运用髋关节推摇拔伸手法治疗初、早期膝骨关节炎:随机对照研究

Treatment of primary and early knee osteoarthritis with hip joint rotative extending manupilation: a randomized controlled study

目的 观察髋关节推摇拔伸手法治疗初、早期膝骨关节炎(KOA)的临床疗效。方法 2022年9月—2023年5月,于河北中医药大学第一附属医院骨伤三科门诊招募148例初、早期KOA患者,采用计算机生成随机数字,分为试验组(74例,脱落8例)、对照组(74例,脱落11例)。2组患者均进行健康教育,试验组在健康教育的基础上运用髋关节推摇拔伸手法(每2日1次)治疗,对照组在健康教育的基础上口服双氯芬酸钠缓释片(75 mg/d)治疗。连续2周。比较2组患者治疗前后及随访(治疗后2周)3个时间节点的视觉模拟评分法(VAS)评分、西大略和麦克马斯特大学(WOMAC)骨关节炎指数评分,比较2组患者治疗前及随访2个时间节点的简明健康状况(SF-36)量表评分,并评价临床疗效。结果 2组患者治疗后及随访时的VAS评分、WOMAC骨关节炎指数评分均较治疗前降低,且试验组的VAS评分、WOMAC骨关节炎指数评分低于对照组(P<0.05)。随访时试验组患者SF-36量表评分高于对照组(P<0.05)。试验组患者总有效率90.9%,高于对照组的79.4%(P<0.05)。结论 运用髋关节推摇拔伸手法治疗初、早期KOA,对减轻患者疼痛、缓解临床症状、改善关节功能疗效确切,较口服双氯芬酸钠缓释片效果更佳,具有较高的临床应用价值。其作用机制可能是由于手法调整患者股骨旋移状态及股骨头与髋臼相对位置,纠正下肢异常力线,平衡膝关节负重状态,从而达到治疗KOA的作用。

Objective To observe the clinical efficacy of hip joint rotative extending manupilation in the treatment of primary and early knee osteoarthritis(KOA).Methods From September 2022 to May 2023,a total of 148 patients with primary and early KOA were recruited from The First Affiliated Hospital of Hebei University of Chinese Medicine.According to the random numbers generated from computer,the patients were randomly divided into the experimental group(74 cases,including eight dropouts)and the control group(74 cases,including 11 dropouts).Both groups received health education,while the experimental group additionally underwent hip joint rotative extending manupilation every two days,the control group received oral diclofenac sodium sustained-release tablets(75 mg/d).Both groups were treated for 2 weeks.The visual analogue scale(VAS)score and the Western Ontario and McMaster University(WOMAC)osteoarthritis index score were compared between the two groups at three time points:before treatment,after treatment,and at follow-up(2 weeks after treatment).The 36-item Short-Form(SF-36)scale score was compared between the two groups at two time points:before treatment and at follow-up.The clinical efficacy was evaluated.Results The VAS score and WOMAC osteoarthritis index score of the two groups after treatment and at follow-up were lower than those before treatment,and the VAS score and WOMAC osteoarthritis index score of the experimental group were lower than those of the control group(P<0.05).The SF-36 scale score was higher in the experimental group than that in the control group at follow-up(P<0.05).The total effective rate was 90.9%in the experimental group,which was higher than 79.3%in the control group(P<0.05).Conclusion Hip joint rotative extending manupilation is effective for relieving pain,alleviating clinical symptoms,and improving joint function in patients with primary and early KOA.It is more effective than oral diclofenac sodium sustained-release tablets and has greater clinical application value.This may be attributed to manual adjustment of the femur rotation status and the relative position between the femoral head and the acetabulum,correcting the abnormal force line of the lower limbs,and balancing the weight-bearing state of the knee joint,so as to achieve the effect of treating KOA.