“按揉拔抖”理筋手法对膝骨关节炎患者关节功能及炎症因子的影响

Effects of Pressing,Rubbing,Pulling,and Shaking Manipulations for Soothing Soft Tissues on the Joint Function and Inflammatory Factors in Patients with Knee Osteoarthritis

【目的】观察“按揉拔抖”理筋手法对膝骨关节炎患者关节功能及炎症因子的影响。【方法】将88例膝骨关节炎患者随机分为治疗组和对照组,每组各44例。对照组给予玻璃酸钠关节腔注射治疗,治疗组给予“按揉拔抖”理筋手法联合玻璃酸钠关节腔注射治疗,疗程为5周并进行至少6个月的随访。观察2组患者治疗前后疼痛视觉模拟量表(visual analogue scale,VAS)评分、利斯霍姆膝关节功能评价量表(Lysholm knee scoring scale,LKSS)评分以及血清肿瘤坏死因子α(TNF-α)和基质金属蛋白酶9(MMP-9)水平的变化情况,并评价2组患者的临床疗效。【结果】(1)88例患者均获得随访,随访时间为6~10个月,中位数为8个月。(2)治疗5周后,2组患者的整体情况均有不同程度好转,治疗组的总有效率为95.45%(42/44),对照组为81.82%(36/44),组间比较(χ^(2)检验),治疗组的疗效明显优于对照组(P<0.05)。(3)治疗后,2组患者的疼痛感均明显缓解,VAS评分均较治疗前明显降低(P<0.01),且治疗组在缓解疼痛方面作用更优,其VAS评分明显低于对照组(P<0.01)。(4)治疗后,2组患者的膝关节功能均得到改善,LKSS评分均较治疗前明显升高(P<0.01),且治疗组在改善膝关节功能方面作用更优,其LKSS评分明显高于对照组(P<0.01)。(5)治疗后,2组患者的血清TNF-α、MMP-9水平均较治疗前明显降低(P<0.01),且治疗组在降低血清TNF-α、MMP-9水平方面均明显优于对照组(P<0.01)。(6)治疗过程中,2组患者均无感染、血栓形成、静脉炎、神经损伤等不良反应发生。【结论】在玻璃酸钠关节腔注射基础上联合“按揉拔抖”理筋手法治疗,能显著缓解膝骨关节炎患者临床症状,改善患者关节功能,安全有效,其疗效优于单纯玻璃酸钠关节腔注射治疗。

Objective To observe the effect of pressing,rubbing,pulling and shaking manipulations for soothing soft tissues on joint function and inflammatory factors in patients with knee osteoarthritis(KOA).Methods Eightyeight KOA patients were randomly divided into the treatment group and the control group,with 44 patients in each group.The control group was treated with intra-articular injection of sodium hyaluronate,while the treatment group was treated with pressing,rubbing,pulling and shaking manipulations for soothing soft tissues combined with intra-articular injection of sodium hyaluronate.The two groups were treated for a 5-week period and were followed up for at least 6 months.The pain visual analogue scale(VAS)score,Lysholm knee scoring scale(LKSS)score,and serum tumor necrosis factor alpha(TNF-α)and matrix metalloproteinase 9(MMP-9)levels in the two groups were observed before and after treatment.After treatment,the clinical efficacy of the two groups of patients was evaluated.Results(1)All of the 88 patients were followed up for 6 to 10 months,with a median of 8 months.(2)After 5 weeks of treatment,the overall conditions of patients in the two groups were improved to different degrees.The overall effective rate of the treatment group was 95.45%(42/44)and that of the control group was 81.82%(36/44),and the intergroup comparison by chi-square test showed that efficacy of the treatment group was significantly superior to that of the control group(P<0.05).(3)After treatment,the pain of patients in the two groups was significantly relieved,and the pain VAS scores of both groups were significantly decreased compared with those before treatment(P<0.01).The effect on relieving pain in the treatment group was superior to that in the control group,and its pain VAS scores were significantly lower than those of the control group(P<0.01).(4)After treatment,the knee function of patients in both groups was improved,and the LKSS scores were significantly increased compared with those before treatment(P<0.01).The effect on improving knee function in the treatment group was superior to that in the control group,and its LKSS scores were significantly higher than those of the control group(P<0.01).(5)After treatment,the serum TNF-αand MMP-9 levels of patients in the two groups were significantly decreased compared with those before treatment(P<0.01),and the effect on lowering serum TNF-αand MMP-9 levels in the treatment group was superior to that in the control group(P<0.01).(6)During the course of treatment,no adverse reactions such as infection,thrombosis,phlebitis and nerve injury occurred in the two groups.Conclusion The application of pressing,rubbing,pulling and shaking manipulations for soothing soft tissues on the basis of intra-articular injection of sodium hyaluronate is more effective on alleviating the clinical symptoms and improving the joint function of the KOA patients than intraarticular injection of sodium hyaluronate alone,and the combined therapy is safe.