电针对膝骨性关节炎患者功能活动及登梯时空参数的影响

Effect of Electro-acupuncture on Functional Status and Temporospatial Variations during Stair Climbing in Knee Osteoarthritis: A Clinical Randomized Controlled Trial

目的:观察电针治疗前后膝骨性关节炎(KOA)患者登梯活动时空参数及关节炎指数的变化,分析针刺对患者登梯能力的影响。方法:36名来自社区的KOA患者在2周等待排除预期的影响后随机分为电针组和非经非穴浅刺组各18例,分别治疗3周共11次后进行功能状况(骨关节炎指数WOMAC评分)及登梯步态检测,分析登梯时空参数及其与WOMAC评分的相关性。结果:等待前2组基线数据除步长时间有差异采用一般线性模型校正外,其他基线齐。治疗前与等待前的各参数比较差异无统计学意义,2组间治疗前各参数比较差异无统计学意义;电针和浅刺治疗后,WOMAC的总分和3个亚量表的评分均较治疗前下降;电针治疗后,KOA患者的上下梯步速和步频均较治疗前明显增加,而步长时间、支撑时间、摆动时间、步行周期及初次双侧支撑时间均较治疗前缩短,但步宽、步长和跨步长治疗前后比较差异无统计学意义;浅刺组治疗后与治疗前上下梯各时空参数比较差异无统计学意义;2组治疗后WOMAC评分及上下梯时空参数比较差异无统计学意义;电针治疗前后WOMAC总分差值、WOMAC疼痛、僵硬、躯体功能3个亚量表评分的差值与上下梯时步宽差值均呈正相关,躯体功能改善程度与上下梯步频的改善程度均呈负相关,与步行周期的改善呈正相关,躯体功能改善和WOMAC总体症状及功能的改善程度与下梯的摆动期改变呈正相关,其余时空参数差值之间比较无明显相关;浅刺对照组WOMAC各评分差值与上下梯时空参数差值之间比较均无明显相关。结论:患者预期在本研究未体现对针刺疗效的影响,电针和非经非穴浅刺均能缓解KOA患者的疼痛和僵硬症状,改善功能状况,但电针还能提高KOA患者的上下梯速度、频率及缩短时间参数,而且电针对KOA患者的症状及功能的改善效应与上下梯步宽及步行效率的提高有关。下梯步宽的改善与电针后疼痛、僵硬、躯体功能的改善均相关,下梯时稳定性及步行效率的改善均与躯体功能改善相关。浅刺虽然在一定程度上可以改善KOA患者的症状及功能,但未对登梯稳定性及步行效率的改变产生明显影响,电针作为治疗KOA的有效康复疗法,能提高患者的登梯活动能力。

Objective： To observe the temporaspatial characteristics of during stair climbing after acupuncture treatment in knee osteoarthritis（ KOA） cases, providing foundation of study on biomechanical mechanism of acupuncture ＇ s rehabilitative effect. Methods： Thirty six KOA cases were recruited from communities. After 2 weeks in waiting list,the subjects were randomized into 2 groups： electro-acupuncture（ EA） and minimal acupuncture（ MA） groups. Each group was composed of 18 cases. Treatment consisted of 11 sessions of treatment in 3 weeks. Outcome measures included functional status by Western Ontario and Mc Master Universities Arthritis Index（ WOMAC） scores and temporospatial variations by motion analysis system. Results： Before enrolling into waiting list,baseline data were comparable except for steptime,which was corrected by general linear model for further comparison. The outcomes measured before treatment didn＇t show significant difference compared with baseline data. All the variations didn＇t show the difference between both groups before treatment; After EA or MA treatment,WOMAC total score and scores in 3 subscales were decreased compared with those before treatment; After EA treatment,step velocity and cadence during both ascending and descending stairs significantly increased,and steptime（ ST）,swing phase（ SP）,gait cycle（ GC） and initial double support time（ IDST） were shortened. However,step width（ SW）,step length（ SL） and stride length（ STL） didn＇t show significant difference compared with those before treatment. 4） In MA control group,all the temporospatial variations didn＇t show the difference compared with those before treatment. 5） WOMAC sores and temporospatial variations during both ascending and descending didn＇t show difference between both groups. 6） In EA group,the difference values（ DV） before and after treatment in WOMAC total score and scores in subscales were positively correlated with DV in SW during both ascending and descending. Difference values in physical function subscale were negatively correlated with DV in cadence,and positively correlated with DV in GC during both ascending and descending. DV in WOMAC total score or subscale of physical function were positively correlated with DV in SW during descending. Other temporospatial variables didn＇t show significant correlations with DV in scales. 7） In MA control group,no correlation showed between DV in WOMAC and DV in temporospatial variations during either ascending or descending. Conclusion： Expectation didn＇t affect the results in this study. Both EA and MA relieved symptoms of pain and stiffness and also enhanced the physical function in KOA cases. EA treatment increased velocity and cadence,shortened temporal variations during both ascending and descending stairs. The effects of EA in improving symptoms and function in KOA was correlated with improvement on step width and locomotion efficiency during both ascending and descending stairs. Improvement of step width during descending was correlated with functional enhancement of pain,stiffness and physical function after EA. Both better stability and efficiency of descending was correlated with better physical function. Though MA relieved symptoms and improved certain function in KOA,it didn＇t impact significantly on stability or efficiency of stair climbing. EA is an effective rehabilitation therapy for KOA and strengthens the functional ability for stair climbing.