膝关节骨性关节炎中西医结合非手术疗法疗效评价

Efficacy evaluation of non-operative treatment methods of integration of traditional Chinese medicine and western medicine in treating knee osteoarthritis

目的:通过观察膝关节活动度、Lysholm膝关节量表评分和3min步行距离3个方面在不同治疗时序内的疗效,评价以"骨正筋柔"为理论基础的中西医非手术综合治疗方法的疗效,并明确应用指征、终止指征和疗效预期。方法:选取2015年1月至2016年6月就诊于本院的30例(脱落1例)膝关节骨性关节炎(KO)患者进行治疗前后队列研究,应用中药浸渍、刮痧、髌股关节松动术、股胫关节中医正骨术和步态矫正训练5种方法综合治疗12周,随访半年,对观察指标进行不同治疗时序和随访前后的疗效评定。结果:治疗24次后,患者膝关节活动度、Lysholm膝关节量表评分和3min步行距离与治疗前比较,差异显著(P<0.01);治疗24次结束时与随访半年后比较,患者膝关节活动度差异无统计学意义,而Lysholm膝关节量表评分和3min步行距离差异显著(P<0.01);治疗1次患者左膝关节活动度就可见到明显改善(P<0.01),在第1周治疗间隔期内,患者左膝关节活动度退回到治疗前水平;治疗8次与24次后膝关节活动度差异无统计学意义。结论:KO患者存在可逆和(或)不可逆的膝关节紊乱,应用中医理筋正骨手法可以恢复可逆性的关节紊乱,但对不可逆的关节紊乱是无效的;自主步态矫正训练可以维持远期疗效。

Objective： To evaluate the efficacy of non-surgical comprehensive treatment method of integration of traditional and western medicine based on the theory of solid skeleton and pliable tendons and clear its application verification, termination verification and efficacy expectation by observing knee mobility, Lysholm knee scoring scale and three-minutes walking distance in different treatment intervals, Methods： Thirty patients with knee osteoarthritis （1 patient was expulsion） were selected for cohort study before and after treatment. These patients were treated with five different treatment methods for 12 weeks, including Chinese materia medica dipping, massage on acupoints, patellofemoral joint mobilization, femorotibial joint bone-setting manipulation and gait correction training, and follow-up for half a year. The observation indexes were documented for efficacy assessment before and after follow-up or at different treatment timings, Results： The observation indexes were significantly improved after treatment （P〈0.01）, however no significant change was found in knee joint activity after follow-up compared with at the end of treatment, while the Lysholm score and the three-minute walking distance were significantly improved （P〈0.01）. One times of treatment, the activity of left knee was significantly improved （P〈0.01）. During the first week treatment interval, the activity of the left knee joint returned to the level before treatment, There was no significant difference in the range of motion between the 8 and 24 times. Conclusion： The present study demonstrated that the reversible and/or irreversible knee joint disorder existed in patients with osteoatthritis. The reversible knee joint disorder could be reversible by the application of TCM bone-setting manipulation, however irreversible joint disorder is not suitable. Furthermore） independent gait correction training could maintain the long-terra curative effect on the treatment of knee osteoarthritis,