手法促进膝关节炎软骨修复的核磁共振病例对照研究

Magnetic resonance assessment the effect of manipulation on knee cartilaginous recovery of osteoarthritis

目的:采用MR观察和评价手法治疗原发性膝关节骨关节炎修复软骨的作用。方法:回顾性研究2005年10月至2007年3月,门诊45～70岁骨关节炎患者50例,将以上病例根据年龄、性别、疾病严重程度配对分为手法治疗组和口服药物组,每组25例,分别采用每周手法治疗1次和硫酸氨基葡萄糖胶囊1500mg/d(分3次口服),治疗1年,在治疗前和治疗后3、6、12个月进行MR检查,观察治疗前后Noyes评分结果、测量软骨最大缺损直径和软骨容积。结果:两组患者治疗后Noyes评分均呈现下降趋势。手法组患者在治疗3个月后软骨缺损最大径减小,治疗6个月和12个月后软骨缺损最大径与治疗前相比差异有统计学意义;药物组患者软骨面缺损最大径也呈现减小趋势,但与治疗前相比差异无统计学意。手法组治疗3、6、12个月时软骨缺损修复好于药物组。手法组患者治疗6个月后软骨总容积与治疗前相比差异有统计学意义,治疗12个月后软骨总容积较治疗前增长58%;药物组患者软骨总容积呈现增加趋势,但与治疗前相比差异无统计学意义。手法组治疗3、6、12个月时软骨总容积增加高于药物组。结论:中医手法治疗原发性膝骨关节炎能够增加软骨容积、修复软骨缺损,是一种治疗原发性膝骨关节炎有效方法。

Objective：To observe and assess the effect of manipulation on knee cartilaginous recovery with knee osteoarthritis （OA）by using magnetic resonance （MR）. Methods：Fifty cases which were suffering from knee OA involved this retrospective study. They were matched-pairs into 2 groups according to their gender, age and severity. Treated with manipulation once a week in one year for manipulation group patients, compared with those orally use with 500 mg glucosamine sulfate （GS） three times per day. Knee cartilage MR were performed before treatment and on 3,6,12 months after treatment, the maximum defect diameter and volume of knee cartilage were assessed with Noyes Score. Result： Both Noyes Score declined in the two groups. But Noyes Score of the manipulation group significantly decreased 6 months after treatment, the same tendency was observed just 12 months after treatment in another group. The maximum defect diameter of knee cartilage began to diminish at 3 months after treatment in the manipulation group, grew significantly at 6 and 12 months after treatment compared with before treatment. In the GS group ,there was no significantly deference in the maximum defect diameter of knee cartilage between after and before treatment. The volume of knee cartilage in manipulation group was greater than the GS group at 3,6,12 months after treatment and significantly increased at 6 months after treatment and grew 58 percent 12 months after treatment. The volume of knee cartilage in GS group had no significantly change, though had a tendency to increase. Conclusion： Manipulation is effective to treatment of knee osteoarthritis by decreasing the maximum defect diameter and increasing the volume of knee cartilage.