手法松解结合针刺治疗膝骨关节炎临床效果及作用机制

Study on clinical effect and mechanism of musculoskeletal manipulations and acupuncture on knee osteoarthritis

目的探讨手法松解结合针刺对膝骨关节炎的临床效果及作用机制。方法选取广州医科大学附属第一医院针灸门诊确诊为膝骨关节炎患者60例分为:手法松解结合针刺、机械推拿结合针刺、常规推拿结合针刺3组,分别对3组患者进行治疗,并在治疗前后行关节功能评定,关节超声及关节X线检测。另设健康对照组20例,研究结束后对收集的数据行方差分析及配对样本t检验。结果3组患者治疗前后膝骨关节炎指数量表评分比较差异有统计学意义(t=8.382、5.681、5.335,均为P<0.01),胫股内侧间隙手法松解组治疗后与治疗前比较差异有统计学意义(P<0.05);髌骨外上缘至股外上髁距离手法松解组治疗前与对照组比较有统计学意义(t=-0.433,P<0.05),3组治疗组治疗后与对照组比较有统计学意义(F=4.395,P<0.05);治疗前后3组股四头肌肌腱弹性与健康对照组比较(治疗前F=5.363,P<0.01;治疗后F=5.250,P<0.01)及髌腱弹性与健康对照组比较减小(治疗前F=17.068,P<0.01;治疗后F=15.064,P<0.01)。结论手法松解结合针刺治疗方法能够对膝骨关节炎患者关节内结构、关节周围肌群力学产生作用以及能促进膝骨关节炎症状改善及生活质量提高。

Objective To explore the treatment outcome and mechanism of musculoskeletal manipulations and acupuncture on knee osteoarthritis.Methods Sixty patients with knee osteoarthritis were diagnosed in the acupuncture clinic of the First Affiliated Hospital of Guangzhou Medical University were divided into three groups by different treatments:the musculoskeletal manipulation combined with acupuncture group,the mechanical massage combined with acupuncture group,and the conventional massage combined with acupuncture group.Three groups adopted knee function evaluation,ultrasound,X-ray detection before and after the treatment.Twenty healthy patients were set as the control group.The data were analyzed by variance analysis and paired sample t test.Results Three groups presented statistically significant difference in the knee osteoarthritis index scale before and after the treatment(t=8.382,5.681,5.335;all P<0.01).After treatment of the medial tibiofemoral clearance group and before treatment,there was a statistically significant difference(P<0.05);the distance from the outer superior edge of the patella to lateral epicondyle of the femoral mandibular release group was statistically significant before treatment compared with the control group(t=-0.433;P<0.05),three groups compared with the control group after treatment,it was statistically significant(F=4.395;P<0.05);the elasticity of the quadriceps tendon of three groups before and after treatment was compared with the healthy control group(before treatment F=5.363,P<0.01,after treatment F=5.250,P<0.05)and patellar tendon elasticity decreased compared with healthy control group(pre-treatment F=17.068,P<0.01,after treatment F=15.064,P<0.01).Conclusion Musculoskeletal manipulation combined with acupuncture can provide good effect on the intra-articular structure of the knee osteoarthritis patients,the mechanics of the muscles around the joint,and can promote the improvement of knee osteoarthritis symptoms and quality of life.