本文選題：膝骨性關(guān)節(jié)炎 + 針刺/電針/淺刺　； 參考：《中國(guó)中醫(yī)基礎(chǔ)醫(yī)學(xué)雜志》2017年08期

【摘要】：目的:觀(guān)察電針治療前后膝骨性關(guān)節(jié)炎(KOA)患者登梯活動(dòng)時(shí)空參數(shù)及關(guān)節(jié)炎指數(shù)的變化,分析針刺對(duì)患者登梯能力的影響。方法:36名來(lái)自社區(qū)的KOA患者在2周等待排除預(yù)期的影響后隨機(jī)分為電針組和非經(jīng)非穴淺刺組各18例,分別治療3周共11次后進(jìn)行功能狀況(骨關(guān)節(jié)炎指數(shù)WOMAC評(píng)分)及登梯步態(tài)檢測(cè),分析登梯時(shí)空參數(shù)及其與WOMAC評(píng)分的相關(guān)性。結(jié)果:等待前2組基線(xiàn)數(shù)據(jù)除步長(zhǎng)時(shí)間有差異采用一般線(xiàn)性模型校正外,其他基線(xiàn)齊。治療前與等待前的各參數(shù)比較差異無(wú)統(tǒng)計(jì)學(xué)意義,2組間治療前各參數(shù)比較差異無(wú)統(tǒng)計(jì)學(xué)意義;電針和淺刺治療后,WOMAC的總分和3個(gè)亞量表的評(píng)分均較治療前下降;電針治療后,KOA患者的上下梯步速和步頻均較治療前明顯增加,而步長(zhǎng)時(shí)間、支撐時(shí)間、擺動(dòng)時(shí)間、步行周期及初次雙側(cè)支撐時(shí)間均較治療前縮短,但步寬、步長(zhǎng)和跨步長(zhǎng)治療前后比較差異無(wú)統(tǒng)計(jì)學(xué)意義;淺刺組治療后與治療前上下梯各時(shí)空參數(shù)比較差異無(wú)統(tǒng)計(jì)學(xué)意義;2組治療后WOMAC評(píng)分及上下梯時(shí)空參數(shù)比較差異無(wú)統(tǒng)計(jì)學(xué)意義;電針治療前后WOMAC總分差值、WOMAC疼痛、僵硬、軀體功能3個(gè)亞量表評(píng)分的差值與上下梯時(shí)步寬差值均呈正相關(guān),軀體功能改善程度與上下梯步頻的改善程度均呈負(fù)相關(guān),與步行周期的改善呈正相關(guān),軀體功能改善和WOMAC總體癥狀及功能的改善程度與下梯的擺動(dòng)期改變呈正相關(guān),其余時(shí)空參數(shù)差值之間比較無(wú)明顯相關(guān);淺刺對(duì)照組WOMAC各評(píng)分差值與上下梯時(shí)空參數(shù)差值之間比較均無(wú)明顯相關(guān)。結(jié)論:患者預(yù)期在本研究未體現(xiàn)對(duì)針刺療效的影響,電針和非經(jīng)非穴淺刺均能緩解KOA患者的疼痛和僵硬癥狀,改善功能狀況,但電針還能提高KOA患者的上下梯速度、頻率及縮短時(shí)間參數(shù),而且電針對(duì)KOA患者的癥狀及功能的改善效應(yīng)與上下梯步寬及步行效率的提高有關(guān)。下梯步寬的改善與電針后疼痛、僵硬、軀體功能的改善均相關(guān),下梯時(shí)穩(wěn)定性及步行效率的改善均與軀體功能改善相關(guān)。淺刺雖然在一定程度上可以改善KOA患者的癥狀及功能,但未對(duì)登梯穩(wěn)定性及步行效率的改變產(chǎn)生明顯影響,電針作為治療KOA的有效康復(fù)療法,能提高患者的登梯活動(dòng)能力。
[Abstract]:Aim: to observe the changes of time and space parameters of ladder activity and arthritis index in patients with knee osteoarthritis before and after electroacupuncture treatment, and to analyze the influence of acupuncture on the ability of ladder climbing. Methods 36 KOA patients from the community were randomly divided into electroacupuncture group (n = 18) and non-meridian superficial needling group (n = 18). Functional status (osteoarthritis index WOMAC score) and ladder gait were measured after 3 weeks of treatment for 11 times respectively. The relationship between the time and space parameters of ladder and WOMAC score was analyzed. Results: the baseline data of the first two groups were aligned except for the difference of step length using general linear model. There was no significant difference between the two groups before treatment, the total score of WO MAC and the scores of three subscales were all decreased after electroacupuncture and superficial acupuncture treatment, and there was no significant difference between the two groups before and after treatment. After electroacupuncture treatment, the up and down step speed and frequency of Kota patients were significantly higher than those before treatment, while the step length, support time, swing time, walking period and the first bilateral support time were shorter than those before treatment, but the step width was wider. There was no significant difference between the two groups before and after treatment, and there was no significant difference between the two groups after treatment and before treatment. There was no significant difference in WOMAC score and up and down ladder parameters between the two groups after treatment. The difference of total score of WOMAC before and after electroacupuncture treatment was positively correlated with the difference of step width of up and down ladder, and the improvement degree of somatic function was negatively correlated with the improvement of step frequency of up and down ladder. There was a positive correlation between the improvement of walking cycle and the improvement of somatic function and the overall symptom and function of WOMAC, but there was no significant correlation between the difference of other space-time parameters. There was no significant correlation between the difference of WOMAC scores and the spatial and temporal parameters of the upper and lower ladder in the superficial needling control group. Conclusion: in this study, the patients expected not to reflect the effect of acupuncture. Both electroacupuncture and non-meridian superficial needling can relieve the pain and stiffness and improve the function of KOA patients, but electroacupuncture can also improve the up and down ladder speed of KOA patients. The effect of electroacupuncture on symptom and function of KOA patients was related to the improvement of step width and walking efficiency. The improvement of step width was related to the improvement of pain, stiffness and body function after electroacupuncture, and the improvement of stability and walking efficiency was related to the improvement of physical function. Although superficial puncture can improve the symptoms and functions of KOA patients to some extent, it has no obvious effect on the stability of ladder and the change of walking efficiency. As an effective rehabilitation therapy for KOA, electroacupuncture can improve the ability of climbing ladder.
【作者單位】： 福建中醫(yī)藥大學(xué)康復(fù)醫(yī)學(xué)院;福建省康復(fù)技術(shù)重點(diǎn)實(shí)驗(yàn)室;福建省康復(fù)產(chǎn)業(yè)研究院;福建中醫(yī)藥大學(xué)附屬康復(fù)醫(yī)院;
【基金】：國(guó)家自然科學(xué)基金面上項(xiàng)目(81273819)-基于三維步態(tài)分析及動(dòng)態(tài)有限元模型探討電針改善膝內(nèi)側(cè)間室骨性關(guān)節(jié)炎患者登梯負(fù)重功能的生物力學(xué)機(jī)制
【分類(lèi)號(hào)】：R246.9

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