针刀松解术联合南少林站桩功锻炼治疗早期膝骨关节炎的临床研究

A clinical study of needle-knife release combined with southern Shaolin standing stake exercises for treatment of early knee osteoarthritis

目的:观察针刀松解术联合南少林站桩功锻炼治疗早期膝骨关节炎的临床疗效。方法:将60例早期膝骨关节炎患者随机分为2组,每组30例。南少林站桩功组采用针刀松解术联合南少林站桩功锻炼治疗,股四头肌锻炼组采用针刀松解术联合股四头肌肌力锻炼治疗。针刀松解术每周治疗1次,共治疗2次;针刀松解术后第2天分别开始南少林站桩功锻炼和股四头肌肌力锻炼,连续锻炼2周。分别于治疗前、治疗结束后,采用膝部疼痛视觉模拟量表(visual analogue scale,VAS)评价患膝疼痛程度,采用西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分评价患膝功能,并于治疗结束后按照自拟标准评价总体疗效。结果:①膝部疼痛VAS评分。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[(4.54±1.03)分,(4.64±1.22)分,t=0.759,P=0.451];治疗结束后南少林站桩功组的膝部疼痛VAS评分低于股四头肌锻炼组[(1.75±0.77)分,(2.35±1.31)分,t=-5.976,P=0.000],2组患者的膝部疼痛VAS评分均较治疗前降低(t=13.360,P=0.000;t=6.020,P=0.000)。②WOMAC评分。治疗前2组患者的WOMAC评分比较,差异无统计学意义[(25.42±5.63)分,(25.56±5.29)分,t=-0.686,P=0.493];治疗结束后南少林站桩功组的WOMAC评分低于股四头肌锻炼组[(13.28±5.40)分,(16.75±4.33)分,t=-0.725,P=0.000],2组患者的WOMAC评分均较治疗前降低(t=-23.456,P=0.000;t=-23.745,P=0.000)。③总体疗效。治疗结束后,南少林站桩功组治愈9例、显效14例、有效5例、无效2例,股四头肌锻炼组治愈2例、显效5例、有效17例、无效6例;南少林站桩功组的总体疗效优于股四头肌锻炼组(R_(南少林站桩功组)=22.28,R_(股四头肌锻炼组)=38.72,Z=-3.819,P=0.000)。结论:针刀松解术联合南少林站桩功锻炼治疗早期膝骨关节炎,可以有效减轻膝关节疼痛,改善膝关节功能,总体疗效优于针刀松解术联合股四头肌肌力锻炼。

Objective:To observe the clinical outcome of needle-knife release combined with southern Shaolin standing stake exercises for treatment of early knee osteoarthritis(KOA).Methods:Sixty patients with early KOA were enrolled in the study and were randomly divided into group A and group B,30 cases in each group.The patients in group A were treated with needle-knife release and southern Shaolin standing stake exercises,while the ones in group B with needle-knife release and quadriceps femoris muscle strength exercises.The needle-knife release was performed once a week for consecutive 2 times,followed by 2-week southern Shaolin standing stake exercises and quadriceps femoris muscle strength exercises respectively on day 2 after the needle-knife release.The knee pain degree and knee function were evaluated by using knee pain visual analogue scale(VAS)and Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score before the treatment and after the end of the treatment respectively,and the total outcome were evaluated according to the self-made evaluation standards after the end of the treatment.Results:①There was no statistical difference in knee pain VAS score between the 2 groups before the treatment(4.54±1.03 vs 4.64±1.22 points,t=0.759,P=0.451).The knee pain VAS score was lower in group A compared to group B after the end of the treatment(1.75±0.77 vs 2.35±1.31 points,t=-5.976,P=0.000),and it decreased in the 2 groups after the end of the treatment compared to pre-treatment(t=13.360,P=0.000;t=6.020,P=0.000).②There was no statistical difference in WOMAC score between the 2 groups before the treatment(25.42±5.63 vs 25.56±5.29 points,t=-0.686,P=0.493).The WOMAC score was lower in group A compared to group B after the end of the treatment(13.28±5.40 vs 16.75±4.33 points,t=-0.725,P=0.000),and it decreased in the 2 groups after the end of the treatment compared to pre-treatment(t=-23.456,P=0.000;t=-23.745,P=0.000).③After the end of the treatment,9 patients were cured,14 good,5 fair and2 poor in group A;while 2 ones were cured,5 good,17 fair and 6 poor in group B.The total outcome was better in group A compared to group B(R_(group A)=22.28,R_(group B)=38.72,Z=-3.819,P=0.000).Conclusion:Needle-knife release combined with southern Shaolin standing stake exercises can effectively relieve knee pain and improve knee function in treatment of early KOA,and its total outcome is better than that of needle-knife release combined with quadriceps femoris muscle strength exercises.