针刺后艾灸联合射频臭氧介入治疗髌股关节疼痛综合征的临床研究

Clinical Analysis of Acupuncture-moxibustion Combined with Radio-frequency Ozone Intervention on Patellofemoral Pain Syndrome

目的观察治疗髌股关节疼痛综合征时采用针刺后艾灸联合射频臭氧介入的临床疗效,分析联合治疗的作用机制。方法将183例髌股关节疼痛综合征住院患者均分为温针组、臭氧组和综合组各61例。各组均采用关节腔冲洗后注射玻璃酸钠及肌力训练等基础治疗。温针组加针刺后艾灸膝眼和梁丘穴;臭氧组于膝眼和梁丘穴注射臭氧介入治疗;综合组在基础治疗后综合温针组和臭氧组的治疗方法,各组均治疗1个疗程21 d。采用多关节等速训练测试系统(角速度为60°/s和120°/s)测试治疗前后腘绳肌(H)和股四头肌(N/M)峰力矩;用表面肌电图仪录股内/外侧肌肌电信号(vM/vL),计算达峰时限差值(ΔTBP),检测治疗前后患者关节液白细胞介素-1β(IL-1β)、透明质酸(HA)含量,比较各组膝关节Kujala评分、视觉模拟量表(VAS)评分并结合总有效率评价临床疗效。结果综合组治疗后vM和vL、N/M和H峰力矩及Kujala评分提高明显,ΔTBP及VAS评分明显降低,与治疗前同组、温针组和臭氧组比较差异有统计学意义(P <0.05)。综合组IL-1β降低幅度与温针组比较差异有统计学意义(P <0.05),但与臭氧组比较差异无统计学意义(P> 0.05)。各组间治疗第21日时HA与治疗前同组比较差异有统计学意义(P <0.05),但组间比较差异无统计学意义(P> 0.05)。综合组有效率为91.80%,与温针组(78.69%)和臭氧组(81.97%)比较差异均有统计学意义(P <0.05)。结论针刺后艾灸联合射频臭氧介入治疗髌股疼痛综合征疗效显著。

Objective： To observe the curative effect of acupuncture after moxibustion combined with radio-frequency ozone intervention on patellofemoral pain syndrome,analyze the mechanism and provide a new method for clinical treatment. Methods： 183 patients were randomly divided into the acupuncture group,the ozone group and the combination group（n = 61）. All groups were treated with articular cavity irrigation,sodium hyaluronate injection and muscle strength training. Each group received corresponding treatment. All were treated for 21 days. The isokinetic testing and training system test（angular velocity for 60°/s and 120°/s） was used test peak torque of hamstring muscle（hamstring muscle,H） and N/M before and after treatment,surface electromyography to record femoral muscle muscle signals（v M/vL）,amd calculate ΔTBP. IL-1β and HA were detected before and after treatment. Kujala scores and VAS scores combined with total efficiency were compared to evaluate the clinical curative effect. Results： After treatment,v M and vL,N/M and H peak torque and Kujala score increased significantly in the combination group,and ΔTBP and VAS scores decreased significantly,with statistically significant difference,compared with the same group before treatment,the other two groups（P〈0.05）. The difference was statistically significant in IL-1β reduction compared with acupuncture group（P〈0.05）,but there was no significant difference,compared with the ozone group（P〈0.05）. There was no significant difference in HA among groups on21 st day in treatment（P〈0.05）,but there was significant difference,compared with before treatment（P〈0.05）.The effective rate of the combination group was 91.80%,significantly different from the other two groups（P〈0.05）. Conclusion： Acupuncture-moxibustion combined with radio-frequency ozone intervention ON patellofemoral pain syndrome is effective.