激光膝三针治疗全膝关节置换术后功能障碍的临床研究
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摘要
目的：
对照观察比较靳氏膝三针穴位激光照射与伪穴位激光照射对微创人工全膝关节置换(MIS-TKA)术后中老年患者的临床疗效,并探讨其作用机理,以初步评价靳氏膝三针穴位激光照射运用于微创人工全膝关节置换(MIS-TKA)术后改善膝关节局部不适的可行性及临床价值,从而可使患者能持续康复治疗以减轻粘连,改善关节活动度,提高术后疗效,并且能缩短治疗疗程,降低医疗成本。
方法：
将60例符合纳入标准的微创全膝关节置换术(MIS-TKA)后患者随机分为三组,每组20例,三组均接受相同机理的非甾体类抗炎药(NSAIDs)与相同的康复治疗,除此之外,以4周膝三针(梁丘、血海、膝眼)穴位激光照射者为治疗组,4周伪穴位激光照射者为对照组,2周伪穴位激光照射与2周穴位激光照射者为对照-治疗组,分别于治疗2周后与4周后以WOMAC量表、HSS量表评分,并测量膝关节活动角度、膝关节周径与计时起立行走测试(TUGT)进行疗效比较。
结果：
以变异数分析(Analysis of Variance, ANOVA)与共变数分析(Analysis of Covariance, ANCOVA)显示治疗2周后,三组患者的WOMAC总计分均有降低,其组间差异具有统计学意义(P=0.014),治疗后各项目中,在疼痛、僵硬的疗效评定上,治疗组优于对照组与对照治疗组(P<0.05)。HSS,总计分则三组患者均有增加,其组间差异具有统计学意义(P=0.016),治疗后各项目中,在疼痛的疗效评定上,治疗组优于对照组与对照治疗组(P<0.05)。膝关节活动角度、膝关节周径与计时起立行走测试(TUGT)的评定上,三组患者的均较治疗前改善,但组间比较,差异无显着性意义(P>0.05)。
治疗4周后,三组患者的WOMAC,总计分均较治疗2周后降低,其组间差异具有统计学意义(P=0.000),治疗后各项目中,在疼痛、僵硬、生理功能的疗效评定上,治疗组与对照治疗组优于对照组(P<0.05)。HSS,总计分则三组患者均较治疗2周后增加,其组间差异具有统计学意义(P=0.000),治疗后各项目中,在疼痛、功能的疗效评定上,治疗组与对照治疗组优于对照组(P<0.05)。膝关节活动角度、膝关节周径与计时起立行走测试(TUGT)的评定上,三组患者均较治疗2周后改善,其中膝关节活动角度与周径的组间比较,差异均有显着性意义(P<0.05),膝关节活动角度与周径疗效评定上,皆为对照-治疗组优于对照组(P<0.05),计时起立行走测试(TUGT)的组间比较,差异则无显着性意义(P>0.05)。
结论：
膝三针穴位激光照射对微创人工全膝关节置换术后患者有确实的疗效,对于患者膝关节的疼痛、僵硬感与日常生理功能有显着的改善作用,本研究可以作为未来临床应用激光针灸于人工全膝关节置换术后患者功能障碍的基础。
Objective
The aim of this study, compared with sham laser acupuncture, was to investigate the effect of laser acupuncture on Jin's3-knee points in middle-aged and elderly adults after minimally invasive surgery total knee arthroplasty (MIS-TKA) and analyze the effectiveness of influence factors to preliminarily assess the possibility of clinical application for MIS-TKA patients to persist rehabilitation so as to reduce adhesion, improve range of motion and increase the profit of total knee arthroplasty surgery. In addition, shortening of the length of stay after operation contributes to reduce medical expenses.
Method
On the basis of inclusion criteria, a total of sixty patients were recruited in this study. They were randomly allocated into experimental (treatment group), control(sham group) or control-experimental groups with20participants in each. Conventional physical therapy programs and NSAIDs of the same mechanism were given to all participants. Besides, the experimental group assumed laser acupuncture on the3-knee points(Liangqiu(ST34), Xuehai (SP10), Xiyan (extra))for four weeks while the control group receiving sham laser acupuncture. The control-experimental group was applied in the first session with two-week sham laser acupuncture and followed by the second session with two-week laser acupuncture. Before and after the first session treatment, the outcome measurement was taken. The same measurement was taken after the second session treatment. The variables measured included WOMAC score, HSS score, knee range of motion, knee circumference, timed up and go test(TUGT).
Results
Results using ANOVA and ANCOVA showed a total WOMAC score was decreased in three groups of patients receiving minimally invasive surgery total knee arthroplasty (MIS-TKA) after the first session and significant difference was found (P=0.014). To analyze the items of pain and stiffness, the experimental group was more effective than the control group(P<0.05). Increase of total HSS score was also noted(P=0.016). To analyze the item of pain, the experimental group was more effective than the control group(P<0.05). Taking measurements of knee range of motion, knee circumference timed up and go test, all of the three groups exhibited improvement, but there were not significantly different within groups (P>0.05).
A total WOMAC score was decreased in three groups of patients receiving minimally invasive surgery total knee arthroplasty (MIS-TKA) after the second session and significant difference was found (P=0.000). To analyze the items of pain, stiffness and physical function, the experimental group was more effective than the control group(P<0.05). Increase of total HSS score was also noted (P=0.000). To analyze the items of pain and function, the experimental group was more effective than the control group (P<0.05). Taking measurements of knee range of motion, knee circumference timed up and go test, all of the three groups exhibited improvement in the second session and the control-experimental group experienced effectiveness in comparison with the control group, while in terras of timed up and go test (TUGT), there were not significantly different within groups (P>0.05).
Conclusions
This study demonstrated a beneficial effect of laser acupuncture on the3-knee points, the effectiveness was shown on pain, stiffness and physical function. The findings can provide leads for investigations of using laser acupuncture for patients with functional impairments after receiving minimally invasive surgery total knee arthroplasty (MIS-TKA) in the future.
对照观察比较靳氏膝三针穴位激光照射与伪穴位激光照射对微创人工全膝关节置换(MIS-TKA)术后中老年患者的临床疗效,并探讨其作用机理,以初步评价靳氏膝三针穴位激光照射运用于微创人工全膝关节置换(MIS-TKA)术后改善膝关节局部不适的可行性及临床价值,从而可使患者能持续康复治疗以减轻粘连,改善关节活动度,提高术后疗效,并且能缩短治疗疗程,降低医疗成本。
方法：
将60例符合纳入标准的微创全膝关节置换术(MIS-TKA)后患者随机分为三组,每组20例,三组均接受相同机理的非甾体类抗炎药(NSAIDs)与相同的康复治疗,除此之外,以4周膝三针(梁丘、血海、膝眼)穴位激光照射者为治疗组,4周伪穴位激光照射者为对照组,2周伪穴位激光照射与2周穴位激光照射者为对照-治疗组,分别于治疗2周后与4周后以WOMAC量表、HSS量表评分,并测量膝关节活动角度、膝关节周径与计时起立行走测试(TUGT)进行疗效比较。
结果：
以变异数分析(Analysis of Variance, ANOVA)与共变数分析(Analysis of Covariance, ANCOVA)显示治疗2周后,三组患者的WOMAC总计分均有降低,其组间差异具有统计学意义(P=0.014),治疗后各项目中,在疼痛、僵硬的疗效评定上,治疗组优于对照组与对照治疗组(P<0.05)。HSS,总计分则三组患者均有增加,其组间差异具有统计学意义(P=0.016),治疗后各项目中,在疼痛的疗效评定上,治疗组优于对照组与对照治疗组(P<0.05)。膝关节活动角度、膝关节周径与计时起立行走测试(TUGT)的评定上,三组患者的均较治疗前改善,但组间比较,差异无显着性意义(P>0.05)。
治疗4周后,三组患者的WOMAC,总计分均较治疗2周后降低,其组间差异具有统计学意义(P=0.000),治疗后各项目中,在疼痛、僵硬、生理功能的疗效评定上,治疗组与对照治疗组优于对照组(P<0.05)。HSS,总计分则三组患者均较治疗2周后增加,其组间差异具有统计学意义(P=0.000),治疗后各项目中,在疼痛、功能的疗效评定上,治疗组与对照治疗组优于对照组(P<0.05)。膝关节活动角度、膝关节周径与计时起立行走测试(TUGT)的评定上,三组患者均较治疗2周后改善,其中膝关节活动角度与周径的组间比较,差异均有显着性意义(P<0.05),膝关节活动角度与周径疗效评定上,皆为对照-治疗组优于对照组(P<0.05),计时起立行走测试(TUGT)的组间比较,差异则无显着性意义(P>0.05)。
结论：
膝三针穴位激光照射对微创人工全膝关节置换术后患者有确实的疗效,对于患者膝关节的疼痛、僵硬感与日常生理功能有显着的改善作用,本研究可以作为未来临床应用激光针灸于人工全膝关节置换术后患者功能障碍的基础。
Objective
The aim of this study, compared with sham laser acupuncture, was to investigate the effect of laser acupuncture on Jin's3-knee points in middle-aged and elderly adults after minimally invasive surgery total knee arthroplasty (MIS-TKA) and analyze the effectiveness of influence factors to preliminarily assess the possibility of clinical application for MIS-TKA patients to persist rehabilitation so as to reduce adhesion, improve range of motion and increase the profit of total knee arthroplasty surgery. In addition, shortening of the length of stay after operation contributes to reduce medical expenses.
Method
On the basis of inclusion criteria, a total of sixty patients were recruited in this study. They were randomly allocated into experimental (treatment group), control(sham group) or control-experimental groups with20participants in each. Conventional physical therapy programs and NSAIDs of the same mechanism were given to all participants. Besides, the experimental group assumed laser acupuncture on the3-knee points(Liangqiu(ST34), Xuehai (SP10), Xiyan (extra))for four weeks while the control group receiving sham laser acupuncture. The control-experimental group was applied in the first session with two-week sham laser acupuncture and followed by the second session with two-week laser acupuncture. Before and after the first session treatment, the outcome measurement was taken. The same measurement was taken after the second session treatment. The variables measured included WOMAC score, HSS score, knee range of motion, knee circumference, timed up and go test(TUGT).
Results
Results using ANOVA and ANCOVA showed a total WOMAC score was decreased in three groups of patients receiving minimally invasive surgery total knee arthroplasty (MIS-TKA) after the first session and significant difference was found (P=0.014). To analyze the items of pain and stiffness, the experimental group was more effective than the control group(P<0.05). Increase of total HSS score was also noted(P=0.016). To analyze the item of pain, the experimental group was more effective than the control group(P<0.05). Taking measurements of knee range of motion, knee circumference timed up and go test, all of the three groups exhibited improvement, but there were not significantly different within groups (P>0.05).
A total WOMAC score was decreased in three groups of patients receiving minimally invasive surgery total knee arthroplasty (MIS-TKA) after the second session and significant difference was found (P=0.000). To analyze the items of pain, stiffness and physical function, the experimental group was more effective than the control group(P<0.05). Increase of total HSS score was also noted (P=0.000). To analyze the items of pain and function, the experimental group was more effective than the control group (P<0.05). Taking measurements of knee range of motion, knee circumference timed up and go test, all of the three groups exhibited improvement in the second session and the control-experimental group experienced effectiveness in comparison with the control group, while in terras of timed up and go test (TUGT), there were not significantly different within groups (P>0.05).
Conclusions
This study demonstrated a beneficial effect of laser acupuncture on the3-knee points, the effectiveness was shown on pain, stiffness and physical function. The findings can provide leads for investigations of using laser acupuncture for patients with functional impairments after receiving minimally invasive surgery total knee arthroplasty (MIS-TKA) in the future.
引文
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