九步八分推拿法对膝关节骨性关节炎女性患者股直肌超声灌注成像的影响

Effects of Nine-step Tuina in Eight Minutes on Ultrasound Perfusion Imaging of Rectus Femoris in Women with Knee Osteoarthritis

目的观察九步八分推拿法治疗女性膝关节骨性关节炎的临床疗效,并分析其可能作用机制。方法纳入20例女性膝关节骨性关节炎患者,选取疼痛程度重的单侧患膝进行为期2周6次的推拿治疗,推拿方案按照九步八分法方案进行。在第1次治疗前、第1次治疗后及第6次治疗后分别使用疼痛数字评分法(NRS)及西部安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分以评价疼痛改善情况,采用股直肌超声灌注成像检测增强达峰时间(TTP)、造影峰值强度(PI)。结果20例受试者脱落1例,最终19例患者纳入统计分析。NRS评分治疗前后三个时间点比较差异均有统计学意义(P=0.001)。WOMAC总分治疗前后三个时间点比较差异均有统计学意义(P=0.007),WOMAC疼痛维度评分(P=0.027)、功能维度评分(P=0.010)治疗前后三个时间点比较差异均有统计学意义,僵硬维度评分治疗前后三个时间点比较差异均无统计学意义(P=0.378)。治疗前后三个时间点TTP比较差异均无统计学意义(P=0.449)。治疗前后三个时间点PI比较差异均有统计学意义(P=0.039)。各时间点两两比较,第1次治疗后较第1次治疗前PI增加(P=0.02),第6次治疗后PI与第1次治疗前比较差异无统计学意义(P=1.000),第6次治疗后PI与第1次治疗后比较差异亦无统计学意义(P=0.200)。结论九步八分推拿法可显著改善女性膝关节骨性患者的关节疼痛和关节功能,其作用机制可能与改善股直肌微循环、调整关节代谢状态有关。

Objective To explore the clinical effect of and possible mechanism of nine-step tuina in eight minutes in the treatment of women with knee osteoarthritis(KOA).Methods A total of 20 women with KOA were included,whose unilateral knee with more severe pain was given six times of nine-step tuina in eight minutes within 2 weeks.Pain improvement was evaluated using the numerical pain scale(NRS)and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),and the time-to-peak(TTP)and peak intensity(PI)were detected by ultrasound perfusion imaging of the rectus femoris before treatment,after the first treatment and the sixth treatment.Results Except for one drop-out,19 patients were included in the statistical analysis.When comparing the results measured at the three time points,there were statistically significant differences in the NRS score(P=0.001).The total WOMAC score(P=0.007),pain domain score(P=0.027)and function domain score(P=0.010)were significantly different except for the stiffness domain score(P=0.378).The results of TTP value measured at the three time points were also not significantly different(P=0.449).There was significantly difference in PI when comparing the results measured at three time points(P=0.039);the PI significantly increased after first treatment than before treatment(P=0.02),while no significant difference was found when comparing the results after sixth treatment than before treatment(P=1.000)and than after first treatment(P=0.200).Conclusion Nine-step tuina in eight minutes can significantly improve joint pain and joint function in women with KOA,and its mechanism may be related to the improvement of the rectus femoris microcirculation and adjustment of the joint metabolic status.