超声可视化针刀联合康复训练治疗膝骨关节炎疗效评价  

Evaluation of the Efficacy of Ultrasound-Guided Visualized Acupotomy Combined with Rehabilitation Training in Treatment of Knee Osteoarthritis

作　　者：潘细桂 连晓文 付解辉 张泽升 刘雪梅 修忠标[3] PAN Xigui;LIAN Xiaowen;FU Jiehui;ZHANG Zesheng;LIU Xuemei;XIU Zhongbiao(The Affiliated Rehabilitation of Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350003,China;Fujian Provincial Key Laboratory of Rehabilitation Technology,Fuzhou,Fujian 350003,China;The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350004,China)

机构地区：[1]福建中医药大学附属康复医院,福建福州350003 [2]福建省康复技术重点实验室,福建福州350003 [3]福建中医药大学附属人民医院,福建福州350004

出　　处：《康复学报》2024年第5期508-515,共8页Rehabilitation Medicine

基　　金：国家自然科学基金面上项目(81873315);福建省教育厅中青年教师教育科研课题(JAT200200)。

摘　　要：目的观察超声可视化针刀联合康复训练治疗膝骨关节炎的疗效。方法选取2021年8月—2023年3月在福建中医药大学附属康复医院收治的膝骨关节炎患者70例,按照随机数字表法分为超声针刀组和常规治疗组,每组35例,其中超声针刀组4例、常规治疗组6例在中途退出,最终超声针刀组纳入31例,常规治疗组纳入29例。超声针刀组在超声引导下行针刀治疗,同时联合股四头肌康复训练;常规治疗组行普通针刺治疗加股四头肌康复训练,比较2组治疗前后视觉模拟评分法(VAS)及西安大略和曼彻斯特大学骨关节炎指数(WOMAC)评分、股四头肌峰力矩值(PT)的变化情况,并比较疗效及安全性。结果治疗后2组VAS评分均降低,与常规治疗组比较,超声针刀组VAS评分降低更明显(P<0.05)。治疗后2组骨关节炎指数(WOMAC)评分均有降低,超声针刀组WOMAC评分低于常规治疗组(P<0.001)。治疗后2组股四头肌PT均明显提高,与常规治疗组比较,超声针刀组提高更显著(P<0.001)。根据经筋辨证分型选取规律性经筋病灶点,选取频率较高的前4位主要为髌内下87.10%(27/31)、鹤顶次83.87%(26/31)、阴陵上77.42%(24/31)、髌外下74.19%(23/31)。髌内下在髌内侧支持带髌骨内下缘附着处回声增强,选取髌骨正下缘内侧旁开2 cm为进针点,针体向内侧偏45°,与皮肤垂直刺入,进针深度为(4.13±0.27)cm;鹤顶次在髌骨附着处股四头肌肌腱增厚,回声增强,髌上囊积液、滑膜增厚,选取髌骨正上缘1 cm处为进针点,髌上囊处针体向头侧偏45°进针,进针深度为(2.16±0.21)cm;阴陵上在鹅足腱胫骨内髁附着处回声增强,鹅足滑囊积液,选取髌骨正下缘内旁开3 cm、向下2 cm处为进针点,进针角度为鹅足滑囊处针体向头侧偏45°,进针深度为(1.97±0.18)cm;髌外下在髌外侧支持带髌骨外下缘附着处回声增强,选取髌骨下缘外侧正中旁开2 cm处为进针点,针体朝外偏45°,与皮肤垂Objective To observe the effect of ultrasound-guided visualized acupotomy combined with rehabilitation training for knee osteoarthritis.Methods A total of 70 patients with knee osteoarthritis,admitted to the Affiliated Rehabilitation of Fujian University of Traditional Chinese Medicine from August 2021 to March 2023 were selected.According to the random number table method,they were divided into ultrasonic needle knife group and conventional treatment group,with 35 cases in each group.Four patients in the ultrasound needle knife group and 6 patients in the conventional treatment group withdrew.Ultimately,31 patients were included in the ultrasonic needle knife group and 29 in the conventional treatment group.The ultrasonic needle knife group underwent needle knife treatment under ultrasound guidance,combined with quadriceps rehabilitation training.The conventional treatment group underwent general acupuncture treatment plus quadriceps rehabilitation training.The visual analogue scale(VAS),the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores,peak torque values of the quadriceps femoris(PT),and efficacy and safety before and after treatment were compared.Results After treatment,the VAS scores decreased in both groups,with the ultrasound needle knife group showing a more significant decrease compared with the conventional treatment group(P<0.05).WOMAC scores decreased in both groups after treatment,and the WOMAC scores of the ultrasound needle knife group were lower than those of the conventional treatment group(P<0.001).The PT of the quadriceps increased significantly in both groups after treatment,and there was more significant in the ultrasound needle knife group compared with the conventional treatment group(P<0.001).On the basis of the selection of regular meridian disease points according to meridian sinew theory,the top 4 frequently selected points were"Binneixia"87.10%(27/31),"Hedingci"83.87%(26/31),"Yinlingshang"77.42%(24/31),and"Binwaixia"74.19%(23/31)."Binneixia"showed echo enha

关 键 词：膝骨关节炎 经筋理论 可视化针刀 股四头肌训练 疗效及安全 

分 类 号：R684.3[医药卫生—骨科学]