改良膝关节牵引结合手法治疗的疗效评价

Evaluation of the effect of modified knee joint traction plus maneuver therapy

目的:评估改良膝关节牵引结合手法对膝关节功能障碍患者的干预效应。方法:选择2001-01/2004-12在南京医科大学第一附属医院康复医学科就诊的膝关节功能障碍患者160例,均自愿参加观察。随机分为两组,对照组和改良组各80例。对照组行传导热治疗、肌力训练、助力运动练习及膝关节屈曲位载荷牵引治疗;改良组在以上治疗方案中将传统的膝关节屈曲位载荷牵引进行改良,并增加膝关节松动术手法治疗。两组患者治疗周期均为3个月。治疗前及治疗3个月后应用膝关节评定量表对两组患者的膝关节运动功能进行评定,量表主要包括评定膝关节功能的1个膝评定量表和1个评定患者步行和上下楼能力的功能量表,基本分都是100分,另外每部分都设定有减分的评定参数。结果:纳入患者160例,分为2组,全部进入结果分析,无脱落。两组患者治疗前及治疗3个月后膝关节评分变化:①两组患者治疗3个月后膝关节功能评分及步行和上下楼评分均显著高于治疗前[对照组:58±11,62±12;23±9,28±7(t=5.91,6.18,P<0.01);改良组:74±10,79±11;22±10,26±9(t=7.21,7.49,P<0.01)]。②改良组膝关节功能评分及步行和上下楼评分均显著高于对照组(t=3.92,4.18,P<0.01)。结论:膝关节屈曲功能障碍康复过程中,改良膝关节屈曲位功能牵引及股胫、髌股关节松动手法的介入,与常规康复方案相比,可以更显著地改善膝关节的运动功能。

AIM： To evaluate the interventional effect of modified knee joint traction combined with maneuver therapy on knee joint dysfunction. METHODS： Totally 160 patients with knee joint dysfunction in the Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University from January 2001 to December 2004 were involved in the study voluntarily. Patients were randomized into control group and modified group of 80 cases in each group. Conductive heat therapy, muscle strength training, assistant exercise and loading traction of the knee joint in flexed position were performed in the control group; modified loading traction of the knee joint in flexed position plus mobilization of the knee joint were performed in the modified group. All the patients were treated for 3 months. Motor function of the knee joint was evaluated in the two groups with knee joint function scale before treatment and after 3-month treatment. The evaluation scale consists of one scale for evaluation of knee and the other for evaluation of walking function and ability of going upstairs or downstairs; totally score is 100, and each part has anevaluation parameter for score subtraction. RESULTS： All the 160 patients were involved in the result analysis. ① After 3-month treatment, scores on walking function and ability of going upstairs or downstairs were improved obviously in the two groups, which were increased from 23±9,28±7 to 58±11,62±12 in the control group（t =5.91,6.18, P 〈 0.01）, and increased from 22±10,26±9 to 74±10,79±11 in the modified group（t=7.21,7.49,P 〈 0.01）. ②The scores on walking function and ability of going upstairs or downstairs were significantly higher in the modified group than in the control group（t=3.92,4.18,P 〈 0.01）. CONCLUSION： During the rehabilitation of the flexion dysfunction of the knee joint, modified loading traction of knee joint in flexed position plus joint mobilization is more effective in the improvement of motor function of the knee joint as compared with routine rehabilitative therapy.