理筋手法联合神经肌肉本体感觉促进技术在肝肾不足、筋脉瘀阻证膝骨关节炎人工全膝关节置换术后的应用  

Application of tendon manipulation combined with proprioceptive neuromuscular facilitation in knee osteoarthritis with liver and kidney deficiency and muscle stasis syndrome after total knee arthroplasty

作　　者：张波[1] 张成林 陈爱丽 许光旭 ZHANG Bo;ZHANG Chenglin;CHEN Aili;XU Guangxu(Department of Rehabilitation Medicine,the Affiliated Suqian First People's Hospital of Nanjing Medical University,Suqian,Jiangsu 223800;Department of Geriatrics,the Affiliated Suqian First People's Hospital of Nanjing Medical University,Suqian,Jiangsu 223800;Rehabilitation Medicine Center,the First Affiliated Hospital with Nanjing Medical University,Nanjing,Jiangsu 210029)

机构地区：[1]南京医科大学附属宿迁第一人民医院康复医学科,江苏宿迁223800 [2]南京医科大学附属宿迁第一人民医院老年医学科,江苏宿迁223800 [3]南京医科大学第一附属医院康复医学中心,江苏南京210029

出　　处：《河北中医》2023年第9期1535-1540,共6页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察理筋手法联合神经肌肉本体感觉促进技术(PNF)在肝肾不足、筋脉瘀阻证膝骨关节炎(KOA)人工全膝关节置换术(TKA)后的应用。方法将80例肝肾不足、筋脉瘀阻证KOA TKA术后患者按照随机数字表法分为2组。对照组40例在常规康复训练基础上加PNF技术,治疗组40例在对照组治疗基础上联合理筋手法治疗。2组均治疗4周。比较2组疗效;比较2组治疗前后中医证候评分;比较2组治疗前后血清炎症因子、血液流变学指标、美国特种医院(HSS)膝关节功能评分变化。结果治疗组剔除1例,对照组剔除3例。治疗组总有效率94.87%(37/39),对照组总有效率78.38%(29/37),治疗组疗效优于对照组(P<0.05)。2组治疗后关节疼痛、胫软膝酸、活动不利、动作牵强评分及总评分均较本组治疗前降低(P<0.05);治疗后治疗组关节疼痛、胫软膝酸、活动不利、动作牵强评分及总评分均低于对照组(P<0.05)。2组治疗后血清C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平均较本组治疗前降低(P<0.05),IL-10水平较本组治疗前升高(P<0.05);治疗后治疗组血清CRP、IL-6、TNF-α水平均低于对照组(P<0.05),IL-10水平高于对照组(P<0.05)。2组治疗后全血黏度(高切、中切、低切)、血浆黏度、红细胞聚集指数均较本组治疗前降低(P<0.05);治疗组治疗后全血黏度(高切、中切、低切)、血浆黏度、红细胞聚集指数均低于对照组(P<0.05)。2组治疗后疼痛、功能、活动度、肌力、屈曲畸形、稳定性评分及总评分均较本组治疗前升高(P<0.05);治疗后治疗组疼痛、功能、活动度、肌力、屈曲畸形、稳定性评分及总评分均高于对照组(P<0.05)。结论理筋手法联合PNF技术能缓解肝肾不足、筋脉瘀阻证KOA患者TKA术后临床症状,促进术后膝关节功能恢复,可能与抑制炎性反应、改善血液流变学指标有关。Objective To observe the applicationof tendon manipulation combined with proprioceptive neuromuscular facilitation(PNF)in knee osteoarthritis(KOA)with liver and kidney deficiency and muscle stasis syndrome after total knee arthroplasty(TKA).Methods A total of 80 KOA patients with liver and kidney deficiency and muscle stasis syndrome undergoing TKA were randomly divided into control group(n=40,3 cases dropped off)and treatment group(n=40,1case dropped off).All patients were treated with routine rehabilitation training,patients in the control were additionally PNF technique,patients in the treatment group were additionally tendon manipulation and PNF technique.Treated for 4 weeks,the aimwas to compare curative effects,traditional chinese medicine(TCM)syndromes scores,serum inflammatory factors,hemorheology indexes,and Hospital for Special Surgery(HSS)score for knee joint function before and after treatment between groups.Results The total effective rate in the treatment group was better than that in the control group(94.87%[37/39]vs 78.38%[29/37],P<0.05).After treatment,the each dimension scores and the total score of TCM syndrome(joint pain,tibial soft knee acid,adverse activity,action traction)in the two groups were significantly lower than thosebefore treatment(P<0.05),and which in the treatment group were significantly lower than those in the control group(P<0.05).Significantly decreased C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α),and significantly increased IL-10 were detected in the two groups when compared with before treatment(P<0.05),andthe differences were significant in CRP,IL-6,TNF-αand IL-10 between groups(all P<0.05).The indexes of whole blood viscosity,plasma viscosity and erythrocyte aggregation in the both groups were significantly lower than those before treatment(P<0.05),and the reduction was more pronounced in the treatment group(P<0.05).The each dimension scores and the total score of pain,function,activity,muscle strength,flexion deformity,stability in the

关 键 词：人工关节 膝关节 外科学 舒筋整复手法 中西医结合疗法 

分 类 号：R247.9[医药卫生—中医临床基础] R648.78[医药卫生—中医学]