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[1]陳雙錢,林定藝,陳文煜.三指按摩手法輔助治療髕股關(guān)節(jié)骨關(guān)節(jié)炎的臨床研究[J].中醫(yī)正骨,2021,33(04):15-19.
　CHEN Shuangqian,LIN Dingyi,CHEN Wenyu.A clinical study of three-finger massage manipulation for adjuvant treatment of patellofemoral osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(04):15-19.
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三指按摩手法輔助治療髕股關(guān)節(jié)骨關(guān)節(jié)炎的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年04期
頁(yè)碼:
15-19
欄目:
臨床研究
出版日期:
2021-04-20

文章信息/Info

Title:
A clinical study of three-finger massage manipulation for adjuvant treatment of patellofemoral osteoarthritis
作者:
陳雙錢; 林定藝; 陳文煜
(溫州市中醫(yī)院,浙江 溫州 325000)
Author(s):
CHEN Shuangqian; LIN Dingyi; CHEN Wenyu
Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou 325000,Zhejiang,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  髕股關(guān)節(jié);  三指按摩手法;  注射; 關(guān)節(jié)內(nèi);  透明質(zhì)酸;  炎癥因子;  臨床試驗(yàn)
Keywords:
osteoarthritis; knee;  patellofemoral joint;  three-finger massage manipulation;  injections; intra-articular;  hyaluronic acid;  inflammatory factors;  clinical trial
摘要:
目的:探討三指按摩手法輔助治療髕股關(guān)節(jié)骨關(guān)節(jié)炎(patellofemoral osteoarthritis,PFOA)的臨床療效。方法:選取116例PFOA患者,隨機(jī)分為2組,每組58例。所有患者均行關(guān)節(jié)鏡下髕股關(guān)節(jié)清理術(shù),術(shù)后1周開(kāi)始于髕股關(guān)節(jié)腔注射玻璃酸鈉注射液,每次注射2 mL,每周1次,連續(xù)治療5周,同時(shí)三指按摩手法組采用劉氏傷科三指按摩手法治療,傳統(tǒng)康復(fù)手法組采用傳統(tǒng)康復(fù)手法治療,均每3 d治療1次,連續(xù)治療20次。分別于治療前、治療結(jié)束后3個(gè)月測(cè)定患者炎癥因子白細(xì)胞介素(interleukin,IL)-1β、IL-6及腫瘤壞死因子(tumor necrosis factor,TNF)-α的血清含量,采用視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分評(píng)價(jià)患膝疼痛程度,采用Lysholm膝關(guān)節(jié)評(píng)分評(píng)價(jià)患膝功能; 于治療結(jié)束后3個(gè)月,觀察并記錄患者PFOA復(fù)發(fā)情況。結(jié)果:①炎癥因子血清含量。治療前,2組患者IL-1β、IL-6、TNF-α血清含量比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(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]; 治療結(jié)束后3個(gè)月,2組患者IL-1β、IL-6、TNF-α血清含量均低于治療前(三指按摩手法組:t=13.436,P=0.000; t=16.468,P=0.000; t=13.598,P=0.000; 傳統(tǒng)康復(fù)手法組:t=8.170,P=0.000; t=8.312,P=0.000; t=8.038,P=0.000),三指按摩手法組患者IL-1β、IL-6、TNF-α血清含量均低于傳統(tǒng)康復(fù)手法組[(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評(píng)分。治療前,2組患者膝部疼痛VAS評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(5.18±0.83)分,(5.33±0.92)分,t=-0.922,P=0.359]; 治療結(jié)束后3個(gè)月,2組患者膝部疼痛VAS評(píng)分均低于治療前(t=23.535,P=0.000; t=14.693,P=0.000),三指按摩手法組患者膝部疼痛VAS評(píng)分低于傳統(tǒng)康復(fù)手法組[(2.12±0.54)分,(3.04±0.75)分,t=-7.581,P=0.000]。③Lysholm膝關(guān)節(jié)評(píng)分。治療前,2組患者Lysholm膝關(guān)節(jié)評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(62.74±9.25)分,(63.64±8.86)分,t=-0.535,P=0.594]; 治療結(jié)束后3個(gè)月,2組患者Lysholm膝關(guān)節(jié)評(píng)分均高于治療前(t=-10.592,P=0.000; t=-5.457,P=0.000),三指按摩手法組患者Lysholm膝關(guān)節(jié)評(píng)分高于傳統(tǒng)康復(fù)手法組[(80.43±8.73)分,(73.44±10.42)分,t=3.916,P=0.000]。④復(fù)發(fā)率。治療結(jié)束后3個(gè)月,三指按摩手法組PFOA復(fù)發(fā)3例,傳統(tǒng)康復(fù)手法組PFOA復(fù)發(fā)10例,三指按摩手法組患者PFOA復(fù)發(fā)率低于傳統(tǒng)康復(fù)手法組(χ2=4.245,P=0.039)。結(jié)論:采用三指按摩手法輔助治療PFOA,與傳統(tǒng)康復(fù)手法輔助治療相比,能夠更好地抑制炎癥反應(yīng),緩解膝部疼痛,改善膝關(guān)節(jié)功能,且復(fù)發(fā)率更低。
Abstract:
To explore the clinical curative effects of three-finger massage manipulation for adjuvant treatment of patellofemoral 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-articular 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 Lysholm 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-1β,IL-6 and TNF-α between 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-1β,IL-6 and TNF-α decreased 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 before 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(χ2=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 rehabilitation manipulation in adjuvant treatment of PFOA with lower recurrence rate.

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通訊作者:陳雙錢 E-mail:[email protected]
更新日期/Last Update: 1900-01-01