肌骨超声下“夹胫推肘牵膝推拿法”治疗膝骨关节炎的临床疗效观察

Clinical observation on "tibial-clipping and elbow-pushing and knee-pulling tuina method" under musculoskeletal ultrasonography in the treatment of knee osteoarthritis

目的通过"夹胫推肘牵膝推拿法"对膝骨关节炎患者进行治疗,再运用肌骨超声观察治疗前后的积液指数与滑膜厚度变化情况以及膝关节周径、疼痛视觉评分(VAS),进而为"夹胫推肘牵膝推拿法"治疗膝骨关节炎提供科学依据。方法本文研究对象为2015年12月～2017年12月在浙江省杭州市中医院推拿科门诊及住院部确诊为膝骨关节炎的患者,并使用"夹胫推肘牵膝推拿法"对其开展治疗,治疗期间密切留意患者膝关节病情变化情况,并记录患者经过手法治疗前后的疼痛视觉评分(VAS)及肌骨超声下测量的患者膝关节积液和关节滑膜组织厚度变化情况,了解患者的膝关节疼痛程度,测量膝关节周径。结果经统计学分析,治疗后总积分明显低于治疗前总积分,与治疗前比较差异有统计学意义(P<0.05),说明治疗后VAS评分优于治疗前。治疗前患者膝关节周径(406.307±44.157)mm,治疗后(388.260±42.130)mm,治疗后周径小于治疗前。肌骨超声下显示关节积液量治疗后较前减少。从滑膜组织增厚情况来看,患者经过治疗后滑膜厚度减少。结论 "夹胫推肘牵膝推拿法"能有效减少膝关节积液量及关节滑膜厚度,从而改善膝关节肿胀,减轻膝关节疼痛,对膝骨关节炎患者治疗效果显著。

Objective To treat patients with knee osteoarthritis by "tibial-clipping and elbow-pushing and knee-pulling tuina method", and to observe the changes of the effusion index and synovial thickness before and after treatment, as well as the circumference, pain of the knee joint, and visual score(VAS) by using the musculoskeletal ultrasound, which provides a scientific basis for the treatment of knee osteoarthritis. Methods The subjects of this study were patients diagnosed with knee osteoarthritis in the outpatient department of the hospital of Hangzhou City Hospital of Zhejiang Province from December 2015 to December 2017, and the method of "tibial-clipping and elbow-pushing and kneepulling tuina method" was used for treatment. The changes of knee joint condition during treatment it was paid close attention to. The changes of the patient's pain visual score (VAS), knee joint effusion and joint synovial tissue thickness under musculoskeletal ultrasound measurement before and after manual treatment. The degree of knee pain in the patient was understood, and the circumference of the knee joint was measured. Results Through statistical analysis, the total score after treatment was significantly lower than the total score before treatment. Compared with the score of pretreatment, there was statistically significant difference(P<0.05), that was the VAS score after treatment was better than that before treatment. The circumference of the knee joint before treatment and after treatment was (406.307±44.157) mm and (388.260±42.130) mm. The circumference after treatment was less than that before treatment. The musculoskeletal ultrasonography showed a decrease in the amount of joint effusion after treatment. From the perspective of synovial tissue thickening, synovial thickness after treatment was reduced. Conclusion "Tibial-clipping and elbowpushing and knee-pulling tuina method" can effectively reduce the amount of knee joint fluid and the thickness of the joint synovium, thereby improving the swelling of the knee joint and reducing the pain of the knee joint. The treatment effect on knee osteoarthritis patients is significant.