[1]张辽,金甬,王焕明,等.“经纬辨证”理论指导下针刀配合手法及蚌式开合功能锻炼治疗髌股关节外侧高压综合征的临床研究[J].中医正骨,2018,30(04):23-27.
　ZHANG Liao,JIN Yong,WANG Huanming,et al.A clinical study of needle-knife therapy under the guidance of Jingwei syndrome differentiation theory combined with manipulation and mussel-style open-close functional exercises for treatment of excessive[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(04):23-27.
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“经纬辨证”理论指导下针刀配合手法及蚌式开合功能锻炼治疗髌股关节外侧高压综合征的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年04期
页码:
23-27
栏目:
临床研究
出版日期:
2018-04-20

文章信息/Info

Title:
A clinical study of needle-knife therapy under the guidance of Jingwei syndrome differentiation theory combined with manipulation and mussel-style open-close functional exercises for treatment of excessive
作者:
张辽1; 金甬1; 王焕明2; 毛宇芳1; 胡浩1; 许旻鸣1
1.浙江省宁波市中医院,浙江 宁波 315010; 2.浙江省中医院,浙江 杭州 310006
Author(s):
ZHANG Liao1; JIN Yong1; WANG Huanming2; MAO Yufang1; HU Hao1; XU Minming1
1.Ningbo Hospital of Traditional Chinese Medicine,Ningbo 315010,Zhejiang,China2.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
关键词:
髌股关节;  膝关节;  疼痛;  小刀针;  肌肉骨骼手法;  运动疗法
Keywords:
Keywords patellofemoral joint;  knee joint;  pain;  small knife needle;  musculoskeletal manipulations;  exercise therapy
摘要:
目的:观察“经纬辨证”理论指导下针刀配合手法及蚌式开合功能锻炼治疗髌股关节外侧高压综合征(excessive lateral pressure syndrome,ELPS)的临床疗效。方法:2015年1月至2017年3月,招募ELPS患者64例,随机分为2组,每组32例。观察组采用“经纬辨证”理论指导下针刀配合内推髌骨手法及蚌式开合功能锻炼治疗,对照组采用传统针刀配合内推髌骨手法及直腿抬高功能锻炼治疗。观察组根据“经纬辨证”理论,以下肢为整体、髌股关节为局部,整体与局部相结合选取进针点; 对照组于髌股关节局部取点。针刀松解均为每周1次,连续松解3次为1个疗程; 内推髌骨手法每日操作2次,连续6周为1个疗程; 蚌式开合功能锻炼及直腿抬高功能锻炼均为每次5 min,每日2次,连续锻炼6周为1个疗程; 均治疗1个疗程。分别于治疗前及末次随访时,采用疼痛视觉模拟量表(visual analogue scale,VAS)评价膝部疼痛程度,采用Lysholm膝关节功能评分和Kujala髌股关节评分评价膝关节及髌股关节功能。结果:所有患者均获随访,随访时间5～8个月,中位数6个月。治疗前2组患者的膝部疼痛VAS评分比较,差异无统计学意义[(6.16±0.92)分,(5.97±0.90)分,t=0.825,P=0.412]; 末次随访时2组患者的膝部疼痛VAS评分均较治疗前降低(t=36.704,P=0.000; t=17.647,P=0.000),且观察组的膝部疼痛VAS评分低于对照组[(1.28±0.77)分,(2.91±0.78)分,t=8.393,P=0.000]。治疗前2组患者的Lysholm膝关节功能评分比较,差异无统计学意义[(59.72±8.55)分,(60.97±8.00)分,t=0.604,P=0.548]; 末次随访时2组患者的Lysholm膝关节功能评分均较治疗前增高(t=30.334,P=0.000; t=25.281,P=0.000),且观察组的Lysholm膝关节功能评分高于对照组[(90.38±4.56)分,(83.50±5.56)分,t=5.407,P=0.000]。治疗前2组患者的Kujala髌股关节评分比较,差异无统计学意义[(52.16±8.54)分,(52.41±9.37)分,t=0.112,P=0.912]; 末次随访时2组患者的Kujala髌股关节评分均较治疗前增高(t=37.512,P=0.000; t=31.191,P=0.000),且观察组的Kujala髌股关节评分高于对照组[(86.38±5.99)分,(82.34±6.45)分,t=2.588,P=0.012]。结论:“经纬辨证”理论指导下针刀配合手法及蚌式开合功能锻炼治疗ELPS,可以减轻膝部疼痛症状、促进膝关节及髌股关节功能恢复,且疗效优于传统针刀配合手法及直腿抬高功能锻炼治疗。
Abstract:
ABSTRACT Objective:To observe the clinical curative effects of needle-knife therapy under the guidance of Jingwei syndrome differentiation theory combined with manipulation and mussel-style open-close functional exercises for treatment of excessive lateral pressure syndrome(ELPS)of patellofemoral joint.Methods:Sixty-four patients with ELPS of patellofemoral joint were recruited from January 2015 to March 2017,and were randomly divided into observation group and control group,32 patients in each group.The patients in observation group were treated with needle-knife therapy under the guidance of Jingwei syndrome differentiation theory combined with manipulation and mussel-style open-close functional exercises,while the patients in control group were treated with traditional needle-knife therapycombined with patellar inward-pushing manipulation and straight-leg-raise functional exercises.According to the Jingwei syndrome differentiation theory,the needle-insertion points were selected by taking lower extremity as the whole and patellofemoral joint as a part and combining the whole with the part in observation group,while the needle-insertion points were selected at patellofemoral joint in control group.Needle-knife release was performed once a week for consecutive 3 times.The patellar inward-pushing manipulation was performed 2 times a day for consecutive 6 weeks.The mussel-style open-close functional exercises and the straight-leg-raise functional exercises were performed 2 times a day,5 minutes at a time for consecutive 6 weeks.The degree of knee pain,the knee joint function and the patellofemoral joint function were evaluated by using pain visual analogue scale(VAS)scores,Lysholm knee function scores and Kujala patellofemoral joint scores before treatment and at follow-up respectively.Results:All patients in the 2 groups were followed up for 5-8 months with a median of 6 months.There was no statistical difference in knee pain VAS scores between the 2 groups before the treatment(6.16+/-0.92 vs 5.97+/-0.90 points,t=0.825,P=0.412).The knee pain VAS scores were lower at last follow-up compared to pretreatment in the 2 groups(t=36.704,P=0.000; t=17.647,P=0.000)and were lower in observation group compared to control group at last follow-up(1.28+/-0.77 vs 2.91+/-0.78 points,t=8.393,P=0.000).There was no statistical difference in Lysholm knee function scores between the 2 groups before the treatment(59.72+/-8.55 vs 60.97+/-8.00 points,t=0.604,P=0.548).The Lysholm knee function scores were higher at last follow-up compared to pretreatment in the 2 groups(t=30.334,P=0.000; t=25.281,P=0.000)and were higher in observation group compared to control group at last follow-up(90.38+/-4.56 vs 83.50+/-5.56 points,t=5.407,P=0.000).There was no statistical difference in Kujala patellofemoral joint scores between the 2 groups before the treatment(52.16+/-8.54 vs 52.41+/-9.37 points,t=0.112,P=0.912).The Kujala patellofemoral joint scores were higher at last follow-up compared to pretreatment in the 2 groups(t=37.512,P=0.000; t=31.191,P=0.000)and were higher in observation group compared to control group at last follow-up(86.38+/-5.99 vs 82.34+/-6.45 points,t=2.588,P=0.012).Conclusion:The combination therapy of needle-knife therapy under the guidance of Jingwei syndrome differentiation theory and manipulation and mussel-style open-close functional exercises can relieve the knee pain and improve the knee joint function and patellofemoral joint function in the treatment of ELPS,moreover,its curative effect is better than that of traditional needle-knife therapy combined with manipulation and straight-leg-raise functional exercises.

参考文献/References:

[1] 冯华,张辉.髌股关节不稳定临床评估与治疗[M].北京:人民军医出版社,2014:133-139.
[2] 亓建洪,黄煌渊,陈世益,等.髌骨倾斜导致髌骨软骨软化实验研究[J].中国运动医学杂志,1999,18(1):14-16.
[3] 何海军,王荣田,谢斌,等.基于“经筋理论”针刀治疗髌骨外侧高压综合征的临床研究[J].中国中医骨伤科杂志,2016,24(8):1-4.
[4] KELLGREN JH,LAWRENCE JS.Radiological assessment of osteo-arthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[5] LYSHOLM J,GILLQUIST J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[6] KUJALA UM,JAAKKOLA LH,KOSKINEN SK,et al.Scoring of patellofemoral disorders[J].Arthroscopy,1993,9(2):159-163.
[7] 张德洲,吴俊华,易雪冰,等.基于MRI探讨髌骨骑跨与髌骨软化症的关系[J].中医正骨,2017,29(11):38-40.
[8] 刘劲松,张道平.小针刀松解髌股外侧支持带治疗髌股外侧高压综合征的临床研究[J].中医正骨,2011,23(7):8-11.
[9] DYE SF,ST?UBLI HU,BIEDERT RM,et al.The mosaic of pathophysiology causing patellofemoral pain:Therapeutic implications[J].Oper Tech Sports Med,1999,7(2):46-54.
[10] SANCHIS-ALFONSO V,ROSELLó-SASTRE E,REVERT F,et al.Histologic retinacular changes associated with ischemia in painful patellofemoral malalignment[J].Orthopedics,2005,28(6):593-599.
[11] 刘劲松,张道平.髌股外侧高压综合征的研究现状[J].中国骨伤,2011,24(5):436-441.
[12] 何克,李忠.关节镜下外侧支持带松解加软骨成形治疗中青年人髌骨外侧高压综合征[J].西南军医,2016,18(3):214-216.
[13] 霍乐乐,高文香,陈磊,等.髌骨外侧关节面成形术治疗髌股外侧高压综合征的疗效观察[J].临床医学,2017,37(4):19-21.
[14] 张辽,金甬,毛宇芳,等.髌旁小切口经髌股关节通道加压埋头空心钉结合缝线锚钉内固定治疗前交叉韧带胫骨止点撕脱骨折[J].中医正骨,2016,28(11):43-46.
[15] KWAK SD,AHMAD CS,GARDNER TR,et al.Harmstrings and iliotibial band forces affect knee kinematics and contact pattern[J].J Orthop Res,2000,18(1):101-108.
[16] CHRISTOFORAKIS J,BULL AM,STRACHAN RK,et al.Effects of lateral retinacular release on the lateral stability of the patella[J].Knee Surg Sports Traumatol Arthrosc,2006,14(3):273-277.
[17] SINGH A,HARIS M,CAI K,et al.High resolution T1ρ mapping of in vivo human knee cartilage at 7T[J].PLoS One,2014,9(5):97486.
[18] 王宏伟,周殿阁.髂胫束松解在外翻膝全膝关节置换术中的作用[J].中国骨与关节损伤杂志,2015,30(8):812-814.
[19] 陈小刚.中医理筋手法与小针刀疗法在筋伤疾病治疗中的协同应用[J].中医正骨,2017,29(5):14-15.

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备注/Memo

备注/Memo:
基金项目:全国名老中医药专家传承工作室建设项目; 浙江省中医药科技计划项目(2018ZB119)通讯作者:张辽 E-mail:drzhangliao@163.com
更新日期/Last Update: 2018-08-24