目的:膝骨关节炎的物理因子治疗方式越来越多,尚缺乏全面评估不同物理因子之间疗效对比的研究。因此,此次研究通过网状Meta分析比较不同物理因子治疗膝骨关节炎的有效性及安全性。方法:应用计算机检索PubMed、Web of Science、Cochrane ...目的:膝骨关节炎的物理因子治疗方式越来越多,尚缺乏全面评估不同物理因子之间疗效对比的研究。因此,此次研究通过网状Meta分析比较不同物理因子治疗膝骨关节炎的有效性及安全性。方法:应用计算机检索PubMed、Web of Science、Cochrane Library、EMbase数据库以及中国知网、维普数据库、万方数据库、中国生物医学文献服务系统,选择各数据库建库至2025-07-25有关物理因子治疗膝骨关节炎的随机对照试验,筛选文献及提取数据后,通过Cochrane推荐的风险偏倚评价工具评估纳入文献的质量,采用Stata 16.0、RevMan 5.4.1软件进行统计学分析。结果:①最终纳入65篇文献,共3418例患者,包括治疗组1726例、对照组1692例,并研究了7种物理因子治疗膝骨关节炎的康复方案。②网状Meta分析显示,在提高治疗总有效率方面,累积概率排名曲线下面积由高到低的干预措施为(排名前3):脉冲电磁场+常规康复>超声波+常规康复>经皮电刺激+常规康复;在改善膝关节目测类比评分方面,累积概率排名曲线下面积由高到低的干预措施为(排名前3):经皮电刺激+常规康复>体外冲击波+常规康复>超声波+常规康复;在改善WOMAC总评分方面,累积概率排名曲线下面积由高到低的干预措施为(排名前3):超声波+常规康复>脉冲电磁场+常规康复>超声波+经皮电刺激+常规康复;在减少WOMAC关节僵硬评分方面,累积概率排名曲线下面积由高到低的干预措施为(排名前3):经皮电刺激+常规康复>超声波+常规康复>超声波+经皮电刺激+常规康复;在改善生活质量SF-36评分方面,累积概率排名曲线下面积由高到低的干预措施为(排名前3):脉冲电磁场+常规康复>体外冲击波+常规康复>超声波+常规康复;在改善Lysholm膝关节评分方面,累积概率排名曲线下面积由高到低的干预措施为(排名前3):超声波+常规康复>超声波+经皮电刺激+常规康复>体外冲击波+常规康复;在不良反应方面,各研究均未报道严重不良反应,多数研究仅报道了轻微的皮肤刺激、过敏反应。结论:经皮电刺激联合常规康复治疗在改善膝骨关节炎患者目测类比评分与WOMAC关节僵硬评分方面显示出较高的优势;超声波联合常规康复治疗在改善Lysholm膝关节评分及WOMAC总评分方面的表现相对较好;脉冲电磁场联合常规康复治疗在改善膝骨关节炎患者整体生活质量方面具有一定的潜在优势,每种物理因子都有其独特的优势,但受纳入文献质量与数量限制,上述结论有待更多高质量、多中心、大样本的随机对照试验加以验证。展开更多
目的比较不同踝关节治疗体位下发散式体外冲击波(rESWT)治疗脑卒中后小腿三头肌痉挛的临床疗效,为优化治疗方案提供循证依据。方法采用前瞻性随机单盲(对评估者设盲)对照设计,纳入2023年6月至2024年12月中山大学附属第五医院收治的58例...目的比较不同踝关节治疗体位下发散式体外冲击波(rESWT)治疗脑卒中后小腿三头肌痉挛的临床疗效,为优化治疗方案提供循证依据。方法采用前瞻性随机单盲(对评估者设盲)对照设计,纳入2023年6月至2024年12月中山大学附属第五医院收治的58例患者,随机分为观察组(踝背屈位29例)和对照组(踝放松位29例)。两组均接受常规康复联合体外冲击波治疗。在治疗前(T_(0))、治疗结束当天(T_(1))、治疗结束2周(T_(2))、治疗结束4周(T_(3))评估踝关节综合痉挛量表(CSS)、10米步行时间(10MWT)、步频、改良Ashworth量表(MAS)、踝关节被动活动度(PROM)及Fugl-Meyer下肢运动功能量表(FMA-L)。结果干预后比较观察组与对照组的干预效果,主要发现如下:(1)CSS评分随时间显著下降,观察组在中期(T_(2))和后期(T_(3))评分显著低于对照组(P<0.01),改善幅度更大(5.65分vs.3.17分,P=0.003)。(2)10MWT结果显示两组改善趋势一致,但观察组在T_(2)时显著优于对照组(P<0.01),总体改善更明显(7.76 s vs.6.38 s)。(3)步频随时长而提高,观察组在T_(2)、T_(3)时均高于对照组(P<0.05),提升幅度更大(15.41步/min vs.11.31步/min)。(4)MAS评分显示,观察组在早中期(T_(1)、T_(2))痉挛缓解优于对照组(P<0.01),但T_(3)时对照组评分更低(P<0.05)。(5)PROM量表显示,观察组在各时点踝背屈活动度改善均优于对照组(P<0.001),总体改善更明显(7.65°vs.4.76°)。(6)FMA-L评分同样显示观察组在各时点运动功能均优于对照组(P<0.001),总体提升幅度更大(1.62分vs.0.55分)。结论在常规康复基础上,rESWT可显著改善脑卒中后踝痉挛及步行功能。俯卧位下踝背屈位在多项功能指标上优于踝放松位,提示牵伸状态可获得更佳疗效,推荐作为临床治疗首选体位。展开更多
Neuromuscular electrical stimulation(NMES)is a well-established therapeutic approach for chronic wounds.Conventionally,NMES involves direct electrode contact with wounds or adjacent healthy skin;however,it is limited ...Neuromuscular electrical stimulation(NMES)is a well-established therapeutic approach for chronic wounds.Conventionally,NMES involves direct electrode contact with wounds or adjacent healthy skin;however,it is limited by the need for wound exposure and by increased pain.Our preliminary study demonstrated the innovative application of remote NMES(rNMES)to the skeletal muscle of the distal calf,which showed the potential to accelerate wound healing in remote areas.rNMES was effective in human clinical trials in our previous work,although the underlying mechanisms remain unclear.As rNMES is often used to stimulate muscle contraction in long-term bedridden patients,we analyzed data from the Gene Expression Omnibus(GEO)database and found that exercise promotes midkine(MDK)expression in muscle.MDK is a small secreted heparin-binding protein that interacts with multiple cell surface receptors to promote growth.In the present study,we found that MDK significantly enhanced macrophage efferocytosis in a low-density lipoprotein receptor-related protein 1(LRP1)-dependent manner.Our findings demonstrate that rNMES upregulates MDK expression in skeletal muscles through the AMPK-ERK axis,facilitating its delivery to wounds through the circulatory system and promoting LRP1-mediated efferocytosis of apoptotic cells,thereby expediting wound healing.展开更多
文摘目的比较不同踝关节治疗体位下发散式体外冲击波(rESWT)治疗脑卒中后小腿三头肌痉挛的临床疗效,为优化治疗方案提供循证依据。方法采用前瞻性随机单盲(对评估者设盲)对照设计,纳入2023年6月至2024年12月中山大学附属第五医院收治的58例患者,随机分为观察组(踝背屈位29例)和对照组(踝放松位29例)。两组均接受常规康复联合体外冲击波治疗。在治疗前(T_(0))、治疗结束当天(T_(1))、治疗结束2周(T_(2))、治疗结束4周(T_(3))评估踝关节综合痉挛量表(CSS)、10米步行时间(10MWT)、步频、改良Ashworth量表(MAS)、踝关节被动活动度(PROM)及Fugl-Meyer下肢运动功能量表(FMA-L)。结果干预后比较观察组与对照组的干预效果,主要发现如下:(1)CSS评分随时间显著下降,观察组在中期(T_(2))和后期(T_(3))评分显著低于对照组(P<0.01),改善幅度更大(5.65分vs.3.17分,P=0.003)。(2)10MWT结果显示两组改善趋势一致,但观察组在T_(2)时显著优于对照组(P<0.01),总体改善更明显(7.76 s vs.6.38 s)。(3)步频随时长而提高,观察组在T_(2)、T_(3)时均高于对照组(P<0.05),提升幅度更大(15.41步/min vs.11.31步/min)。(4)MAS评分显示,观察组在早中期(T_(1)、T_(2))痉挛缓解优于对照组(P<0.01),但T_(3)时对照组评分更低(P<0.05)。(5)PROM量表显示,观察组在各时点踝背屈活动度改善均优于对照组(P<0.001),总体改善更明显(7.65°vs.4.76°)。(6)FMA-L评分同样显示观察组在各时点运动功能均优于对照组(P<0.001),总体提升幅度更大(1.62分vs.0.55分)。结论在常规康复基础上,rESWT可显著改善脑卒中后踝痉挛及步行功能。俯卧位下踝背屈位在多项功能指标上优于踝放松位,提示牵伸状态可获得更佳疗效,推荐作为临床治疗首选体位。
基金supported by the National Natural Science Foundation of China(Grant No.82271252 to W.L.,No.8217091029 to T.W.and No.82204542 to L.H.)the Key Medical Research Projects of Jiangsu Health and Health Commission(Grant No.K2023066 to L.Z.)the Taishan Industrial Talent Project(Grant No.2020-371722-73-03-097290 to W.L.).
文摘Neuromuscular electrical stimulation(NMES)is a well-established therapeutic approach for chronic wounds.Conventionally,NMES involves direct electrode contact with wounds or adjacent healthy skin;however,it is limited by the need for wound exposure and by increased pain.Our preliminary study demonstrated the innovative application of remote NMES(rNMES)to the skeletal muscle of the distal calf,which showed the potential to accelerate wound healing in remote areas.rNMES was effective in human clinical trials in our previous work,although the underlying mechanisms remain unclear.As rNMES is often used to stimulate muscle contraction in long-term bedridden patients,we analyzed data from the Gene Expression Omnibus(GEO)database and found that exercise promotes midkine(MDK)expression in muscle.MDK is a small secreted heparin-binding protein that interacts with multiple cell surface receptors to promote growth.In the present study,we found that MDK significantly enhanced macrophage efferocytosis in a low-density lipoprotein receptor-related protein 1(LRP1)-dependent manner.Our findings demonstrate that rNMES upregulates MDK expression in skeletal muscles through the AMPK-ERK axis,facilitating its delivery to wounds through the circulatory system and promoting LRP1-mediated efferocytosis of apoptotic cells,thereby expediting wound healing.
