肌肉能量技术联合常规康复治疗对老年膝骨关节炎患者的影响

Effect of Muscle Energy Technique Combined with Conventional Rehabilitation Therapy on Elderly Patients with Knee Osteoarthritis

目的:观察肌肉能量技术联合常规康复治疗对老年膝骨关节炎(KOA)患者的影响。方法:选取2021年2月—2022年8月在上海市第六人民医院康复医学科治疗的老年KOA患者84例,采用SPSS 22.0统计软件产生随机数列分为对照组和观察组,每组42例。在治疗过程中,对照组2例因患者主动要求退出,最终纳入老年KOA患者82例,其中对照组40例、观察组42例。2组均接受常规康复治疗(功率自行车、物理因子治疗),其中功率自行车训练20 min/次,动态干扰电和超短波治疗等物理因子治疗30 min/次(每项15 min/次),1次/d,5 d/周,持续治疗4周。观察组在对照组基础上接受肌肉能量技术治疗,30 min/次,1次/d,5 d/周,共治疗4周。分别于治疗前、治疗4周后、治疗6个月后采用西安大略和曼彻斯特大学骨性关节炎指数(WOMAC)评估老年KOA患者关节疼痛程度、关节僵硬程度和日常生活活动能力。分别于治疗前、治疗4周后采用关节角度测量尺测量膝关节活动度(ROM);采用等速肌力测试与训练系统测试股四头肌肌力[股四头肌峰力矩(PT)、股四头肌峰力矩体质量比(PT/BW)]。结果:①WOMAC评分:与治疗前比较,2组治疗4周后、治疗6个月后WOMAC关节疼痛、关节僵硬、日常生活活动能力评分和WOMAC总分均明显降低,差异具有统计学意义(P<0.05)。与对照组同一时间点比较,观察组治疗4周后、6个月后WOMAC关节疼痛、关节僵硬、日常生活活动能力评分和WOMAC总分均明显更低,差异具有统计学意义(P<0.05)。②ROM、PT和PT/BW:与治疗前比较,2组治疗4周后ROM、PT和PT/BW均明显升高,差异具有统计学意义(P<0.05)。与对照组比较,观察组治疗4周后ROM、PT和PT/BW均明显更高,差异具有统计学意义(P<0.05)。结论:肌肉能量技术联合常规康复治疗能有效缓解老年KOA患者膝关节疼痛和僵硬程度,改善膝关节活动度和股四头肌肌力,值得临床推广应用。

Objective:To observe the effect of muscle energy technique combined with conventional rehabilitation therapy on elderly patients with knee osteoarthritis(KOA).Methods:A total of 84 patients with KOA in the rehabilitation medicine department of Shanghai Sixth People's Hospital from February 2021 to August 2022 were randomly divided into control group and observation group according to the random number sequence generated by SPSS 22.0 statistical software,with 42 cases in each group.During the course of treatment,two cases in the control group withdrew at the request,and a total of 82 cases were finally included,with 40 cases in the control group and 42 cases in the observation group.Both groups received conventional rehabilitation therapy(power bicycle and physical modality therapy),including power bicycle training for 20 min a time,and physical modality therapy of 15 min dynamic interferential electricity and 15 min ultrashort wave therapy each time,once a day,five days a week,lasting for four weeks.The observation group received muscle energy technique treatment on the basis of the control group,30 minutes a time,once a day,five days a week,lasting for four weeks.Before treatment,after four weeks of treatment and at six months follow-up,the Western Ontario and Manchester Universities Osteoarthritis Indexes(WOMAC)was used to evaluate the degree of joint pain,joint stiffness and activities of daily living of patients with KOA.Before treatment and after four weeks of treatment,a goniometer was used to evaluate the range of motion(ROM)of the knee joint;the isokinetic muscle strength test and training system was used to evaluate quadriceps femoris muscle strength[quadriceps femoris peak torque(PT),quadriceps femoris peak torque to body weight ratio(PT/BW)].Results:(1)WOMAC score:compared with that before treatment,the WOMAC joint pain,joint stiffness,activities of daily living score and total WOMAC score of the two groups decreased significantly after four weeks treatment and at six months follow-up(P<0.05).Compared with the control group at the same time,the WOMAC joint pain,joint stiffness,activity of daily living score and total WOMAC score in the observation group were significantly lower after four weeks treatment and at six months follow-up(P<0.05).(2)ROM,PT and PT/BW:compared with those before treatment,ROM,PT and PT/BW of both groups were significantly higher after four weeks treatment(P<0.05).Compared with the control group,ROM,PT and PT/BW in the observation group were significantly higher after four weeks treatment,and the differences were statistically significant(P<0.05).Conclusion:Muscle energy technique combined with conventional rehabilitation therapy can effectively relieve the pain and stiffness of knee joint of patients with KOA,and improve the range of motion of knee joint and quadriceps femoris muscle strength,which is recommended for clinical application.