骨通贴膏结合免荷型膝关节护具治疗内侧间室膝骨性关节炎临床研究
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摘要
目的观察骨通贴膏与免荷型膝关节护具治疗内侧间室膝骨性关节炎的临床疗效。方法选取114例内侧间室膝骨性关节炎患者,按治疗方式的不同均分为3组,A组为骨通贴膏联合免荷型膝关节护具组(简称贴膏护具组),B组为免荷型膝关节护具组(简称护具组),C组为骨通贴膏组(简称贴膏组)。各组治疗前及治疗后1个月比较股四头肌肌力、双足四点负重d值(简称d值)、压痛和疼痛视觉模拟评分(VAS),结合膝关节功能HSS评分和骨痹的疗效标准评定临床综合疗效。结果共108例患者完成治疗并获得随访,均未出现明显不良反应。治疗后1个月,各组股四头肌肌力、d值均有明显改善(P<0.01),但组间无明显差异(P>0.05);治疗后,各组压痛、VAS及HSS评分均明显改善(P<0.01),且A组改善均优于B组及C组。自拟疗效评价标准显示,各组患者临床疗效比较,差异有统计学意义(χ~2=8.922,P=0.012<0.05),进一步比较,A组和C组中位数有明显差异(χ~2=-20.778,P=0.009<0.01),A组和B组、B组和C组中位数差异无统计学意义(χ~2=-12.431,-8.347,P=0.227,0.699>0.05)。结论骨通贴膏结合免荷型膝关节护具治疗可显著提高内侧间室膝骨性关节炎的临床疗效。
Objective To investigated the clinical effects of Gutong Plastercombined with off-loading brace in treating medial compartment knee osteoarthritis. Methods Totally 114 patients with medial compartment knee osteoarthritis were divided into three groups according to the different treatment methods. The group A was treated with Gutong Plastercombined with off-loading brace,the group B was treated with off-loading brace,the group C was treated with Gutong Plaster. Before treatment and 1 month after treatment,the quadriceps femoris myodynamia,double foot four point weight d value( referred to as d value),VAS and HSS scores were compared between the two groups. The clinical efficacy was evaluated by HSS score and Criteria of heumatism. Results Totally 108 patients finished treatment and followed up for 1 month,there were no adverse reactions in the 3 groups. After 1 months treatment,thequadriceps femoris myodynamia and d value in each group were significantly changed( P < 0. 01),but there was no significant difference among the three groups( P>0. 05). After treatment,the tenderness,VAS and HSS scores of all groups were significantly improved( P < 0. 01),and the improvement of group A was better than that of group B and group C. According to the evaluation standard of efficacy,the clinical effects of the 3 groups had significantly difference( χ~2 = 8. 922,P = 0. 012 < 0. 05),and the difference of median between group A and group C was statistically significant( χ~2 =-20. 778,P = 0. 009<0. 01),the differences of median between group A and group B,group B and group C were not statistically significant( χ~2 =-12. 431,-8. 347,P = 0. 227,0. 699 > 0. 05). Conclusion Gutong Plastercombined with off-loading brace in treating medial compartment knee osteoarthritis can obviously improve the clinical efficacy.
Objective To investigated the clinical effects of Gutong Plastercombined with off-loading brace in treating medial compartment knee osteoarthritis. Methods Totally 114 patients with medial compartment knee osteoarthritis were divided into three groups according to the different treatment methods. The group A was treated with Gutong Plastercombined with off-loading brace,the group B was treated with off-loading brace,the group C was treated with Gutong Plaster. Before treatment and 1 month after treatment,the quadriceps femoris myodynamia,double foot four point weight d value( referred to as d value),VAS and HSS scores were compared between the two groups. The clinical efficacy was evaluated by HSS score and Criteria of heumatism. Results Totally 108 patients finished treatment and followed up for 1 month,there were no adverse reactions in the 3 groups. After 1 months treatment,thequadriceps femoris myodynamia and d value in each group were significantly changed( P < 0. 01),but there was no significant difference among the three groups( P>0. 05). After treatment,the tenderness,VAS and HSS scores of all groups were significantly improved( P < 0. 01),and the improvement of group A was better than that of group B and group C. According to the evaluation standard of efficacy,the clinical effects of the 3 groups had significantly difference( χ~2 = 8. 922,P = 0. 012 < 0. 05),and the difference of median between group A and group C was statistically significant( χ~2 =-20. 778,P = 0. 009<0. 01),the differences of median between group A and group B,group B and group C were not statistically significant( χ~2 =-12. 431,-8. 347,P = 0. 227,0. 699 > 0. 05). Conclusion Gutong Plastercombined with off-loading brace in treating medial compartment knee osteoarthritis can obviously improve the clinical efficacy.
引文
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[8]Kellgren JH,Lawrence JS.Radiological assessment of rheumatoid arthritis[J].Ann Rheum Dis,1957,16(4):485-493.
[9]朱立国,于杰,高景华,等.颈肩部压痛的测定及其在神经根型颈椎病诊疗过程中的意义[J].颈腰痛杂志,2008,29(1):6-9.
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[13]申延清,刘风霞,曹红,等.膝骨关节炎患者的临床表现及相关影响因素[J].中国组织工程研究与临床康复,2011,15(9):1643-1646.
[14]Chutkan NB.The effect of bracing on varus gonarthrosis[J].Orthopedics,2011,34(4):300-301.
[15]Kirkley A,Webster-Bogaert S,Litchfield R,et al.The effect of bracing on varus gonarthrosis[J].J Bone Joint Surg Am,1999,81(4):539-548.
[2]Cahue S,Dunlop D,Hayes K,et al.Varus-valgus alignment in the progression of patellofemoral osteoarthritis[J].Arthritis Rheum,2004,50(7):2184-2190.
[3]万世元,奚小冰.天和骨通贴膏治疗膝骨关节炎的临床疗效评价研究[J].中国医药导刊,2015,17(12):1231-1234.
[4]许金海,王国栋,薛瑞瑞,等.骨通贴膏配合运动疗法治疗膝骨关节炎的随机对照临床研究[J].中国医药导刊,2015,17(12):1265-1269.
[5]Komistek RD,Dennis DA,Northcut EJ,et al.An in vivo analysis of the effectiveness of the osteoarthritic knee brace during heelstrike of gait[J].Arthroplasty,1999,14(6):738-742.
[6]Segal NA.Bracing and orthoses:a review of efficacy and mechanical effects for tibiofemoral osteoarthritis[J].PM R,2012,4(5 Suppl):S89-S96.
[7]Hochberg MC,Altman RD,Brandt KD,et al.Guidelines for the medical management of osteoarthritis.Part II.Osteoarthritis of the knee[J].Arthritis Rheum,1995,38(11):1541-1546.
[8]Kellgren JH,Lawrence JS.Radiological assessment of rheumatoid arthritis[J].Ann Rheum Dis,1957,16(4):485-493.
[9]朱立国,于杰,高景华,等.颈肩部压痛的测定及其在神经根型颈椎病诊疗过程中的意义[J].颈腰痛杂志,2008,29(1):6-9.
[10]Aitken RC.Measurement of feelings using visual analogue scales[J].Proc R Soc Med,1969,62(10):989-993.
[11]Marx RG,Stump TJ,Jones EC,et al.Development and evaluation of an activity scale for disorders of the knee[J].Am J Sports Med,2001,29(2):213.
[12]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:30-31.
[13]申延清,刘风霞,曹红,等.膝骨关节炎患者的临床表现及相关影响因素[J].中国组织工程研究与临床康复,2011,15(9):1643-1646.
[14]Chutkan NB.The effect of bracing on varus gonarthrosis[J].Orthopedics,2011,34(4):300-301.
[15]Kirkley A,Webster-Bogaert S,Litchfield R,et al.The effect of bracing on varus gonarthrosis[J].J Bone Joint Surg Am,1999,81(4):539-548.