神经肌肉运动训练对膝骨关节炎患者的疼痛与功能恢复的临床疗效观察

The effects of neuromuscular exercise programme on pain and physical function in patients with knee osteoarthritis

目的观察并研究神经肌肉运动训练(neuromuscular exercise,NEMEX)对膝骨关节炎(knee osteoarthritis,KOA)患者在疼痛和功能改善方面的临床效果。方法 2016年12月—2017年12月选取符合纳入标准的70例退行性KOA患者随机分为对照组、观察组,每组各35例。观察组患者给予8周的NEMEX,对照组给予8周股四头肌肌力训练。分别于治疗前,治疗1、2、4、8周后采用西安大略与麦克马斯特大学骨关节炎评分量表(The Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)的疼痛量表和关节功能量表对患者进行评估。结果观察组患者治疗前和治疗1、2、4、8周WOMAC疼痛评分分别为(24.2±10.0)、(23.4±9.1)、(18.9±8.2)、(15.0±6.3)、(15.0±7.0)分,对照组分别为(25.6±9.8)、(24.1±9.2)、(20.2±8.8)、(15.2±6.0)、(11.4±5.3)分,两组治疗1周后的WOMAC疼痛评分较治疗前降低均不明显(P>0.05),但在治疗2、4、8周后WOMAC疼痛评分均较治疗前明显降低(P<0.05);治疗前及治疗1、2、4周后两组组间差异均无统计学意义(P>0.05),治疗8周后两组组间差异有统计学意义(t=2.439,P<0.05)。观察组患者治疗前和治疗1、2、4、8周WOMAC功能评分分别为(94.3±31.0)、(81.8±28.3)、(68.9±22.1)、(34.0±15.1)、(22.0±8.0)分,对照组分别为(92.7±31.8)、(82.6±29.3)、(75.2±22.9)、(52.2±20.0)、(43.4±18.2)分,治疗1、2、4、8周后两组患者的WOMAC功能评分较治疗前均有明显改善(P<0.05);治疗前及治疗1、2周后两组组间差异均无统计学意义(P>0.05),在治疗4、8周后观察组功能优于对照组,差异有统计学意义(t=–4.287、–6.355,P<0.05)。结论 NEMEX与股四头肌肌力训练在缓解KOA导致的疼痛方面具有相近的临床效果。且两种训练方式都能够有效提高患者的功能水平,NEMEX较股四头肌肌力训练改善更明显。

Objective To observe and study the effect of neuromuscular exercise （NEMEX） on pain and physical function in patients with knee osteoarthritis （KOA）. Methods From December 2016 to December 2017, a total of 70 participants with degenerative KOA were randomly divided into the control group and the observation group, with 35 participants in each group. The participants in the observation group received 8-weeks NEMEX, and the ones in the control group received 8-week quadriceps strengthening. The Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） pain subscale and the WOMAC physical functional subscale were used to measure pain and physical function before treatment and after 1 week, 2 weeks, 4 weeks, and 8 weeks of treatment. Results The WOMAC pain scores of participants before treatment and after 1 week, 2 weeks, 4 weeks, and 8 weeks of treatment were 24.2±10.0, 23.4±9.1, 18.9±8.2, 15.0±6.3, 15.0±7.0, respectively in the observation group, and 25.6±9.8, 24.1±9.2, 20.2±8.8, 15.2±6.0, 11.4±5.3, respectively in the control group. After 1 week of treatment, neither group showed a significant change in pain than pretreatment （P〉0.05）, but after 2, 4, 8 weeks of treatment, both groups showed significant improvements in pain （P〈0.05）. There was no significant between-group difference in pain before treatment or after 1 week, 2 weeks, and 4 weeks of treatment （P〉0.05）, but after 8 weeks of treatment, statistically significant difference in WOMAC pain score was found between the two groups （t=2.439, P〈0.05）. The WOMAC physical function scores of participants before treatment and after 1 week, 2 weeks, 4 weeks, and 8 weeks of treatment were 94.3±31.0, 81.8±28.3, 68.9±22.1, 34.0±15.1, 22.0±8.0, respectively in the observation group, and 92.7±31.8, 82.6±29.3, 75.2±22.9, 52.2±20.0, 43.4±18.2 respectively in the control group. After 1 week, 2 weeks, 4 weeks and 8 weeks of treatment, both groups showed significant changes in WOMAC physical function scores than pretreatment （P〈0.05）. There was no statistically significant between-group difference before treatment or after 1, 2 weeks of treatment in physical function （P〉0.05）. The functional improvements in the observation group were significantly better than those in the control group after 4 and 8 weeks of treatment, and the differences were statistically significant （t=–4.287, –6.355; P〈0.05）. Conclusion NEMEX and quadriceps strengthening have similar effects in relieve pain in patients with KOA. And both exercises can effectively improve the physical function, and NEMEX is better than quadriceps strengthening on physical function improvement in patients with KOA.