[1]周凌峰,郑晓,汤雨婷,等.髋外展肌等速训练联合理筋整复手法治疗膝骨关节炎的临床研究[J].中医正骨,2025,37(12):1-7.
　ZHOU Lingfeng,ZHENG Xiao,TANG Yuting,et al.A clinical study of hip abductor isokinetic training combined with tendon rectification manipulation for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(12):1-7.
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髋外展肌等速训练联合理筋整复手法治疗膝骨关节炎的临床研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年12期
页码:
1-7
栏目:
临床研究
出版日期:
2025-12-20

文章信息/Info

Title:
A clinical study of hip abductor isokinetic training combined with tendon rectification manipulation for treatment of knee osteoarthritis
作者:
周凌峰; 郑晓; 汤雨婷; 孙阳; 李岩峰; 张盛禹; 徐轶飞; 陆丽源; 朱颖慧; 毛娇
(上海中医药大学附属市中医医院,上海 200071)
Author(s):
ZHOU Lingfeng; ZHENG Xiao; TANG Yuting; SUN Yang; LI Yanfeng; ZHANG Shengyu; XU Yifei; LU Liyuan; ZHU Yinghui; MAO Jiao
Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China
关键词:
骨关节炎; 膝;  运动疗法;  髋外展肌;  股四头肌;  等速运动;  理筋手法;  整复疗法;  随机对照试验专题
Keywords:
osteoarthritis; knee;  exercise therapy;  hip abductor;  quadriceps femoris muscle;  isokinetic exercise;  therapeutic manipulation for injured soft tissue;  reduction therapy;  randomized controlled trials as topic
摘要:
目的:探讨髋外展肌等速训练联合理筋整复手法治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效和安全性。方法:将2024年8月至2025年5月收治的84例KOA患者随机分为2组,每组42例,均进行股四头肌训练。在此基础上,理筋组给予理筋整复手法治疗; 联合组在理筋组治疗的基础上进行髋外展肌等速训练。股四头肌训练、理筋整复手法治疗及髋外展肌等速训练均隔天1次,共治疗6周。分别于治疗前和治疗结束后,测定患侧膝关节西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分、疼痛视觉模拟量表(visual analogue scale,VAS)评分、关节活动度、髋外展肌相对峰值力矩、股四头肌达峰力矩时间。试验期间,观察患者的并发症发生情况。结果:①一般情况。试验期间联合组失访1例,最终共有83例纳入统计。②WOMAC评分。治疗前2组患者的WOMAC评分比较,差异无统计学意义。治疗结束后,2组患者的WOMAC评分均较治疗前降低[(33.32±5.36)分,(20.41±3.94)分,t=35.584,P=0.000;(35.24±5.21)分,(26.43±4.44)分,t=40.254,P=0.000],联合组的评分低于理筋组(t=6.523,P=0.000)。③膝关节疼痛VAS评分。治疗前2组患者的膝关节疼痛VAS评分比较,差异无统计学意义。治疗结束后,2组患者的膝关节疼痛VAS评分均较治疗前降低[(5.88±1.45)分,(2.41±1.52)分,t=15.861,P=0.000;(5.74±1.42)分,(3.02±1.24)分,t=12.872,P=0.000],联合组的评分低于理筋组(t=2.006,P=0.048)。④膝关节活动度。治疗前2组患者的膝关节活动度比较,差异无统计学意义。治疗结束后,2组患者的膝关节活动度均较治疗前增大(106.50°±4.47°,119.43°±4.25°,t=-57.537,P=0.000; 107.41°±4.59°,114.93°±4.60°,t=-33.969,P=0.000),联合组的膝关节活动度大于理筋组(t=-4.616,P=0.000)。⑤髋外展肌相对峰值力矩。治疗前2组患者的髋外展肌相对峰值力矩比较,差异无统计学意义。治疗结束后,联合组的髋外展肌相对峰值力矩较治疗前增大[(0.96±0.10)Nm·kg-1,(1.02±0.09)Nm·kg-1,t=-20.695,P=0.000]; 理筋组治疗前后髋外展肌相对峰值力矩的差异无统计学意义; 联合组的髋外展肌相对峰值力矩大于理筋组(t=-2.707,P=0.008)。⑥股四头肌达峰力矩时间。治疗前2组患者的股四头肌达峰力矩时间比较,差异无统计学意义。治疗结束后,2组患者的股四头肌达峰力矩时间均较治疗前缩短[(603.00±25.86)ms,(383.88±26.67)ms,t=283.406,P=0.000;(596.98±24.25)ms,(491.29±25.98)ms,t=117.936,P=0.000],联合组的股四头肌达峰力矩时间短于理筋组(t=18.586,P=0.000)。⑦并发症。试验期间,联合组和理筋组分别有3例和2例出现轻微的肌肉酸胀,经休息、放松后均自行缓解。结论:髋外展肌等速训练联合理筋整复手法治疗KOA,可增强髋外展肌肌力、激活股四头肌,从而有效减轻膝关节疼痛症状、增加膝关节活动度、改善膝关节功能; 其疗效优于理筋整复手法,且安全性与之相当。
Abstract:
Objective:To evaluate the clinical efficacy and safety of hip abductor isokinetic training combined with tendon rectification manipulation in treatment of knee osteoarthritis(KOA).Methods:Eighty-four KOA patients,recruited from August 2024 to May 2025,were enrolled in the study,and randomized into manipulation group and combination group,with 42 ones in each group.All patients in the 2 groups were instructed to perform quadriceps training,then,the ones in the manipulation group were further treated with tendon rectification manipulation,and the ones in the combination group with hip abductor isokinetic training,except for the tendon rectification manipulation.All interventions were performed once every other day for consecutive 6 weeks.After that,the affected knee Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score,pain visual analogue scale(VAS)score,range of motion(ROM),relative peak torque of the hip abductors,and time to peak torque of the quadriceps were measured before and after the treatment,and the complications were monitored throughout the trial.Results:①General information.One patient was lost to follow-up in the combination group,and 83 cases were included in the final analysis.②WOMAC score.The WOMAC score showed no significant difference between the 2 groups before the treatment,while it decreased in the 2 groups after the end of the treatment compared to pre-treatment(33.32±5.36 vs 20.41±3.94 points,t=35.584,P=0.000; 35.24±5.21 vs 26.43±4.44 points,t=40.254,P=0.000),with the lower values observed in the combination group(t=6.523,P=0.000).③Affected knee pain VAS score.The knee pain VAS score showed no significant difference between the 2 groups before the treatment,but it decreased in the 2 groups after the end of the treatment compared to pre-treatment(5.88±1.45 vs 2.41±1.52 points,t=15.861,P=0.000; 5.74±1.42 vs 3.02±1.24 points,t=12.872,P=0.000),with the lower values observed in the combination group(t=2.006,P=0.048).④Affected knee ROM.The knee ROM showed no significant difference between the 2 groups before the treatment,but it increased in the 2 groups after the end of the treatment compared to pre-treatment(106.50±4.47 vs 119.43±4.25 degrees,t=-57.537,P=0.000; 107.41±4.59 vs 114.93±4.60 degrees,t=-33.969,P=0.000),with a greater increase observed in the combination group(t=-4.616,P=0.000).⑤Relative peak torque of the hip abductors.The relative peak torque of the hip abductors showed no significant difference between the 2 groups before the treatment,while,it merely increased in the combination group after the end of the treatment compared to pre-treatment(0.96±0.10 vs 1.02±0.09 Nm/kg,t=-20.695,P=0.000),but not different in manipulation group between pre-treatment and post-treatment,with the greater values observed in the combination group(t=-2.707,P=0.008).⑥Time to peak torque of the quadriceps.The time to peak torque of the quadriceps showed no significant difference between the 2 groups before the treatment,but it shortened in the 2 groups after the end of the treatment compared to pre-treatment(603.00±25.86 vs 383.88±26.67 milliseconds,t=283.406,P=0.000; 596.98±24.25 vs 491.29±25.98 milliseconds,t=117.936,P=0.000),with a more pronounced shortening observed in the combination group(t=18.586,P=0.000).⑦Complications.Throughout the trial,3 patients in the combination group and 2 ones in the manipulation group experienced mild muscle soreness and distension,which resolved spontaneously after rest and relaxation.Conclusion:Combination of hip abductor isokinetic training with tendon rectification manipulation can enhance the strength of hip abductor and activate the quadriceps,thereby effectively alleviating the knee pain,increasing the knee ROM,and improving the knee function.Its therapeutic efficacy is superior to that of performing tendon rectification manipulation alone,with a comparable safety profile.

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备注/Memo

备注/Memo:
基金项目:上海市卫生健康委员会科研项目(20234Y0140)
通讯作者:郑晓 E-mail:15021795998@163.com
(收稿日期:2025-07-17 本文编辑:李晓乐)
更新日期/Last Update: 2025-12-20