电针对膝关节骨性关节炎患者登梯活动时下肢动力学影响的临床研究

Kinetic mechanism of electroacupuncture for stair climbing in knee osteoarthritis patients

目的:采用三维运动分析观察电针治疗对膝关节骨性关节炎(KOA)患者登梯活动时动力学即不同平面关节负荷的影响,为研究针灸康复疗法的生物力学机制提供参考。方法:根据随机数字表法将40例KOA患者随机分成观察组和对照组,每组20例,最终各18例完成研究。观察组穴取内膝眼、犊鼻、阳陵泉、阴陵泉、血海、梁丘、足三里,对照组于经穴旁开约2 cm处浅刺。观察组于内膝眼和阴陵泉、梁丘和阳陵泉连接电针仪,对照组在其相应穴旁处连接电针仪。观察组采用频率为2 Hz的连续方波,对照组无电流输出。两组各治疗11次,共3周。于治疗前后进行登梯步态检测,分析上、下梯步速及登梯动力学参数(矢状面髋、膝、踝关节屈伸峰力矩及冠状面膝内收外力矩)的变化。结果:治疗后,观察组上、下梯步速均较治疗前明显增加(P<0.05,P<0.01),上、下梯时踝关节跖屈肌峰力矩、上梯时第二膝内收外力矩峰值(PEKAM2)均明显增大(P<0.05,P<0.01)。对照组治疗后,下梯时第一膝内收外力矩峰值(PEKAM1)和PEKAM2均较治疗前减小(P<0.05,P<0.01)。观察组上梯时步速差值与踝跖屈肌群力矩差值呈正相关(r=0.598,P<0.01)。排除步速的影响后,上梯时踝跖屈肌峰力矩的组内差异无统计学意义(P>0.05)。结论:电针能提高KOA患者的上下梯速度,对登梯过程中矢状面和冠状面的关节负荷均有一定的影响,改善了关节负荷的能力,但上梯的关节负荷改变可能与步速的增加有关。电针与最小针刺对关节负荷的效应不同,但具体机制不够明确,有待进一步深入探讨。

Objective To observe the kinetic change that reflects joint loading in different planes during stair climbing in knee osteoarthritis（KOA） after electroacupuncture（EA） by three-dimensional motion analysis,so as to provide reference for its biomechanical mechanism treated with acupuncture.Methods Forty KOA patients,in accordance with the random number table,were assigned into an observation group and a control group,20 cases in each one and finally 18 cases completed.Acupoints in the observation group were Neixiyan（EX-LE 4）,Dubi（ST 35）,Yanglingquan（GB 34）,Yinlingquan（SP 9）,Xuehai（SP 10）,Liangqiu（ST 34） and Zusanli（ST 36）;points in the control groups were located about 2 cm next to the above acupoints with shallow acupuncture.EA was connected at Neixiyan（EX-LE 4） and Yinlingquan（SP 9）,Liangqiu（ST 34） and Yanglingquan（GB 34）.The frequency was 2 Hz with continuous wave in the observation group and there was no current in the control group for the corresponding points.All the treatment was given for 3 weeks,totally 11 times.Climbing stairs gait was measured before and after treatment.Velocities and kinetic parameters during ascending and descending stairs were analyzed,including flexion and extension peak torques of hip,knee,ankle on the vertical plane,external knee adduction moment on the coronal plane.Results After treatment in the observation group,velocities during ascending and descending stairs significantly increased（P〈0.05,P〈0.01）;maximal ankle plantar flexor moments during ascending and descending stairs and the second peak external knee adduction moment（PEKAM2） during ascending stairs significantly increased（P〈0.05,P〈0.01）.After treatment in the control group,the first peak external knee adduction moment（PEKAM1） and PEKAM2 during descending stairs were less than those before treatment（P〈0.05,P〈0.01）.In the observation group,the difference value（DV） of velocity before and after treatment was positively correlated to DV in the torque of ankle plantar flexors during ascending stairs in the observation group（r=0.598,P〈0.01）.Excluding the impact of velocity,the DV of the maximal torque of ankle plantar flexors during ascending stairs didn＇t show difference in the observation group（P〈0.05）.Conclusion EA can increase the velocities of ascending and descending stairs of KOA patients.It improves the loading capacity of knee joint on both sagittal and coronary planes.But its effect during ascending may be correlated with the increase of velocity.The mechanism of different effects between EA and minimal acupuncture on joint moments is still unclear and warrants further study.