[1]沈海,何春江,罗小兵,等.髋膝联合针刺疗法对早中期膝骨关节炎患者下肢运动功能的影响[J].中医正骨,2018,30(12):4-8.
　SHEN Hai,HE Chunjiang,LUO Xiaobing,et al.Effects of hip and knee acupuncture therapy on motor function of lower limbs of patients with early-middle knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(12):4-8.
点击复制

髋膝联合针刺疗法对早中期膝骨关节炎患者下肢运动功能的影响()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年12期
页码:
4-8
栏目:
骨科运动康复
出版日期:
2018-12-20

文章信息/Info

Title:
Effects of hip and knee acupuncture therapy on motor function of lower limbs of patients with early-middle knee osteoarthritis
作者:
沈海1; 何春江2; 罗小兵1; 张纯2; 田国刚2; 何栩1
(1.四川省骨科医院,四川 成都 610041; 2.成都体育学院,四川 成都 610041)
Author(s):
SHEN Hai1; HE Chunjiang2; LUO Xiaobing1; ZHANG Chun2; TIAN Guogang2; HE Xu1
1.Sichuan Orthopaedic Hospital,Chengdu 610041,Sichuan,China 2.Chengdu Sport Institute,Chengdu 610041,Sichuan,China
关键词:
骨关节炎; 膝;  针刺疗法;  肌力;  姿势平衡;  临床试验
Keywords:
osteoarthritis; knee;  acupuncture therapy;  muscle strength;  postural balance;  clinical trial
摘要:
目的:观察髋膝联合针刺疗法对早中期膝骨关节炎(knee osteoarthritis,KOA)患者下肢运动功能的影响。方法:将80例符合要求的早中期(Kellgren-Lawrence分级为0级、Ⅰ级、Ⅱ级或Ⅲ级)KOA患者随机分为2组,每组40例。联合针刺组采用髋膝联合针刺疗法治疗,局部针刺组在膝关节周围取穴针刺治疗。2组针刺治疗均隔天1次,3次为1个疗程,间隔2 d后开始下一疗程,共治疗4个疗程。分别于治疗前和治疗结束后进行等速肌力测试和单脚站立时间测定。结果:治疗前2组患者的膝关节伸直肌力、膝关节屈曲肌力、髋关节伸直肌力、髋关节屈曲肌力、髋关节外展肌力、髋关节内收肌力及单脚站立时间比较,组间差异均无统计学意义[(1.170±0.456)Nm·kg-1,(1.251±0.415)Nm·kg-1,t=-0.065,P=0.614;(0.637±0.294)Nm·kg-1,(0.793±0.332)Nm·kg-1,t=-0.051,P=0.688;(1.440±0.800)Nm·kg-1,(1.450±0.707)Nm·kg-1,t=-0.034,P=0.729;(1.031±0.462)Nm·kg-1,(1.084±0.331)Nm·kg-1,t=-0.073,P=0.596;(0.829±0.355)Nm·kg-1,(0.858±0.281)Nm·kg-1,t=-0.031,P=0.735;(0.746±0.319)Nm·kg-1,(0.742±0.335)Nm·kg-1,t=0.016,P=0.830;(3.2±0.3)s,(2.9±0.3)s,t=0.409,P=0.224)]。治疗结束后,2组患者的膝关节伸直肌力、膝关节屈曲肌力、髋关节伸直肌力、髋关节屈曲肌力、髋关节外展肌力、髋关节内收肌力及单脚站立时间均较治疗前增加[联合针刺组:t=-2.175,P=0.023; t=-2.492,P=0.003; t=-2.280,P=0.014; t=-2.193,P=0.019; t=-2.457,P=0.006; t=-2.363,P=0.009; t=-4.061,P=0.000。局部针刺组:t=-2.018,P=0.044; t=-2.275,P=0.014; t=-2.110,P=0.027; t=-2.079,P=0.033; t=-2.166,P=0.024; t=-2.254,P=0.015; t=-4.270,P=0.000]; 联合针刺组的膝关节伸直肌力、膝关节屈曲肌力、髋关节伸直肌力、髋关节屈曲肌力、髋关节外展肌力、髋关节内收肌力及单脚站立时间均大于局部针刺组[(1.559±0.429)Nm·kg-1,(1.357±0.321)Nm·kg-1,t=2.128,P=0.026;(1.087±0.340)Nm·kg-1,(0.912±0.214)Nm·kg-1,t=2.065,P=0.039;(1.926±0.774)Nm·kg-1,(1.631±0.224)Nm·kg-1,t=2.090,P=0.028;(1.431±0.154)Nm·kg-1,(1.212±0.234)Nm·kg-1,t=2.073,P=0.035;(1.274±0.312)Nm·kg-1,(1.001±0.116)Nm·kg-1,t=2.292,P=0.013;(1.231±0.164)Nm·kg-1,(0.967±0.645)Nm·kg-1,t=2.084,P=0.031;(10.5±0.4)s,(7.3±0.2)s,t=2.471,P=0.005]。结论:髋膝联合针刺疗法能有效增强早中期KOA患者的患肢肌力和身体平衡协调能力,其效果优于膝关节局部针刺治疗。
Abstract:
Objective:To observe the effects of hip and knee acupuncture therapy on motor function of lower limbs of patients with early-middle knee osteoarthritis(KOA).Methods:Eighty patients with early-middle KOA(Kellgren-Lawrence grade 0,Ⅰ,ⅡandⅢ)enrolled in the study were randomly divided into group A and group B,40 cases in each group.The patients in group A were treated with acupuncture therapy at hip and knee,while the patients in group B were treated with acupuncture therapy at acupoints around the knee.The acupuncture therapies were performed in patients of the 2 groups on alternate days for 4 courses of treatment,three times for each course with a 2-day rest-insertion between courses.The isokinetic muscle strength and one-foot standing time were measured before treatment and after the end of the treatment respectively.Results:There was no statistical difference in knee extensor muscle strength,knee flexor muscle strength,hip extensor muscle strength,hip flexor muscle strength,hip abductor muscle strength,hip adductor muscle strength and one-foot standing time between the 2 groups before the treatment(1.170+/-0.456 vs 1.251+/-0.415 Nm/kg,t=-0.065,P=0.614; 0.637+/-0.294 vs 0.793+/-0.332 Nm/kg,t=-0.051,P=0.688; 1.440+/-0.800 vs 1.450+/-0.707 Nm/kg,t=-0.034,P=0.729; 1.031+/-0.462 vs 1.084+/-0.331 Nm/kg,t=-0.073,P=0.596; 0.829+/-0.355 vs 0.858+/-0.281 Nm/kg,t=-0.031,P=0.735; 0.746+/-0.319 vs 0.742+/-0.335 Nm/kg,t=0.016,P=0.830; 3.2+/-0.3 vs 2.9+/-0.3 seconds,t=0.409,P=0.224).The knee extensor muscle strength,knee flexor muscle strength,hip extensor muscle strength,hip flexor muscle strength,hip abductor muscle strength,hip adductor muscle strength and one-foot standing time increased in both of the 2 group after the end of the treatment compared to pre-treatment(Group A:t=-2.175,P=0.023; t=-2.492,P=0.003; t=-2.280,P=0.014; t=-2.193,P=0.019; t=-2.457,P=0.006; t=-2.363,P=0.009; t=-4.061,P=0.000.Group B:t=-2.018,P=0.044; t=-2.275,P=0.014; t=-2.110,P=0.027; t=-2.079,P=0.033; t=-2.166,P=0.024; t=-2.254,P=0.015; t=-4.270,P=0.000).The knee extensor muscle strength,knee flexor muscle strength,hip extensor muscle strength,hip flexor muscle strength,hip abductor muscle strength and hip adductor muscle strength were greater and the one-foot standing time was longer in group A compared to group B(1.559+/-0.429 vs 1.357+/-0.321 Nm/kg,t=2.128,P=0.026; 1.087+/-0.340 vs 0.912+/-0.214 Nm/kg,t=2.065,P=0.039; 1.926+/-0.774 vs 1.631+/-0.224 Nm/kg,t=2.090,P=0.028; 1.431+/-0.154 vs 1.212+/-0.234 Nm/kg,t=2.073,P=0.035; 1.274+/-0.312 vs 1.001+/-0.116 Nm/kg,t=2.292,P=0.013; 1.231+/-0.164 vs 0.967+/-0.645 Nm/kg,t=2.084,P=0.031; 10.5+/-0.4 vs 7.3+/-0.2 seconds,t=2.471,P=0.005).Conclusion:Hip and knee acupuncture therapy can effectively enhance muscle strength of affected limbs and balance and coordination ability of body in patients with early-middle KOA,and its curative effect is better than that of knee local acupuncture therapy.

参考文献/References:

[1] 陈瑶,俞泳,何成奇.膝骨关节炎患者本体感觉、肌力及关节功能的相关性研究[J].四川大学学报(医学版),2015,46(6):880-884.
[2] 李宁华,张耀南,张毅,等.国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较[J].中国组织工程研究与临床康复,2007,11(39):7758-7760.
[3] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.
[4] 洪昆达,万甜,陈鸿,等.浅针配合委中放血治疗急性期膝骨性关节炎的临床研究[J].中华中医药杂志,2015,30(6):2226-2229.
[5] 黄振,宋双临.温针灸配合乌蛇土鳖胶囊治疗膝骨性关节炎临床研究[J].中华中医药学刊,2012,30(12):2776-2778.
[6] 包飞,张燕,吴志宏,等.电针治疗膝骨关节炎疗效观察及对软骨磁共振T2图的影响[J].中国针灸,2013,33(3):193-197.
[7] 徐超,俞国旭,陈瀚宇.中医辅助对退行性骨关节病关节镜术后康复治疗疗效[J].中华中医药学刊,2018,36(5):1266-1268.
[8] MCGIBBON CA,KREBS DE.Compensatory gait mechanics in patients with unilateral knee arthritis[J].J Rheumatol,2002,29(11):2410-2419.
[9] KELLGREN JH,LAWRENCE JS.Radiological assessment of osteo-arthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[10] PINCIVERO DM,GANDAIO CB,ITO Y.Gender-specific knee extensor torque,flexor torque,and muscle fatigue responses during maximal effort contractions[J].Eur J Appl Physiol,2003,89(2):134-141.
[11] 张里援.水针刀疗法联合通痹酊剂热敷治疗膝骨关节炎寒湿痹阻证[J].中医正骨,2018,30(6):62-66.
[12] 蒋科卫,温建民,焦权明,等.中西医对膝骨关节炎的认识和治疗[J].中医正骨,2016,28(4):59-61.
[13] 乐意,金荣疆,阳杨,等.从下肢生物力学来解析膝骨关节炎[J].中国康复理论与实践,2013,19(6):505-509.
[14] 赵军,王庆甫.小针刀疗法结合功能锻炼治疗Kellgren-LawranceⅢ级膝骨关节炎[J].中医正骨,2018,30(2):65-68.
[15] 尤桂杰,顾丽燕,史清钊.步态与膝关节伤痛[J].中国体育科技,2003,39(2):56-58.
[16] 李腾辉,陈民.玻璃酸钠膝关节腔注射联合骨瓜提取物穴位注射治疗Kellgren-LawrenceⅢ、Ⅳ级膝骨关节炎的临床研究[J].中医正骨,2016,28(4):12-15.
[17] 孙士全,谭涛.针灸治疗膝骨关节炎的作用机制探讨[J].中国医药导报,2017,14(10):127-130.
[18] HUANG LP,ZHOU S,LU Z,et al.Bilateral effect of unilateral electroacupuncture on muscle strength[J].J Altern Complement Med,2007,13(5):539-546.
[19] PAYTON S,STEVEN DB.The effect of manual acupuncture and electroacupuncture on lower limb muscle strength[J].J Acupunct Tuina Sci,2017,15(1):47-53.

相似文献/References:

[1]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[2]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[3]郑春松,叶蕻芝,李西海,等.透骨消痛胶囊中补肾柔肝药和活血祛风药治疗 骨关节炎作用方式的计算机模拟比较[J].中医正骨,2015,27(07):6.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Comparison of the mode of action of Bushen Rougan(补肾柔肝)drugs versus Huoxue Qufeng(活血祛风)drugs contained in Tougu Xiaotong Jiaonang(透骨消痛胶囊)for the treatment of osteoarthritis:A computer simulation study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):6.
[4]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[5]郑春松,叶蕻芝,李西海,等.独活寄生汤含药血清对白细胞介素1β诱导的 退变关节软骨细胞中基质金属蛋白酶 和环氧化酶2表达的影响[J].中医正骨,2015,27(12):1.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Impact of Duhuo Jisheng Tang(独活寄生汤)medicated serum on expression of matrix metalloproteinase and cyclooxygenase 2 in degenerative articular chondrocytes induced by interleukin-1 beta[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):1.
[6]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[7]冯荣,王平,李炳奇,等.铍针刺络拔罐结合中药口服治疗膝骨关节炎合并 原发性血小板增多症1例[J].中医正骨,2015,27(12):73.
[8]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[9]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[10]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[11]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[12]明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25.
[13]张杰,王人彦,张玉柱.膝骨关节炎的治疗进展[J].中医正骨,2015,27(10):68.
[14]梁朝,蔡静怡,闫立,等.针刀疗法改善膝骨关节炎早期疼痛症状的疗效评价[J].中医正骨,2015,27(09):9.
　LIANG Zhao,CAI Jingyi,YAN Li,et al.Evaluation of the curative effect of needle-knife therapy for relieving knee pain in patients with early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):9.
[15]王建武,党建军,李强,等.四联疗法治疗膝骨关节炎[J].中医正骨,2015,27(08):44.
[16]刘红娟,郭会利,郭树农.云克联合中药治疗膝骨关节炎的护理[J].中医正骨,2015,27(08):75.
[17]陈卫衡.探索建立系统的膝骨关节炎中医临床科研范式 和理论体系[J].中医正骨,2015,27(07):1.
[18]帅波,沈霖,杨艳萍,等.加味青娥丸治疗膝骨关节炎的作用机制研究[J].中医正骨,2015,27(07):15.
　SHUAI Bo,SHEN Lin,YANG Yanping,et al.Study on the mechanism of action of Jiawei Qing'e Wan(加味青娥丸)for the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):15.
[19]梅其杰,袁长深,段戡,等.壮药骨痹方烫熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):27.
　MEI Qijie,YUAN Changshen,DUAN Kan,et al.Clinical study of the curative effect of hot compressing and rubbing with packet of Gubi Fang(骨痹方)combined with exercise therapy in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):27.
[20]王丹辉,张燕,刘丽娟,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白 关节腔注射联合中药薰洗治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):31.
　WANG Danhui,ZHANG Yan,LIU Lijuan,et al.Clinical study on intra-articular injection of TypeⅡrecombinant human tumor necrosis factor receptor-Fc fusion protein combined with Chinese herbal steaming and washing therapy for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):31.

备注/Memo

备注/Memo:
基金项目:四川省科技厅科技支撑项目(2014SZ0003-2) 通讯作者:沈海 E-mail:2430967067@qq.com (收稿日期:2018-10-16 本文编辑:李晓乐)
更新日期/Last Update: 2019-05-30