發(fā)布時(shí)間：2019-02-15 07:01

【摘要】：目的：通過(guò)比較針刀與關(guān)節(jié)腔注射玻璃酸鈉注射液治療膝骨關(guān)節(jié)炎對(duì)關(guān)節(jié)功能、臨床癥狀及關(guān)節(jié)間隙的改變,分析兩種治療方法的療效差異,并從生物力學(xué)水平探討針刀干預(yù)膝骨關(guān)節(jié)炎的可能作用機(jī)制。方法：1、將120例患者隨機(jī)分為治療組60例和對(duì)照組60例,最后完成實(shí)驗(yàn)的治療組53例,對(duì)照組52例。治療組取血海、梁丘、陰陵泉、陽(yáng)陵泉、鶴頂穴及髕周壓痛點(diǎn)、內(nèi)外側(cè)副韌帶、髕韌帶起止點(diǎn)進(jìn)行針刀松解剝離粘連攣縮,1周1次,5次為1個(gè)療程；對(duì)照組行關(guān)節(jié)腔內(nèi)注射玻璃酸鈉注射液治療,1周1次,5次為1個(gè)療程。兩組治療前后關(guān)節(jié)功能、臨床癥狀進(jìn)行對(duì)比觀察。2、分別從兩組患者中隨機(jī)選擇10例X線分級(jí)為Ⅱ級(jí)的患者,在治療前進(jìn)行膝關(guān)節(jié)MRI掃描,一個(gè)療程結(jié)束3個(gè)月后再進(jìn)行一次膝關(guān)節(jié)MRI復(fù)查。對(duì)比治療前后關(guān)節(jié)間隙的變化情況。3、選取1名正常男性青年進(jìn)行膝關(guān)節(jié)橫斷MRI掃描,圖像經(jīng)計(jì)算機(jī)處理后,按三維有限元網(wǎng)格劃分原則,劃分1716個(gè)節(jié)點(diǎn),1215個(gè)單元,運(yùn)用Super-Sap有限元計(jì)算程序,分別建立對(duì)照組(針刀未干預(yù)髕韌帶止點(diǎn)及肌腱纖維粘連)、模擬針刀組1(針刀剝離髕韌帶止點(diǎn)粘連)、模擬針刀組2(針刀疏通肌腱纖維間的粘連)、模擬針刀組3(針刀疏通剝離髕韌帶止點(diǎn)及肌腱纖維粘連)三維有限元模型。按各組不同治療方法模擬出膝部實(shí)際受力大小和方向,對(duì)模型加載相同載荷,計(jì)算得出模型中各節(jié)點(diǎn)及單元的應(yīng)力值。結(jié)果：1、膝關(guān)節(jié)運(yùn)動(dòng)功能比較：1個(gè)療程結(jié)束后,兩組患者各期膝關(guān)節(jié)運(yùn)動(dòng)功能評(píng)分均明顯高于治療前(P0.01)；治療組Ⅰ期、Ⅱ期膝關(guān)節(jié)運(yùn)動(dòng)功能評(píng)分增加程度明顯高于同期對(duì)照組(P0.01),Ⅲ期治療組雖高于同期對(duì)照組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2、臨床癥狀分析比較：1個(gè)療程結(jié)束后,兩組各期膝關(guān)節(jié)臨床癥狀評(píng)分均明顯低于治療前(P0.01)；治療組Ⅰ期、Ⅱ期膝關(guān)節(jié)臨床癥狀評(píng)分降低程度明顯高于同期對(duì)照組(P0.01),Ⅲ期治療組雖高于同期對(duì)照組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3、關(guān)節(jié)間隙比較：1個(gè)療程結(jié)束3個(gè)月后治療組關(guān)節(jié)間隙增大程度明顯高于對(duì)照組(P0.01)。4、膝關(guān)節(jié)三維有限元分析：模擬針刀組1、模擬針刀組2、模擬針刀組3的髕韌帶及內(nèi)外側(cè)半月板、軟骨Mises應(yīng)力值均較對(duì)照組減小,關(guān)節(jié)內(nèi)側(cè)軟骨及半月板比外側(cè)更容易遭到破壞。結(jié)論：1、針刀療法治療膝骨關(guān)節(jié)炎在關(guān)節(jié)運(yùn)動(dòng)功能、臨床癥狀及關(guān)節(jié)間隙變化上均較關(guān)節(jié)腔注射玻璃酸鈉注射液具有更好的療效。2、針刀干預(yù)膝骨關(guān)節(jié)炎的可能作用機(jī)制是針刀能夠松解膝關(guān)節(jié)周?chē)浗M織粘連,改善關(guān)節(jié)內(nèi)部力學(xué)環(huán)境,從而延緩關(guān)節(jié)軟骨退變,改善臨床癥狀。3、針刀能通過(guò)松解剝離髕周軟組織粘連及韌帶攣縮,改善膝關(guān)節(jié)軟組織生物力學(xué),重建關(guān)節(jié)內(nèi)力學(xué)平衡狀態(tài)。
[Abstract]:Objective: to compare the effect of needle knife and sodium hyaluronate injection in the treatment of knee osteoarthritis. The possible mechanism of needle-knife intervention in knee osteoarthritis was discussed from the biomechanical level. Methods: 1. 120 patients were randomly divided into treatment group (n = 60) and control group (n = 60). In the treatment group, blood sea, Liang Qiu, Yin Ling Quan, Yang Ling Quan, Heding Point and peripatellar tenderness point, external collateral ligament, patellar ligament starting and ending point were removed by needle knife, once a week, 5 times as a course of treatment. The control group was treated with intraarticular injection of sodium hyaluronate once a week and 5 times as a course of treatment. The articular function and clinical symptoms of the two groups were compared before and after treatment. (2) Ten patients with X-ray grade 鈪，

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