针刺结合康复指导治疗膝关节骨性关节炎的疗效评估

Curative effect of acupuncture combined with rehabilitation guidance on knee osteoarthritis

目的:探讨针刺与日常生活活动指导、康复锻炼结合治疗对膝关节骨性关节炎的干预作用。方法:选择2002-02/2004-05在上海第九人民医院中医科门诊就诊的膝关节骨性关节炎患者42例,均知情同意。分为2组,针刺组20例,结合治疗组22例。针刺组患者仅接受针刺治疗,选穴原则:内外膝眼,血海,梁丘,委中,阳陵泉,采用平补平泻的针刺手法,留针30min,前2周治疗3次/周,后两2周2次/周。结合治疗组患者在针刺基础上,另外接受详细康复指导,包括:①过度使用患肢关节有害。②适当的功能锻炼,3次/d,每次10～15min,两侧下肢交替进行。③肥胖患者积极减肥以减轻体质量。两组分别治疗4周,根据Lysholm膝关节评分量表进行膝关节运动功能评估,将膝关节症状分为8个项目:①跛行:无～严重或恒定性为5～0分。②需要支持:无～不能负重为5～0分。③交锁:无交锁且无卡住的感觉～检查时发现交锁为15～0分。④不稳定:无一时性软踏～每一步都出现为25～0分。⑤疼痛:无～经常疼痛为25～0分。⑥肿胀:无～经常性为10～0分。⑦上下楼梯:无困难～不可能为10～0分。⑧下蹲:无困难～不可能为5～0分。结果:进入结果分析针刺组和结合治疗组分别为20和22例。①各项Lysholm膝关节运动功能评分比较:针刺组及结合治疗组患者治疗4周后评分犤(2.50±1.70,3.15±1.88,7.80±2.04,14.25±2.55,9.52±0.97,6.60±2.35,5.80±2.42,3.60±0.82);(4.59±1.26,3.45±1.88,12.05±2.52,20.45±3.42,22.95±2.52,7.82±2.04,7.09±1.82,4.23±0.43)犦均较治疗前显著提高犤(1.70±1.84,1.60±1.50,6.20±2.42,10.25±3.80,5.36±0.78,4.00±1.03,2.90±2.20,2.50±1.70);(2.00±1.60,1.73±1.39,8.18±3.97,10.82±4.51,4.77±3.93,4.13±1.98,3.00±2.20,2.64±1.68)犦(t=2.072～7.227,P<0.05～0.01)。②治疗前后评分的差值:结合治疗组显著高于针刺组(t=2.315～4.960,P<0.05)。结论:针刺组和结合治疗组均能有效改善膝关节骨性关节炎患者的膝关节运动功能,但结合治疗组的干预效果更加显著,能更有效的达到减轻症状、维持运动功能的目的,说明日常的康复指导和患者的自我管理是治疗膝关节骨性关节炎的关键。

AIM： To observe the therapeutic effect of acupuncture combined with guidance of activities of daily living（ADL） and rehabilitation exercise in the treatment of knee osteoarthritis. METHODS： From February 2002 to May 2004, 42 patients with knee osteoarthfitis were treated in the outpatient department of Traditional Chinese Medicine, Shanghai Ninth People＇s Hospital. They were informed consent, and then divided into two groups： acupuncture group（n=20） and combined treatment group （n=22）, The patients in acupuncture group received only acupuncture treatment based on the principle： internal and external Xiyan（Extra 36）, Xuehai（Sp 10）, Liangqiu（S 34）, Weizhong（B 40）, Yanglingquan（G 34）, and the reinforcing and reducing method was used and retained for 30 minutes, 3 times a week in the first two weeks and twice a week in the following two weeks. The patients in combined treatmerit group received regular rehabilitation guidance besides the acupuncture treatment, including： ①To explain to the patients the harm of using knee joints excessively, ②Doing physical exercise appropriately on double lower limbs alternatively, 3 times a day, 10 to 15 minutes for each, ③To propose patients lose weight if necessary. At 4 weeks after treatment, the motor function of knee joints was evaluated in all the cases according to Lysholm knee scoring scale, and the symptoms of knee joints were aggregated into eight items： ①Limp, none to severity or constancy as 5 to 0 marks, ②demands for support, none to being unable to loading weight as 5 to 0 marks, ③locking, no locking and no blocking to locking as 15 to 0 marks, ④instability, no transient soft step to soft step as 25 to 0 marks, ⑤pain, no pain to pain as 25 to 0 marks, ⑥swelling, no swelling to often swelling as 10 to 0 marks, ⑦stair activity, no difficuhy to inability as 10 to 0 marks , ⑧squat, no difficulty to inability as 5 to 0 marks. RESULTS： In the result analysis, 20 patients in the acupuncture group and 22 in the combined treatment group were involved. ① In the comparison of motor function of knee joint in Lysholm knee scoring scale： The scores of all the indexes in Lysholm knee scoring scale in the acupuncture group and the combined treatment group at 4 weeks after treatment was 2.50±1.70, 3.15±1.88, 7.80±2.04, 14.25±2.55, 9.52±0.97, 6.60±2.35, 5.80±2.42, 3.60±0.82 and 4.59±1.26, 3.45±1.88, 12.05±2.52, 20.45±3.42, 22.95±2.52, 7.82±2.04, 7.09±1.82, 4.23±0.43, significantlCy higher than those before treatment [（1.70±1.84, 1.60±1.50, 6.20±2.42, 10.25±3.80, 5.36±0.78, 4.00±1.03, 2.90±2.20, 2.50±1.70） and （2.00±1.60, 1.73±1.39, 8.18±3.97, 10.82±4.51, 4.77±3.93, 4.13±1.98, 3.00±2.20, 2.64±1.68）]（t=2.072 to 7.227, P 〈 0.05 to 0.01）. ②The score difference of Lysholm knee scoring scale after treatment and before treatment was significantly higher in the combined treatment group than in the acupuncture group（t=2.315 to 4.960, P 〈 0.05）. CONCLUSION： Both acupuncture and acupuncture combined with rehabilitation exercise can improve the motor function of knee joint in patients with knee osteoarthritis effectively, but the latter one has more remarkable effect, relieves symptoms and maintains motor function more obviously, Accordingly, a self-management program（health education and exercise instruction） is the key to treating patients with knee osteoarthritis.