点穴揉筋推拿法治疗膝骨关节炎伸直障碍的临床疗效及力学机制  

Clinical efficacy and mechanical mechanism of pressing acupoints and kneading tendon massage in the treatment of knee osteoarthritis with straightening disorder

作　　者：王翠平[1] 梁翼[1] 余文景[1] 沙湖[1] 程松苗 WANG Cuiping;LIANG Yi;YU Wenjing;SHA Hu;CHENG Songmiao(Sichuan Orthopaedic Hospital,Chengdu 610000,Sichuan,China)

机构地区：[1]四川省骨科医院,四川成都610000

出　　处：《现代中西医结合杂志》2023年第8期1080-1085,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：2021年四川省干部保健科研课题(川干研2021-610)。

摘　　要：目的 观察点穴揉筋推拿法治疗膝骨关节炎(KOA)伸直障碍的临床疗效及对X射线下生物力学指标的影响。方法 选择2019年1月—2021年10月在四川省骨科医院就诊的140例KOA伴有伸直障碍患者,按照治疗方法不同分为2组:69例接受下肢皮牵引+中医推拿治疗为对照组,71例接受下肢皮牵引+点穴揉筋推拿治疗为观察组。按照1∶1最近临匹配法将2组患者进行匹配,比较2组治疗6周后临床疗效、疼痛程度(VAS评分)、膝关节功能(WOMAC评分)、膝关节活动度、膝关节液中炎性因子水平[肿瘤坏死因子α(TNF-α)、白细胞介素-17(IL-17)、白细胞介素-1(IL-1)]及X射线下生物力学指标(股骨胫角、膝关节内侧间隙及外侧间隙)。结果 140例患者中最终92例匹配成功,观察组及对照组各46例。倾向性评分匹配后,治疗6周后观察组的治疗总有效率为89.13%(41/46),显著高于对照组的71.74%(33/46),差异有统计学意义(P<0.05);观察组VAS评分、WOMAC总分及膝关节液中TNF-α、IL-17、IL-1水平均显著低于治疗前及对照组(P均<0.05),膝关节活动度显著高于治疗前及对照组(P均<0.05),X射线股骨胫角显著小于治疗前及对照组(P均<0.05),膝关节内侧及外侧间隙显著大于治疗前及对照组(P均<0.05)。结论 点穴揉筋推拿法治疗KOA伸直障碍可有效缓解疼痛、僵直等症状,减轻局部炎性反应,改善膝关节功能及X射线下生物力学指标。Objective It is to observe the clinical efficacy of pressing acupoints and kneading tendon massage in the treatment of knee osteoarthritis(KOA)with straightening disorder and the effect on biomechanical indexes under X-ray.Methods One hundred and forty patients with KOA with straightening disorder treated at Sichuan Orthopedic Hospital from January 2019 to October 2021 were selected and divided into two groups according to different treatment methods:69 cases receiving lower limb skin traction+traditional Chinese medical massage as the control group and 71 cases receiving lower limb skin traction+pressing acupoints and kneading tendon massage as the observation group.The patients in the two groups were matched according to the 1∶1 nearest proximity matching method,and the clinical efficacy,degree of pain(VAS score),knee function(WOMAC score),knee mobility,levels of inflammatory factors(tumor necrosis factor-α(TNF-α),interleukin-17(IL-17),interleukin-1(IL-1)in knee joint fluid and X-ray biomechanical indexes(femoral tibial angle,medial space and lateral space of knee joints)after 6 weeks of treatment were compared between the two groups.Results Among the 140 patients,92 patients were finally matched successfully,46 cases in the observation group and 46 cases in the control group.After the propensity score matching,the total effective rate of treatment after 6 weeks of treatment was 89.13%(41/46)in the observation group,which was significantly higher than that 71.74%(33/46)in the control group,and the difference was statistically significant(P<0.05).After 6 weeks of treatment,the VAS score,total WOMAC score and the levels of TNF-α,IL-17 and IL-1 in knee joint fluid in the observation group were significantly lower than those in the pre-treatment and control groups(all P<0.05),the knee mobility was significantly higher than that of the pre-treatment and control groups(both P<0.05),X-ray femoral tibial angle was significantly smaller than that of the pre-treatment and control groups(both P<0.05),and medial space

关 键 词：膝骨关节炎 伸直障碍 点穴揉筋 推拿 力学指标 

分 类 号：R684.3[医药卫生—骨科学]