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[1]張磊,熊鹿靜,李炳坤,等.電針足少陽經(jīng)穴在膝關節(jié)前交叉韌帶損傷術后康復中的應用價值[J].中醫(yī)正骨,2022,34(06):9-16.
　ZHANG Lei,XIONG Lujing,LI Bingkun,et al.Application value of electroacupuncture at points of foot Shaoyang meridian in postoperative rehabilitation of anterior cruciate ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(06):9-16.
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電針足少陽經(jīng)穴在膝關節(jié)前交叉韌帶損傷術后康復中的應用價值()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年06期
頁碼:
9-16
欄目:
臨床研究
出版日期:
2022-06-20

文章信息/Info

Title:
Application value of electroacupuncture at points of foot Shaoyang meridian in postoperative rehabilitation of anterior cruciate ligament injuries
作者:
張磊1; 熊鹿靜2; 李炳坤1; 唐小高1; 喻林1; 周鑫1
(1.西南醫(yī)科大學附屬中醫(yī)醫(yī)院,四川 瀘州 646000; 2.西南醫(yī)科大學臨床醫(yī)學院,四川 瀘州 646000)
Author(s):
ZHANG Lei1; XIONG Lujing2; LI Bingkun1; TANG Xiaogao1; YU Lin1; ZHOU Xin1
1.The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China 2.The Clinical Medical College of Southwest Medical University,Luzhou 646000,Sichuan,China
關鍵詞:
膝損傷;  前交叉韌帶;  電針;  膽經(jīng);  本體感覺;  穴; 懸鐘;  穴; 陽陵泉;  穴; 膝陽關;  穴; 環(huán)跳
Keywords:
knee injuries;  anterior cruciate ligament;  electroacupuncture;  gallbladder meridian;  proprioception;  Point GB39(Xuanzhong);  Point GB34(Yanglingquan);  Point GB33(Xiyangguan);  Point GB30(Huantiao)
摘要:
目的:探討電針足少陽經(jīng)穴在膝關節(jié)前交叉韌帶(anterior cruciate ligament,ACL)損傷術后康復中的應用價值。方法:納入膝關節(jié)ACL部分損傷患者50例。由同一組醫(yī)生行膝關節(jié)鏡下腓骨長肌腱單束ACL重建術,術后第2天開始電針患側足少陽經(jīng)的懸鐘、陽陵泉、膝陽關、環(huán)跳4穴。每天1次,連續(xù)治療6 d為1個療程,2個療程間隔1 d,共治療6個療程。比較治療前及治療開始后2周、4周、6周時雙側膝關節(jié)的被動活動察覺閾值(threshold to detection of passive motion,TTDPM)、關節(jié)位置覺(joint position sense,JPS)以及體感誘發(fā)電位(somatosensory evoked potentials,SEPs)P40起始潛伏期、波幅和運動神經(jīng)傳導速度(motor nerve conduction velocity,MCV)潛伏期、波幅。結果:①TTDPM。時間因素和分組因素存在交互效應(F=312.586,P=0.000)。雙側膝關節(jié)TTDPM總體比較,差異有統(tǒng)計學意義,即存在分組效應(F=406.942,P=0.000)。治療前后不同時間點間膝關節(jié)TTDPM的差異有統(tǒng)計學意義,即存在時間效應(F=334.592,P=0.000)。患側膝關節(jié)TTDPM隨時間呈下降趨勢(3.57°±0.53°,2.61°±0.47°,2.21°±0.39°,1.92°±0.28°,F=349.201,P=0.000),健側隨時間無明顯變化(1.44°±0.10°,1.42°±0.12°,1.40°±0.10°,1.41°±0.07°,F=2.772,P=0.052)。治療前后各時間點,患側膝關節(jié)TTDPM均較健側高(t=29.528,P=0.000; t=21.642,P=0.000; t=16.658,P=0.000; t=13.642,P=0.000)。②JPS。時間因素和分組因素存在交互效應(F=201.439,P=0.000)。雙側膝關節(jié)JPS總體比較,差異有統(tǒng)計學意義,即存在分組效應(F=532.141,P=0.000)。治療前后不同時間點間膝關節(jié)JPS的差異有統(tǒng)計學意義,即存在時間效應(F=209.843,P=0.000)。患側膝關節(jié)JPS隨時間呈改善趨勢(4.31°±0.71°,3.62°±0.65°,3.23°±0.60°,2.64°±0.54°,F=211.272,P=0.000),健側隨時間無明顯變化(1.49°±0.13°,1.47°±0.11°,1.48°±0.10°,1.47°±0.10°,F=1.333,P=0.277)。治療前后各時間點,患側膝關節(jié)JPS均較健側差(t=28.782,P=0.000; t=23.278,P=0.000; t=20.698,P=0.000; t=15.864,P=0.000)。③SEPsP40起始潛伏期。時間因素和分組因素存在交互效應(F=740.633,P=0.000)。雙側膝關節(jié)SEPsP40起始潛伏期總體比較,差異有統(tǒng)計學意義,即存在分組效應(F=12 153.958,P=0.000)。治療前后不同時間點間膝關節(jié)SEPsP40起始潛伏期的差異有統(tǒng)計學意義,即存在時間效應(F=817.474,P=0.000)。患側膝關節(jié)SEPsP40起始潛伏期隨時間呈縮短趨勢[(49.23±1.95)ms,(43.87±1.81)ms,(38.33±1.91)ms,(34.68±1.39)ms,F=1 406.798,P=0.000],健側隨時間無明顯變化[(30.78±0.92)ms,(30.42±1.15)ms,(30.41±0.98)ms,(30.39±1.10)ms,F=1.680,P=0.173]。治療前后各時間點,患側膝關節(jié)SEPsP40起始潛伏期均較健側長(t=64.829,P=0.000; t=51.154,P=0.000; t=26.471,P=0.000; t=18.256,P=0.000)。④SEPsP40波幅。時間因素和分組因素存在交互效應(F=540.382,P=0.000)。雙側膝關節(jié)SEPsP40波幅總體比較,差異有統(tǒng)計學意義,即存在分組效應(F=1 309.833,P=0.000)。治療前后不同時間點間膝關節(jié)SEPsP40波幅的差異有統(tǒng)計學意義,即存在時間效應(F=619.578,P=0.000)。患側膝關節(jié)SEPsP40波幅隨時間呈增高趨勢[(1.36±0.10)mv,(1.67±0.11)mv,(1.83±0.10)mv,(1.97±0.09)mv,F=926.454,P=0.000],健側隨時間無明顯變化[(2.27±0.08)mv,(2.29±0.09)mv,(2.28±0.06)mv,(2.29±0.07)mv,F=2.258,P=0.084]。治療前后各時間點,患側膝關節(jié)SEPsP40波幅均較健側低(t=-69.500,P=0.000; t=-42.342,P=0.000; t=-30.748,P=0.000; t=-22.211,P=0.000)。⑤MCV潛伏期。時間因素和分組因素存在交互效應(F=647.733,P=0.000)。雙側膝關節(jié)MCV潛伏期總體比較,差異有統(tǒng)計學意義,即存在分組效應(F=828.428,P=0.000)。治療前后不同時間點間膝關節(jié)MCV潛伏期的差異有統(tǒng)計學意義,即存在時間效應(F=673.718,P=0.000)。患側膝關節(jié)MCV潛伏期隨時間呈縮短趨勢[(20.63±1.37)ms,(17.94±1.49)ms,(16.67±1.30)ms,(14.36±0.99)ms,F=866.063,P=0.000]; 健側隨時間無明顯變化[(12.27±0.39)ms,(12.24±0.44)ms,(12.22±0.49)ms,(12.21±0.39)ms,F=0.282,P=0.839]。治療前后各時間點,患側膝關節(jié)MCV潛伏期均較健側長
Abstract:
Objective:To explore the applied value of electroacupuncture(EA)at points of foot Shaoyang meridian in postoperative rehabilitation of anterior cruciate ligament(ACL)injuries.Methods:Fifty patients with partial ACL injuries were enrolled in the study,and they were treated with arthroscopic ACL reconstruction with single-bundle peroneus longus tendon by the same surgeons.The EA was performed at points of Xuanzhong(GB39),Yanglingquan(GB34),Xiyangguan(GB33)and Huantiao(GB30)at affected side from the postoperative day 2,once a day for consecutive 6 courses of treatment,6 days for each course with a 1-day rest-insertion between courses.The threshold to detection of passive motion(TTDPM),joint position sense(JPS),onset latency(OL)and amplitude of somatosensory evoked potentials(SEPs)P40 as well as latency and amplitude of motor nerve conduction velocity(MCV)were compared between affected knee and unaffected knee before the treatment and at 2,4 and 6 weeks after the beginning of the treatment respectively.Results:①There was interaction between time factor and group factor in knee TTDPM(F=312.586,P=0.000).There was statistical difference in TTDPM between affected knee and unaffected knee in general,in other words,there was group effect(F=406.942,P=0.000).There was statistical difference in TTDPM between different timepoints before and after the treatment,in other words,there was time effect(F=334.592,P=0.000).The TTDPM presented a downward trend over time in affected knee(3.57±0.53,2.61±0.47,2.21±0.39,1.92±0.28 degrees,F=349.201,P=0.000),whereas it displayed no evident change over time in unaffected knee(1.44±0.10,1.42±0.12,1.40±0.10,1.41±0.07 degrees,F=2.772,P=0.052).The TTDPM was higher in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=29.528,P=0.000; t=21.642,P=0.000; t=16.658,P=0.000; t=13.642,P=0.000).②There was interaction between time factor and group factor in knee JPS(F=201.439,P=0.000).There was statistical difference in JPS between affected knee and unaffected knee in general,in other words,there was group effect(F=532.141,P=0.000).There was statistical difference in knee JPS between different timepoints before and after the treatment,in other words,there was time effect(F=209.843,P=0.000).The JPS presented an improving trend over time in affected knee(4.31±0.71,3.62±0.65,3.23±0.60,2.64±0.54 degrees,F=211.272,P=0.000),whereas it displayed no evident change over time in unaffected knee(1.49±0.13,1.47±0.11,1.48±0.10,1.47±0.10 degrees,F=1.333,P=0.277).The JPS was poorer in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=28.782,P=0.000; t=23.278,P=0.000; t=20.698,P=0.000; t=15.864,P=0.000).③There was interaction between time factor and group factor in OL of SEPsP40(F=740.633,P=0.000).There was statistical difference in OL of SEPsP40 between affected knee and unaffected knee in general,in other words,there was group effect(F=12 153.958,P=0.000).There was statistical difference in OL of SEPsP40 of knee between different timepoints before and after the treatment,in other words,there was time effect(F=817.474,P=0.000).The OL of SEPsP40 presented a shortening trend over time in affected knee(49.23±1.95,43.87±1.81,38.33±1.91,34.68±1.39 ms,F=1 406.798,P=0.000),whereas it displayed no evident change over time in unaffected knee(30.78±0.92,30.42±1.15,30.41±0.98,30.39±1.10 ms,F=1.680,P=0.173).The OL of SEPsP40 was longer in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=64.829,P=0.000; t=51.154,P=0.000; t=26.471,P=0.000; t=18.256,P=0.000).④There was interaction between time factor and group factor in amplitude of SEPsP40(F=540.382,P=0.000).There was statistical difference in amplitude of SEPsP40 between affected knee and unaffected knee in general,in other words,there was group effect(F=1 309.833,P=0.000).There was statistical difference in amplitude of SEPsP40 of knee between different timepoints before and after the treatment,in other words,there was time effect(F=619.578,P=0.000).The amplitude of SEPsP40 presented an increasing trend over time in affected knee(1.36±0.10,1.67±0.11,1.83±0.10,1.97±0.09 mv,F=926.454,P=0.000),whereas it displayed no evident change over time in unaffected knee(2.27±0.08,2.29±0.09,2.28±0.06,2.29±0.07 mv,F=2.258,P=0.084).The amplitude of SEPsP40 was lower in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=-69.500,P=0.000; t=-42.342,P=0.000; t=-30.748,P=0.000; t=-22.211,P=0.000).⑤There was interaction between time factor and group factor in latency of MCV(F=647.733,P=0.000).There was statistical difference in latency of MCV between affected knee and unaffected knee in general,in other words,there was group effect(F=828.428,P=0.000).There was statistical difference in latency of MCV of knee between different timepoints before and after the treatment,in other words,there was time effect(F=673.718,P=0.000).The latency of MCV presented a shortening trend over time in affected knee(20.63±1.37,17.94±1.49,16.67±1.30,14.36±0.99 ms,F=866.063,P=0.000),whereas it displayed no evident change over time in unaffected knee(12.27±0.39,12.24±0.44,12.22±0.49,12.21±0.39 ms,F=0.282,P=0.839).The latency of MCV was longer in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=44.622,P=0.000; t=26.899,P=0.000; t=27.612,P=0.000; t=15.341,P=0.000).⑥There was interaction between time factor and group factor in amplitude of MCV(F=2 208.831,P=0.000).There was statistical difference in amplitude of MCV between affected knee and unaffected knee in general,in other words,there was group effect(F=3 582.216,P=0.000).There was statistical difference in amplitude of MCV of knee between different timepoints before and after the treatment,in other words,there was time effect(F=2 362.807,P=0.000).The amplitude of MCV presented an increasing trend over time in affected knee(3.76±0.10,4.26±0.13,4.58±0.11,4.78±0.09 mv,F=4 397.711,P=0.000),whereas it displayed no evident change over time in unaffected knee(5.23±0.07,5.24±0.06,5.23±0.06,5.24±0.05 mv,F=2.144,P=0.098).The amplitude of MCV was lower in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=-171.500,P=0.000; t=-63.024,P=0.000; t=-48.938,P=0.000; t=-40.251,P=0.000).Conclusion:EA at points of foot Shaoyang meridian can improve the knee proprioception to some extent in patients who underwent ACL reconstruction for partial ACL injuries,but the knee proprioception cann't be completely recovered in the short term after surgery.

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備注/Memo

備注/Memo:
基金項目:瀘州市人民政府-西南醫(yī)科大學科技戰(zhàn)略合作項目(2018LZXNYD-ZK43); 西南醫(yī)科大學-西南醫(yī)科大學附屬中醫(yī)醫(yī)院聯(lián)合項目(2018XYLH-001) 通訊作者:周鑫 E-mail:[email protected]
更新日期/Last Update: 1900-01-01