针刀松解联合Mulligan手法治疗中期膝骨关节炎临床观察

Clinical Observation of the Treatment of Intermediate Stage Knee Osteoarthritis with Acupotomology Combined with Mulligan Manipulation

目的:观察针刀松解联合Mulligan手法治疗中度膝骨关节炎的临床效果。方法:选取2019年9月至2020年9月上海中医药大学附属龙华医院和上海中医药大学附属龙华医院金山分院门诊收治的KOA患者120例作为研究对象,按照随机数字表法随机分为针刀组、手法组和联合组,每组40例。针刀组采用单纯针刀治疗,手法组采用Mulligan手法治疗,联合组采用针刀联合Mulligan手法治疗。分别观察2组患者治疗前、治疗后及随访24周骨关节炎指数、疼痛视觉模拟评分变化情况、5次坐立试验情况和2组患者临床疗效情况。结果:与针刀组、手法组比较,联合组在治疗后和随访24周,在疼痛视觉模拟评分、骨关节炎指数评分和5次坐立试验情况改善方面差异均有统计学意义(均P<0.01),联合组临床疗效总有效率为97.50%,明显优于针刀组(92.10%)和手法组(75.00%),差异有统计学意义(P<0.05)。结论:针刀联合Mulligan手法治疗中度膝骨关节炎,在改善患者关节疼痛、僵硬和活动不利等症状在近期与远期疗效方面均效果显著,值得临床推广应用。

Objective:To explore the clinical effect of acupotomology combined with Mulligan manipulation in the treatment of intermediate stage knee osteoarthritis(KOA).Methods:A total of 120 patients with intermediate stage degenerative KOA treated at the Longhua Hospital Affiliated to Shanghai University of traditional Chinese Medicine and its Jinshan Branch from September 2019 to September 2020 were selected for the study.These patients were randomly divided into acupotomy group(n=40),manipulation group(n=40),and combined group(n=40).The acupotomy group was treated with acupotomy alone,the manipulation group was treated with Mulligan manipulation,and the combined group received a combination of acupotomology and Mulligan manipulation.The changes in osteoarthritis indices,pain visual analog scale scores,results of the sit-to-stand test at 5 repetitions,and clinical efficacy of the three groups were observed before treatment,after treatment and at a 24-week follow-up.Results:Compared with the manipulation group and acupotomy group,the combined group showed statistically significant differences in the pain visual analogue score,osteoarthritis index scores and the results of the sit-to-stand test at 5 repetitions after treatment and at a 24-week follow-up(P<0.01).The overall clinical efficacy rate in the combined group was 97.50%,which was significantly higher than that in the acupotomy group(92.10%)and that in the manipulation group(75.00%),with statistically significant differences(P<0.05).Conclusion:Acupotomology combined with Mulligan manipulation in the treatment of intermediate stage KOA exhibits significant efficacy in improving the symptoms such as joint pain,stiffness,and impaired mobility,both in the short-term and long-term.This approach is worthy of clinical promotion and application.