“经纬辨证”理论指导下针刀配合手法及蚌式开合功能锻炼治疗髌股关节外侧高压综合征的临床研究

A clinical study of needle-knife therapy under the guidance of Jingwei syndrome differentiation (经纬辨证) theory combined with manipulation and mussel-style open-close functional exercises for treatment of excessive lateral pressure syndrome of patellofem

目的:观察"经纬辨证"理论指导下针刀配合手法及蚌式开合功能锻炼治疗髌股关节外侧高压综合征(excessive lateral pressure syndrome,ELPS)的临床疗效。方法:2015年1月至2017年3月,招募ELPS患者64例,随机分为2组,每组32例。观察组采用"经纬辨证"理论指导下针刀配合内推髌骨手法及蚌式开合功能锻炼治疗,对照组采用传统针刀配合内推髌骨手法及直腿抬高功能锻炼治疗。观察组根据"经纬辨证"理论,以下肢为整体、髌股关节为局部,整体与局部相结合选取进针点;对照组于髌股关节局部取点。针刀松解均为每周1次,连续松解3次为1个疗程;内推髌骨手法每日操作2次,连续6周为1个疗程;蚌式开合功能锻炼及直腿抬高功能锻炼均为每次5 min,每日2次,连续锻炼6周为1个疗程;均治疗1个疗程。分别于治疗前及末次随访时,采用疼痛视觉模拟量表(visual analogue scale,VAS)评价膝部疼痛程度,采用Lysholm膝关节功能评分和Kujala髌股关节评分评价膝关节及髌股关节功能。结果:所有患者均获随访,随访时间5~8个月,中位数6个月。治疗前2组患者的膝部疼痛VAS评分比较,差异无统计学意义[(6.16±0.92)分,(5.97±0.90)分,t=0.825,P=0.412];末次随访时2组患者的膝部疼痛VAS评分均较治疗前降低(t=36.704,P=0.000;t=17.647,P=0.000),且观察组的膝部疼痛VAS评分低于对照组[(1.28±0.77)分,(2.91±0.78)分,t=8.393,P=0.000]。治疗前2组患者的Lysholm膝关节功能评分比较,差异无统计学意义[(59.72±8.55)分,(60.97±8.00)分,t=0.604,P=0.548];末次随访时2组患者的Lysholm膝关节功能评分均较治疗前增高(t=30.334,P=0.000;t=25.281,P=0.000),且观察组的Lysholm膝关节功能评分高于对照组[(90.38±4.56)分,(83.50±5.56)分,t=5.407,P=0.000]。治疗前2组患者的Kujala髌股关节评分比较,差异无统计学意义[(52.16±8.54)分,(52.41±9.37)分,t=0.112,P=0.912];末次随访时2组患者的Kujala髌股关节评分均较治疗前增高(t=37.512,P=0.000;t=31.191,P=0.000),且观察组的Kujala髌股关节评分高于对照组[(86.38±5.99)分,(82.34±6.45)分,t=2.588,P=0.012]。结论:"经纬辨证"理论指导下针刀配合手法及蚌式开合功能锻炼治疗ELPS,可以减轻膝部疼痛症状、促进膝关节及髌股关节功能恢复,且疗效优于传统针刀配合手法及直腿抬高功能锻炼治疗。

Objective： To observe the clinical curative effects of needle - knife therapy under the guidance of Jingwei syndrome differ-entiation theory combined with manipulation and mussel - style open - close functional exercises for treatment of excessive lateral pressure syndrome （ ELPS） of patellofemoral joint. Methods ： Sixty - four patients with ELPS of patellofemoral joint were recruited from January 2015 to March 2017,and were randomly divided into observation group and control group,32 patients in each group. The patients in observation group were treated with needle - knife therapy under the guidance of Jingwei syndrome differentiation theory combined with manipulation and mussel - style open - close functional exercises, while the patients in control group were treated with traditional needle - knife therapy combined with patellar inward - pushing manipulation and straight - leg - raise functional exercises. According to the Jingwei syndrome dif-ferentiation theory,the needle - insertion points were selected by taking lower extremity as the whole and patellofemoral joint as a part and combining the whole with the part in observation group,while the needle - insertion points were selected at patellofemoral joint in control group. Needle - knife release was performed once a week for consecutive 3 times. The patellar inward - pushing manipulation was performed 2 times a day for consecutive 6 weeks. The mussel - style open - close functional exercises and the straight - leg - raise functional exercises were performed 2 times a day,5 minutes at a time for consecutive 6 weeks. The degree of knee pain,the knee joint function and the patel-lofemoral joint function were evaluated by using pain visual analogue scale（ VAS） scores, Lysholm knee function scores and Kujala patel-lofemoral joint scores before treatment and at follow - up respectively. Results ： A l l patients in the 2 groups were followed up for 5- 8 months with a median of 6 months. There was no statistical difference in knee pain VAS scores between the 2 groups before the treatment （6.16 ＋/- 0. 92 vs 5.97 ＋/- 0. 90 points, ^ = 0. 825 ,P = 0. 412） . The knee pain VAS scores were lower at last follow - up compared to pre-treatment in the 2 groups（^ =36. 704,P =0. 000;^ = 17. 647,P =0.000）and were lower in observation group compared to control group at last follow - up（ 1.28 ＋/-0. 77 vs 2. 91 ＋/-0. 78 points,^ = 8. 393 ,P =0. 000） . There was no statistical difference in Lysholm knee func-tion scores between the 2 groups before the treatment（59. 72 ＋/- 8. 55 vs 60. 97 ＋/- 8. 00 points, ^ = 0. 604 ,P = 0. 548 ） . The Lysholm knee function scores were higher at last follow - up compared to pretreatment in the 2 groups（ t = 30. 334,P = 0. 000;^ = 25. 281 ,P = 0. 000） and were higher in observation group compared to control group at last follow - up（90. 38 ＋/-4. 56 vs 83. 50 ＋/-5. 56 points, t =5. 407,P = 0. 000） . There was no statistical difference in Kujala patellofemoral joint scores between the 2 groups before the treatment（52. 16 ＋/- 8. 54 vs 52. 41 ＋/- 9. 37 points,t =0. 112, P = 0 .912） . The Kujala patellofemoral joint scores were higher at last follow - up compared to pre-treatment in the 2 groups（ t =37. 512,P = 0. 000;t = 31. 191,P =0. 000） and were higher in observation group compared to control group at last follow - up（ 86. 38 ＋/-5. 99 vs 82. 34 ＋/- 6. 45 points^ =2. 588 ,P =0. 012） . Conclusion： The combination therapy of needle - knife therapy under the guidance of Jingwei syndrome differentiation theory and manipulation and mussel - style open - close functional exercises can relieve the knee pain and improve the knee joint function and patellofemoral joint function in the treatment of ELPS,moreover,its cura-tive effect is better than that of traditional needle - knife therapy combined with manipulation and straight - leg - raise functional exercises.