调和阴阳针刀治疗膝关节骨关节炎:随机对照试验

Tiaohe Yinyang acupotomy for knee osteoarthritis:a randomized controlled trial

目的:观察调和阴阳针刀治疗膝关节骨关节炎(KOA)的临床疗效。方法:将88例KOA患者随机分为调和阴阳针刀组和安慰针刀组,每组44例。调和阴阳针刀组分别于膝关节阴面(鹅足、腘肌止点等4~5个高应力点)及阳面(髌下韧带刺激点、髌上囊等1~2个高应力点)予针刀治疗;安慰针刀组于相同部位予假针刀治疗,均每周1次,共治疗2周。分别于治疗前后观察两组患者西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、视觉模拟量表(VAS)评分、膝关节内侧副韧带和外侧副韧带厚度、膝关节活动度和足底压力分布,并于治疗结束后3个月随访时记录调和阴阳针刀组WOMAC及VAS评分。结果:治疗后,两组患者WOMAC各分项评分(疼痛、僵硬、功能)及总分、VAS评分均较治疗前降低(P<0.05),调和阴阳针刀组WOMAC疼痛评分、功能评分、总分及VAS评分低于安慰针刀组(P<0.05);两组患者治疗前后内外侧副韧带厚度、膝关节活动度比较,差异均无统计学意义(P>0.05)。治疗后,调和阴阳针刀组足底内侧压强升高、外侧压强降低(P<0.05),足底力线向内侧移动;随访时,调和阴阳针刀组WOMAC各分项评分及总分、VAS评分均低于治疗前与治疗后(P<0.05)。结论:调和阴阳针刀可通过改变膝关节局部生物应力,进而改善患者膝关节的临床症状。

Objective To observe the clinical efficacy of Tiaohe Yinyang acupotomy(acupotomy for regulating and harmonizing yin and yang)for knee osteoarthritis(KOA).Methods A total of 88 patients with KOA were randomized into a acupotomy group and a sham-acupotomy group,44 cases in each group.In the acupotomy group,acupotomy was applied at yin side(4-5 high stress points i.e.pes anserinus and terminal of popliteus)and yang side(1-2 high stress points i.e.stimulation point of infrapatellar ligament and suprapatellar bursa)of knee joint.In the sham-acupotomy group,sham-acupotomy was applied at the same points as the acupotomy group.The treatment was given once a week for 2 weeks in the two groups.Before and after treatment,the Western Ontario and McMaster Universities arthritis index(WOMAC)score,visual analogue scale(VAS)score,thickness of medial and lateral collateral ligaments of knee joint,motion range of knee joint and plantar pressure distribution were observed in the two groups.In the follow-up of 3 months after treatment,the WOMAC and VAS scores were recorded in the acupotomy group.Results After treatment,the sub item scores(pain,stiffness and function)and total scores of WOMAC and VAS scores were decreased in the both groups(P<0.05),pain score,function score and total score of WOMAC and VAS score in the acupotomy group were lower than those in the sham-acupotomy group(P<0.05).Before and after treatment,there were no statistical differences in thickness of medial and lateral collateral ligaments of knee joint and motion range of knee joint between the two groups(P>0.05).After treatment,the plantar medial pressure was increased while the plantar lateral pressure was decreased(P<0.05),and the plantar force line moved medially in the acupotomy group.In the follow-up,the sub item scores and total score of WOMAC and VAS score were lower than those before and after treatment in the acupotomy group(P<0.05).Conclusion Tiaohe Yinyang acupotomy can improve the clinical symptoms of knee joint in patients with KOA by changing the local biological stress.