Protocol-optimizing study of combining Tuina and horse-riding squat exercise for knee osteoarthritis  

推拿结合马裆势练习治疗膝骨关节炎的优化方案研究

作　　者：XING Hua SHEN Jiayun GONG Li LI Jianhua SHAO Sheng CHU Yuzhou HE Pengfei CHEN Hao KANG Zhiran DAI Dacheng 邢华;沈佳韵;龚利;李建华;邵盛;储宇舟;何鹏飞;陈浩;康知然;戴大城(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200437,China;Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200071,China)

机构地区：[1]Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200437,China [2]Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200071,China

出　　处：《Journal of Acupuncture and Tuina Science》2022年第2期139-151,共13页针灸推拿医学（英文版）

基　　金：国家自然科学基金项目,No.8197151584;上海市“科技创新行动计划”启明星培育杨帆专项,No.22YF1444300;上海市进一步加快中医药事业发展三年行动计划,No.ZY(2018-2020)-ZWB-1001-FWB-08;非药物疗法临床研究中心项目;上海中医药大学预算内项目,No.2021LK091。

摘　　要：Objective To evaluate the efficacy of Tuina(Chinese therapeutic massage)manipulation plus horse-riding squat exercise in treating knee osteoarthritis(KOA)and optimize the combining protocol.Methods Based on a 2×2 factorial design,120 eligible KOA patients were randomized into a manipulation group(group A1B2),a manipulation plus horse-riding squat group(group A1B1),a sitting knee-adjustment group(group A2B2 group),and a sitting knee-adjustment plus horse-riding squat group(group A2B1),with 30 cases in each group.The intervention was conducted three times a week,lasting for four weeks.The Western Ontario and McMaster Universities osteoarthritis index(WOMAC)was taken as the major measure for efficacy evaluation(including three component scores,pain,stiffness,and daily function,and total score).Results The three component scores(pain,stiffness,and daily function)and the total score of WOMAC showed significant differences after the intervention in the four groups(P<0.05).There were significant inter-group differences in the WOMAC stiffness score amongst the four groups after the intervention(P<0.05).In group A1B1,the step length,stride,walking speed,and knee joint flexion angle changed significantly after treatment(P<0.05).After the intervention,the step length changed significantly in group A1B2(P<0.05),and the walking speed changed significantly in group A2B1(P<0.05).There were no significant differences in the step length,stride,walking speed,or knee joint flexion angle among the four groups(P>0.05).The extensor peak torque at 180°/s changed significantly in group A1B2 after treatment(P<0.05).Neither the intra-group nor the inter-group comparisons of the four groups revealed significant differences in the other isokinetic muscle strength parameters(P>0.05).The main effect of manipulation showed significant in affecting the WOMAC pain and total scores(P<0.05).The main effect of horse-riding squat exercise showed significant in affecting the WOMAC pain and stiffness scores(P<0.05).Conclusion The four treatment prot目的评价推拿手法结合马裆势练习治疗膝骨关节炎(KOA)的疗效,以优化组合方案。方法采用2×2析因设计,将120例符合纳入标准的KOA患者随机分为手法组(A1B2组),手法结合马裆势组(A1B1组),坐位调膝组(A2B2组)和坐位调膝结合马裆势组(A2B1组),每组30例。患者每周干预3次,持续4周。主要疗效评价指标为西安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分(包括疼痛、僵硬、日常功能3项评分和总分),次要疗效评价指标为步态分析(包括步长、步幅、步速和膝关节屈曲角度)和等速肌力测试(60°/s和180°/s角速度下的屈肌和伸肌峰力矩)。结果四组WOMAC疼痛、僵硬、日常功能3项评分和总分治疗前后组内差异均具有统计学意义(P<0.05)。四组治疗后WOMAC僵硬评分有统计学差异(P<0.05)。A1B1组治疗前后步长、步幅、步速及膝关节屈曲角度的差异有统计学意义(P<0.05);A1B2组治疗前后步长具有统计学差异(P<0.05),A2B1组治疗前后步速具有统计学差异(P<0.05)。四组步长、步幅、步速和膝关节屈曲角度组间差异均无统计学意义(P>0.05)。A1B2组治疗前后180°/s角速度伸肌峰力矩有统计学差异(P>0.05)。等速肌力测试的其余指标四组组内及组间差异均无统计学意义(P>0.05)。手法主效应对于WOMAC疼痛评分及总分的改变有统计学意义(P>0.05);马裆势练习主效应对WOMAC疼痛和僵硬评分的改变具有统计学意义(P>0.05)。结论四种治疗方案均可以改善KOA症状,如缓解疼痛和僵硬,增强日常功能。A2B1组关节僵硬减轻效果最佳。手法治疗和马裆势练习在缓解疼痛方面都起主效应作用。马裆势练习在减轻关节僵硬方面起主效应作用。

关 键 词：TUINA MASSAGE Manual Therapies Physical and Breathing Exercises Horse-riding Squat Exercise Osteoarthritis Knee Factorial Design 

分 类 号：R244.1[医药卫生—针灸推拿学]