针刀疗法联合玻璃酸钠治疗40例膝骨关节炎的临床研究[J].中华全科医学,2016,14(2):215-216.
[2] 廖化敏,何增义.红外线照射联合穴位贴敷及功能锻炼治疗老年膝骨性关节炎的临床疗效及护理[J].激光杂志,2016,37(1):152-154.
[3] 潘化平,冯慧,陈攻,等.运动方式对膝关节骨性关节炎患者运动功能及关节液中NO、MMPs-9水平影响的研究[J].中国康复医学杂志,2016,31(9):960-963.
[4] LOREDO-PéREZ A A,MONTALVO-BLANCO C E,HERNáNDEZ-GONZáLEZ L I,et al.High-fat diet exacerbates pain-like behaviors and periarticular bone loss in mice with CFA-induced knee arthritis[J].Obesity,2016,24(5):1106-1115.
[5] 佚名.温针灸阳陵泉联合等速肌力训练治疗膝关节骨性关节炎的疗效观察[J].中国中西医结合杂志,2018,38(6):655-657.
[6] ?IESTAD B E,WHITE D K,BOOTON R,et al.Longitudinal course of physical function in people with symptomatic knee osteoarthritis:data from the multicenter osteoarthritis study and the osteoarthritis initiative[J].Arthritis Care Res (Hoboken),2016,68(3):325-331.
[7] 王晓敏,赖震,包晓萍,等.中药熏蒸联合玻璃酸钠关节注射治疗老年膝骨性关节炎的疗效观察[J].中华物理医学与康复杂志,2017,39(2):152-153.
[8] 高明霞,林强,陈安亮,等.低强度脉冲超声联合药物治疗创伤性膝关节骨性关节炎的临床研究[J].中国康复医学杂志,2016,31(8):862-867.
[9] 兰纯娜,王如蜜,周罗治非,等.有氧运动在预防兔膝骨关节炎发生中的作用及其机制研究[J].中华物理医学与康复杂志,2016,38(8):561-565.
[10] SONG G M,TIAN X,JIN Y H,et al.Moxibustion is an alternative in treating knee osteoarthritis:the evidence from systematic review and meta-analysis[J].Medicine,2016,95(6):e2790.
[11] 杨静怡,何红晨,宗慧燕,等.步态分析在膝关节骨性关节炎中的应用进展[J].中国康复医学杂志,2016,31(10):1168-1170.
[12] 刘扬.白细胞介素-24基因在膝关节骨性关节炎发病中的作用及意义[J].中国现代医学杂志,2016,26(13):63-67.
[13] 王敏,刘绍凡,赵蓉,等.高频超声在膝骨性关节炎药物治疗疗效评价中的应用价值[J].重庆医学,2017,46(26):3709-3711.
[14] HOCHBERG M C,MARTEL-PELLETIER J,MONFORT J,et al.Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis:a multicentre,randomised,double-blind,non-inferiority trial versus celecoxib[J].Ann Rheum Dis,2016,75(1):37-44.
[15] 田少奇,王斌,刘江俊,等.微创单髁置换治疗膝关节骨性关节炎及骨坏死的中期临床疗效[J].中华创伤杂志,2016,32(7):632-637.
[16] 冯激波,吴恙,倪东亮,等.唑来膦酸联合透明质酸钠治疗绝经后骨质疏松合并膝骨关节炎的临床效果分析[J].中华全科医学,2016,14(6):928-930.
[17] 岳萍,高亮,陈默,等.温针灸对膝骨性关节炎兔行为学及关节软骨肿瘤坏死因子-α、基质金属蛋白酶-3含量的影响[J].针刺研究,2016,41(3):235-239.
[18] DE ROOIJ M,VAN DER LEEDEN M,HEYMANS M W,et al.Course and predictors of pain and physical functioning in patients with hip osteoarthritis:systematic review and meta-analysis[J].J Rehabil Med,2016,48(3):245-252.
[19] 罗学辉,谢学文,曾文磊,等.关节镜下有限清理术配合伤科黄水外敷治疗膝骨性关节炎的效果[J].广东医学,2016,37(7):1078-1081.
[20] 韩艳,周文芳,吴云刚,等.针刀疗法联合玻璃酸钠治疗40例膝骨关节炎的临床研究[J].中华全科医学,2016,14(2):215-216.