运动针法与整骨疗法治疗创伤性膝关节炎的疗效观察
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摘要
目的:探究运动针法与整骨疗法治疗创伤性膝关节炎的临床疗效。方法:将51例创伤性膝关节炎患者分为3组,即常规组、运动针法组和整骨疗法组。常规组17例,男12例,女5例;年龄(49.4±8.9)岁;病程(4.89±1.52)年;治疗前WOMAC总评分100.77±15.48。运动针法组17例,男11例,女6例;年龄(48.6±10.1)岁;病程(4.21±1.37)年;治疗前WOMAC总评分106.16±14.95。整骨疗法组17例,男8例,女9例;年龄(52.3±8.4)岁;病程(4.79±1.50)年;治疗前WOMAC总评分103.87±10.14。常规组予常规康复治疗,运动针法组采用常规康复治疗方法加运动针法,整骨疗法组采用整骨疗法加常规康复治疗。比较治疗前及治疗4周后3组患者的WOMAC评分及膝关节活动度变化情况。结果:整骨疗法组整体疗效优于常规治疗组(Z=3.151,P=0.005)。治疗前后WOMAC评分,常规组:疼痛23.84±4.66、11.98±2.66,僵硬10.44±1.71、6.42±0.74,日常活动困难程度66.49±11.85、35.80±4.44;运动针法组:疼痛22.64±3.22、8.90±2.19,僵硬11.82±2.57、6.03±1.06,日常活动困难程度71.72±13.59、32.94±4.73;整骨疗法组:疼痛22.38±3.68、10.66±2.75,僵硬11.81±2.08、5.63±1.69,日常活动困难程度69.69±8.96、28.84±5.76。治疗后组间比较,在疼痛得分方面运动针法组优于其他两组,僵硬得分3组间差异无统计学意义,日常活动困难程度整骨疗法组优于其他两组,WOMAC总分运动针法与整骨疗法组均优于常规组,但两者间差异无统计学意义。结论:在常规康复治疗基础上加用运动针法与整骨疗法,对于创伤性膝关节炎患者关节疼痛、关节活动障碍等方面的改善具有积极意义,值得推广。
Objective:To explore the clinical efficacy of exercise acupuncture and osteopathy in the treatment of traumatic knee arthritis. Methods:Fifty one patients with traumatic knee arthritis were divided into three groups :routine group,exercise acupuncture group and osteopathy group. In the routine group,there were 17 cases,12 males and 5 females,with a mean age of(49.4 ±8.9) years old;the averaged course of disease was(4.89 ±1.52) years;total WOMAC score before treatment was100.77±15.48. Seventeen patients(11 males and 6 females) in the exercise acupuncture group were aged(48.6±10.1) years old;the course of disease was(4.21±1.37) years;and the total WOMAC score before treatment was 106.16±14.95. In the osteopathy group,there were 17 cases,8 males and 9 females,with a mean age of(52.3±8.4) years old;the average course of disease was(4.79±1.50) years;total WOMAC score before treatment was 103.87±10.14. The patients in the routine group were treated with routine rehabilitation;the patients in the exercise acupuncture group were treated with routine rehabilitation combined with exercise acupuncture,and the patients in the osteopathy group were treated with osteopathy combined with routine rehabilitation. The changes of WOMAC score and ROM in three groups were compared before treatment and 4 weeks after treatment. Results:The overall effect of osteopathy group was better than that of routine group(Z=3.151,P=0.005). The scores of WOMAC before and after treatment:pain of 23.84±4.66,11.98±2.66,stiffness of 10.44±1.71,6.42±0.74,daily life of 66.49±11.85,35.80±4.44 in the routine group;pain of 22.64±3.22,8.90±2.19,stiffness of 11.82±2.57,6.03±1.06,daily life of 71.72±13.59,32.94±4.73 in the exercise acupuncture group;pain of 22.38±3.68,10.66±2.75,stiffness of 11.81±2.08,5.63±1.69,daily life of 69.69±8.96,28.84±5.76 in the osteopathy group. Compared with the other two groups after treatment,the improvement of pain score in the exercise acupuncture group was better than those in the other two groups. There were no significant differences in stiffness score among the three groups. The degree of difficulty in daily life in the osteopathy group was better than that in the other two groups. The total score of WOMAC in the exercise acupuncture group and the osteopathy group were better than that in the conventional group,but there was no significant difference between the two groups. Conclusion:On the basis of routine rehabilitation treatment,exercise needling and osteopathy have positive significance for the improvement of joint pain and dysfunction of joint movement in patients with traumatic knee arthritis,with certain popularlized value in the treatment of traumatic knee arthritis.
Objective:To explore the clinical efficacy of exercise acupuncture and osteopathy in the treatment of traumatic knee arthritis. Methods:Fifty one patients with traumatic knee arthritis were divided into three groups :routine group,exercise acupuncture group and osteopathy group. In the routine group,there were 17 cases,12 males and 5 females,with a mean age of(49.4 ±8.9) years old;the averaged course of disease was(4.89 ±1.52) years;total WOMAC score before treatment was100.77±15.48. Seventeen patients(11 males and 6 females) in the exercise acupuncture group were aged(48.6±10.1) years old;the course of disease was(4.21±1.37) years;and the total WOMAC score before treatment was 106.16±14.95. In the osteopathy group,there were 17 cases,8 males and 9 females,with a mean age of(52.3±8.4) years old;the average course of disease was(4.79±1.50) years;total WOMAC score before treatment was 103.87±10.14. The patients in the routine group were treated with routine rehabilitation;the patients in the exercise acupuncture group were treated with routine rehabilitation combined with exercise acupuncture,and the patients in the osteopathy group were treated with osteopathy combined with routine rehabilitation. The changes of WOMAC score and ROM in three groups were compared before treatment and 4 weeks after treatment. Results:The overall effect of osteopathy group was better than that of routine group(Z=3.151,P=0.005). The scores of WOMAC before and after treatment:pain of 23.84±4.66,11.98±2.66,stiffness of 10.44±1.71,6.42±0.74,daily life of 66.49±11.85,35.80±4.44 in the routine group;pain of 22.64±3.22,8.90±2.19,stiffness of 11.82±2.57,6.03±1.06,daily life of 71.72±13.59,32.94±4.73 in the exercise acupuncture group;pain of 22.38±3.68,10.66±2.75,stiffness of 11.81±2.08,5.63±1.69,daily life of 69.69±8.96,28.84±5.76 in the osteopathy group. Compared with the other two groups after treatment,the improvement of pain score in the exercise acupuncture group was better than those in the other two groups. There were no significant differences in stiffness score among the three groups. The degree of difficulty in daily life in the osteopathy group was better than that in the other two groups. The total score of WOMAC in the exercise acupuncture group and the osteopathy group were better than that in the conventional group,but there was no significant difference between the two groups. Conclusion:On the basis of routine rehabilitation treatment,exercise needling and osteopathy have positive significance for the improvement of joint pain and dysfunction of joint movement in patients with traumatic knee arthritis,with certain popularlized value in the treatment of traumatic knee arthritis.
引文
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[7]马玉峰,王庆甫,陈兆军,等.膝关节骨性关节炎X线测量与WOMAC评分的多重线性回归分析[J].中国骨伤,2012,25(5):373-376.MA YF,WANG QF,CHEN ZJ,et al.Multiple linear regression analysis of X ray measurement and WOMAC scores of knee osteoarthritis[J].Zhongguo Gu Shang/China J Orthop Trauma,2012,25(5):373-376.Chinese with abstract in English.
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[10]安雪军,宋洁富,魏杰,等.全髋关节置换术治疗髋臼骨折内固定术后继发创伤性髋关节炎的疗效观察[J].中国骨伤,2017,30(3):233-235.AN XJ,SONG JF,WEI J,et al.Total hip arthroplasty for post traumatic arthritis after internal fixation of acetabular fracture[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(3):233-235.Chinese with abstract in English.
[11]卞蓉民.运动针法结合常规针刺治疗颈型颈椎病疗效观察[J].上海针灸杂志,2015,34(12):1216-1218.BIAN RM.Clinical observations on the efficacy of acupuncture kinesitherapy plus conventional acupuncture in treating cervical spondylosis[J].Shang Hai Zhen Jiu Za Zhi,2015,34(12):1216-1218.Chinese.
[12]孙谊.运动针法配合推拿四步疗法治疗腰椎小关节紊乱症的临床疗效观察[J].中医临床研究,2015,7(9):108-109.SUN Y.Curative observation on treatment of lumbar small joint disturbance by acupuncture kinesitherapy combined with four step Tuina[J].Zhong Yi Lin Chuang Yan Jiu,2015,7(9):108-109.Chinese.
[13]Zhang Y,Bao F,Wang Y,et al.Influence of acupuncture in treatment of knee osteoarthritis and cartilage repairing[J].Am J Transl Res,2016,8(9):3995-4002.
[14]刘俊宏.针灸对膝骨关节炎患者TNF-α及关节活动度的影响[J].陕西中医,2018,39(1):116-118.LIU JH.Effect of acupuncture and moxibustion on TNF-αand joint mobility in patients with knee osteoarthritis[J].Shaan Xi Zhong Yi,2018,39(1):116-118.Chinese.
[15]Anderst WJ,Gale T,LeVasseur C,et al.Intervertebral kinematics of the cervical spine before,during,and after high velocity low amplitude manipulation[J].Spine J,2018,18(12):2333-2342.
[16]Harwich AS.Joint manipulation:toward a general theory of high velocity,low amplitude thrust techniques[J].J Chiropr Humanit,2017,24(1):15-23.
[17]夏项军,田山.隔药饼灸配合肌肉能量技术治疗早期膝骨关节炎疗效观察[J].上海针灸杂志,2018,37(4):457-460.XIA XJ,TIAN S.Observations on the efficacy of medicinal cake moxibustion plus muscle energy technique in treating early knee osteoarthritis[J].Shang Hai Zhen Jiu Za Zhi,2018,37(4):457-460.Chinese.
[18]黄莉华,吴毅,刘强.肌肉能量技术联合常规康复训练治疗老年膝骨性关节炎的疗效分析[J].老年医学与保健,2017,23(6):485-487.HUANG LH,WU Y,LIU Q.Effect of muscle energy technology combined with conventional rehabilitation program on elderly patients with knee osteoarthritis[J].Lao Nian Yi Xue Yu Bao Jian,2017,23(6):485-487.Chinese.
[19]陈蔚,郭燕梅,李晓英,等.西安大略和麦克马斯特大学骨关节炎指数的重测信度[J].中国康复理论与实践,2010,16(1):23-24.CHEN W,GUO YM,LI XY,et al.Test retest reliability of western ontario and mcMaster university qsteoarthritis index[J].Zhongguo Kang Fu Li Lun Yu Shi Jian,2010,16(1):23-24.Chinese.
[2]Patzkowski JC,Owens JG,Blanck RV,et al.Management of posttraumatic osteoarthritis with an integrated orthotic and rehabilitation initiative[J].J Am Acad Orthop Surg,2012,20(Suppl 1):S48-S53.
[3]Riordan EA,Little C,Hunter D.Pathogenesis of post traumatic OAwith a view to intervention[J].Best Pract Res Clin Rheumatol,2014,28(1):17-30.
[4]中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.Joint Surgery Group,Orthopaedic Society,Chinese Medical Association.Guidelines for the diagnosis and treatment of osteoarthritis(2018 edition)[J].Zhonghua Gu Ke Za Zhi,2018,38(12):705-715.Chinese.
[5]Kellgren JH,Lawrence JS.Radiological assessment of osteo arthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[6]Jalal Y,Ahmad A,Rahman AU,et al.Effectiveness of muscle energy technique on cervical range of motion and pain[J].J Pak Med Assoc,2018,68(5):811-813.
[7]马玉峰,王庆甫,陈兆军,等.膝关节骨性关节炎X线测量与WOMAC评分的多重线性回归分析[J].中国骨伤,2012,25(5):373-376.MA YF,WANG QF,CHEN ZJ,et al.Multiple linear regression analysis of X ray measurement and WOMAC scores of knee osteoarthritis[J].Zhongguo Gu Shang/China J Orthop Trauma,2012,25(5):373-376.Chinese with abstract in English.
[8]Driban JB,Eaton CB,Lo GH,et al.Association of knee injuries with accelerated knee osteoarthritis progression:data from the Osteoarthritis Initiative[J].Arthritis Care Res(Hoboken),2014,66(11):1673-1679.
[9]Lieberthal J,Sambamurthy N,Scanzello CR.Inflammation in joint injury and post traumatic osteoarthritis[J].Osteoarthritis Cartilage,2015,23(11):1825-1834.
[10]安雪军,宋洁富,魏杰,等.全髋关节置换术治疗髋臼骨折内固定术后继发创伤性髋关节炎的疗效观察[J].中国骨伤,2017,30(3):233-235.AN XJ,SONG JF,WEI J,et al.Total hip arthroplasty for post traumatic arthritis after internal fixation of acetabular fracture[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(3):233-235.Chinese with abstract in English.
[11]卞蓉民.运动针法结合常规针刺治疗颈型颈椎病疗效观察[J].上海针灸杂志,2015,34(12):1216-1218.BIAN RM.Clinical observations on the efficacy of acupuncture kinesitherapy plus conventional acupuncture in treating cervical spondylosis[J].Shang Hai Zhen Jiu Za Zhi,2015,34(12):1216-1218.Chinese.
[12]孙谊.运动针法配合推拿四步疗法治疗腰椎小关节紊乱症的临床疗效观察[J].中医临床研究,2015,7(9):108-109.SUN Y.Curative observation on treatment of lumbar small joint disturbance by acupuncture kinesitherapy combined with four step Tuina[J].Zhong Yi Lin Chuang Yan Jiu,2015,7(9):108-109.Chinese.
[13]Zhang Y,Bao F,Wang Y,et al.Influence of acupuncture in treatment of knee osteoarthritis and cartilage repairing[J].Am J Transl Res,2016,8(9):3995-4002.
[14]刘俊宏.针灸对膝骨关节炎患者TNF-α及关节活动度的影响[J].陕西中医,2018,39(1):116-118.LIU JH.Effect of acupuncture and moxibustion on TNF-αand joint mobility in patients with knee osteoarthritis[J].Shaan Xi Zhong Yi,2018,39(1):116-118.Chinese.
[15]Anderst WJ,Gale T,LeVasseur C,et al.Intervertebral kinematics of the cervical spine before,during,and after high velocity low amplitude manipulation[J].Spine J,2018,18(12):2333-2342.
[16]Harwich AS.Joint manipulation:toward a general theory of high velocity,low amplitude thrust techniques[J].J Chiropr Humanit,2017,24(1):15-23.
[17]夏项军,田山.隔药饼灸配合肌肉能量技术治疗早期膝骨关节炎疗效观察[J].上海针灸杂志,2018,37(4):457-460.XIA XJ,TIAN S.Observations on the efficacy of medicinal cake moxibustion plus muscle energy technique in treating early knee osteoarthritis[J].Shang Hai Zhen Jiu Za Zhi,2018,37(4):457-460.Chinese.
[18]黄莉华,吴毅,刘强.肌肉能量技术联合常规康复训练治疗老年膝骨性关节炎的疗效分析[J].老年医学与保健,2017,23(6):485-487.HUANG LH,WU Y,LIU Q.Effect of muscle energy technology combined with conventional rehabilitation program on elderly patients with knee osteoarthritis[J].Lao Nian Yi Xue Yu Bao Jian,2017,23(6):485-487.Chinese.
[19]陈蔚,郭燕梅,李晓英,等.西安大略和麦克马斯特大学骨关节炎指数的重测信度[J].中国康复理论与实践,2010,16(1):23-24.CHEN W,GUO YM,LI XY,et al.Test retest reliability of western ontario and mcMaster university qsteoarthritis index[J].Zhongguo Kang Fu Li Lun Yu Shi Jian,2010,16(1):23-24.Chinese.