摘要
目的:探讨三指按摩手法辅助治疗髌股关节骨关节炎(patellofemoral osteoarthritis,PFOA)的临床疗效。方法:选取116例PFOA患者,随机分为2组,每组58例。所有患者均行关节镜下髌股关节清理术,术后1周开始于髌股关节腔注射玻璃酸钠注射液,每次注射2 mL,每周1次,连续治疗5周,同时三指按摩手法组采用刘氏伤科三指按摩手法治疗,传统康复手法组采用传统康复手法治疗,均每3 d治疗1次,连续治疗20次。分别于治疗前、治疗结束后3个月测定患者炎症因子白细胞介素(interleukin,IL)-1β、IL-6及肿瘤坏死因子(tumor necrosis factor,TNF)-α的血清含量,采用视觉模拟量表(visual analogue scale,VAS)评分评价患膝疼痛程度,采用Lysholm膝关节评分评价患膝功能;于治疗结束后3个月,观察并记录患者PFOA复发情况。结果:①炎症因子血清含量。治疗前,2组患者IL^(-1)β、IL-6、TNF-α血清含量比较,组间差异均无统计学意义[(33.85±7.25)pg·mL^(-1),(35.02±8.79)pg·mL^(-1),t=-0.782,P=0.436;(27.65±4.85)pg·mL^(-1),(26.68±5.93)pg·mL^(-1),t=0.964,P=0.337;(38.45±8.26)pg·mL^(-1),(40.14±9.56)pg·mL^(-1),t=-1.019,P=0.310];治疗结束后3个月,2组患者IL^(-1)β、IL-6、TNF-α血清含量均低于治疗前(三指按摩手法组:t=13.436,P=0.000;t=16.468,P=0.000;t=13.598,P=0.000;传统康复手法组:t=8.170,P=0.000;t=8.312,P=0.000;t=8.038,P=0.000),三指按摩手法组患者IL^(-1)β、IL-6、TNF-α血清含量均低于传统康复手法组[(18.74±4.56)pg·mL^(-1),(23.48±6.20)pg·mL^(-1),t=-4.690,P=0.000;(14.38±3.76)pg·mL^(-1),(18.34±4.82)pg·mL^(-1),t=-4.933,P=0.000;(20.46±5.77)pg·mL^(-1),(27.38±7.40)pg·mL^(-1),t=-5.616,P=0.000]。②膝部疼痛VAS评分。治疗前,2组患者膝部疼痛VAS评分比较,差异无统计学意义[(5.18±0.83)分,(5.33±0.92)分,t=-0.922,P=0.359];治疗结束后3个月,2组患者膝部疼痛VAS评分均低于治疗前(t=23.535,P=0.000;t=14.693,P=0.000),三指按摩手法组患者膝部疼痛VAS评分低于传统康复手法组[(2.12±0.54)分,(3.04±0.75)分,t=-7.581,P=0.000]。③Lysholm膝关节评分。治疗前,2组患者Lysholm膝关节评分比较,差异无统计学意义[(62.74±9.25)分,(63.64±8.86)分,t=-0.535,P=0.594];治疗结束后3个月,2组患者Lysholm膝关节评分均高于治疗前(t=-10.592,P=0.000;t=-5.457,P=0.000),三指按摩手法组患者Lysholm膝关节评分高于传统康复手法组[(80.43±8.73)分,(73.44±10.42)分,t=3.916,P=0.000]。④复发率。治疗结束后3个月,三指按摩手法组PFOA复发3例,传统康复手法组PFOA复发10例,三指按摩手法组患者PFOA复发率低于传统康复手法组(χ^(2)=4.245,P=0.039)。结论:采用三指按摩手法辅助治疗PFOA,与传统康复手法辅助治疗相比,能够更好地抑制炎症反应,缓解膝部疼痛,改善膝关节功能,且复发率更低。
Objective:To explore the clinical curative effects of three-finger massage manipulation for adjuvant treatment of patellofem-oral osteoarthritis(PFOA).Methods:One hundred and sixteen PFOA patients were selected and randomly divided into 2 groups,58 cases in each group.All patients in the 2 groups were treated with arthroscopic patellofemoral debridement,followed by patellofemoral intra-artic-ular injection of sodium hyaluronate at 1 week after the surgery,once a week,2 mL at a time,for consecutive 5 weeks.Moreover,58 patients were treated with three-finger massage manipulation of Liu’s department of traumatology(three-finger massage manipulation group),while the others were treated with conventional rehabilitation manipulation(conventional rehabilitation manipulation group),1 time every 3 days for consecutive 20 times.The serum levels of inflammatory cytokines including interleukin(IL)-1β,IL-6 and tumor necrosis factor(TNF)-αwere measured,and the knee pain degree and knee function were evaluated by using visual analogue scale(VAS)scores and Ly-sholm knee scores respectively before the treatment and at 3 months after the end of treatment.The PFOA recurrence was observed and recorded at 3 months after the end of treatment.Results:There was no statistical difference in serum levels of IL^(-1)β,IL-6 and TNF-αbetween the 2 groups before the treatment(33.85±7.25 vs 35.02±8.79 pg/mL,t=-0.782,P=0.436;27.65±4.85 vs 26.68±5.93 pg/mL,t=0.964,P=0.337;38.45±8.26 vs 40.14±9.56 pg/mL,t=-1.019,P=0.310).The serum levels of IL^(-1)β,IL-6 and TNF-αdecreased at 3 months after the end of treatment compared to pretreatment in the 2 groups(three-finger massage manipulation group:t=13.436,P=0.000;t=16.468,P=0.000;t=13.598,P=0.000;conventional rehabilitation manipulation group:t=8.170,P=0.000;t=8.312,P=0.000;t=8.038,P=0.000),and were lower in three-finger massage manipulation group compared to conventional rehabilitation manipulation group(18.74±4.56 vs 23.48±6.20 pg/mL,t=-4.690,P=0.000;14.38±3.76 vs 18.34±4.82 pg/mL,t=-4.933,P=0.000;20.46±5.77 vs 27.38±7.40 pg/mL,t=-5.616,P=0.000).There was no statistical difference in knee pain VAS scores between the 2 groups before the treatment(5.18±0.83 vs 5.33±0.92 points,t=-0.922,P=0.359).The knee pain VAS scores decreased at 3 months after the end of treatment compared to pretreatment in the 2 groups(t=23.535,P=0.000;t=14.693,P=0.000),and were lower in three-finger massage manipulation group compared to conventional rehabilitation manipulation group(2.12±0.54 vs 3.04±0.75 points,t=-7.581,P=0.000).There was no statistical difference in Lysholm knee scores between the 2 groups be-fore the treatment(62.74±9.25 vs 63.64±8.86 points,t=-0.535,P=0.594).The Lysholm knee scores increased at 3 months after the end of treatment compared to pretreatment in the 2 groups(t=-10.592,P=0.000;t=-5.457,P=0.000),and were higher in three-finger massage manipulation group compared to conventional rehabilitation manipulation group(80.43±8.73 vs 73.44±10.42 points,t=3.916,P=0.000).At 3 months after the end of treatment,recrudescent PFOA were found in 3 patients in three-finger massage manipulation group and 10 patients in conventional rehabilitation manipulation group.The recurrence rate of PFOA was lower in three-finger massage manipulation group compared to conventional rehabilitation manipulation group(χ^(2)=4.245,P=0.039).Conclusion:Three-finger massage manipulation can better inhibit inflammatory reaction,relieve knee pain and improve knee function compared to conventional reha-bilitation manipulation in adjuvant treatment of PFOA with lower recurrence rate.
作者
陈双钱
林定艺
陈文煜
CHEN Shuangqian;LIN Dingyi;CHEN Wenyu(Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou 325000,Zhejiang,China)
出处
《中医正骨》
2021年第4期15-19,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
骨关节炎
膝
髌股关节
三指按摩手法
注射
关节内
透明质酸
炎症因子
临床试验
osteoarthritis,knee
patellofemoral joint
three-finger massage manipulation
injections,intra-articular
hyaluronic acid
inflam-matory factors
clinical trial
