摘要
目的探讨针刺“相对穴”联合股四头肌等长收缩训练用于老年膝骨关节炎(KOA)患者的价值。方法回顾性分析2021年5月至2023年5月承德医学院附属医院收治的106例老年KOA患者的临床资料,根据患者康复治疗方案不同将患者分为观察组(n=51)和对照组(n=55)。观察组给予患者针刺“相对穴”联合股四头肌等长收缩训练,对照组给予患者股四头肌等长收缩训练。比较两组患者康复效果及干预前后视觉模拟评分量表(VAS)、日常生活能力量表(ADL)、Lysholm评分及白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)、股四头肌峰力距值、股四头肌总功量值及股四头肌平均功率的差异。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。结果观察组患者康复效果总有效率显著高于对照组(90.20%和70.91%),差异有统计学意义(P<0.05)。观察组干预后VAS与ADL评分[(2.04±0.67)分、(2.08±0.80)分]显著低于干预前[(6.18±1.51)分、(7.56±1.49)分]及对照组干预后[(3.88±1.05)分、(3.97±1.22)分];Lysholm评分[(75.19±10.15)分]显著高于干预前[(55.95±6.53)分]及对照组干预后[(69.44±8.36)分],差异均有统计学意义(P<0.05)。观察组干预后关节滑液中IL-1β、TNF-α及VEGF水平[(6.19±1.00)pg/ml、(1.14±0.46)pg/ml、(320.36±37.12)ng/ml]显著低于干预前[(15.81±3.19)pg/ml、(5.50±1.03)pg/ml、(557.15±84.06)ng/ml]及对照组干预后[(9.16±2.12)pg/ml、(2.88±0.73)pg/ml、(411.50±50.27)ng/ml],差异均有统计学意义(P<0.05)。观察组患者干预后股四头肌峰力距值、股四头肌总功量值及股四头肌平均功率[(70.22±14.11)N.m、(418.94±73.15)J、(42.57±11.19)W]显著高于干预前[(52.14±10.36)N.m、(249.28±67.30)J、(30.69±8.25)W]及对照组干预后[(63.28±13.06)N.m、(355.24±70.27)J、(38.14±10.26)W],差异均有统计学意义(P<0.05)。康复治疗过程中仅观察组出现不良反应,其中皮下血肿1例,滞针2例,经对症处理后症状消失,未见膝关节疼痛、肿胀加剧情况。结论针刺“相对穴”联合股四头肌等长收缩训练可缓解老年膝骨关节炎患者的疼痛,提高患者关节功能。
Objective To explore the value of acupuncture at“relative point”combined with isometric contraction training of quadriceps femoris(QF)for knee osteoarthritis(KOA)in the elderly patients.Methods Clinical data of 106 elderly KOA patients admitted to our hospital from May 2021 to May 2023 were collected and retrospectively analyzed.According to their rehabilitation treatment regimens,they were divided into observation group(n=51,acupuncture at“relative point”combined with QF isokinetic contraction training)and control group(n=55,QF isokinetic contraction training).The rehabilitation efficacy,visual analogue scale(VAS)score,score of ability of daily living(ADL)scale,Lysholm score,serum levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and vascular endothelial growth factor(VEGF),and peak torque value,total muscular work and average muscular power of QF were compared between the two groups.SPSS statistics 22.0 was used for data analysis.Based on data type,student′s t test orχ^(2) test was employed for intergroup comparison.Results The total effective rate of rehabilitation efficacy was significantly higher in the observation group than the control group(90.20%vs 70.91%,P<0.05).The observation group had obviously lower VAS and ADL scores after intervention[(2.04±0.67)and(2.08±0.80)points]when compared with the scores before intervention[(6.18±1.51)and(7.56±1.49)points],and with those in the control group after intervention[(3.88±1.05)and(3.97±1.22)points],and notably higher Lysholm score(75.19±10.15)after intervention than that before intervention(55.95±6.53)and that of the control group(69.44±8.36)after intervention(all P<0.05).The levels of IL-1β,TNF-αand VEGF in synovial fluid of the observation group after intervention[(6.19±1.00)pg/ml,(1.14±0.46)pg/ml,(320.36±37.12)ng/ml]were significantly lower than those before intervention[(15.81±3.19)pg/ml,(5.50±1.03)pg/ml,(557.15±84.06)ng/ml]and control group after intervention[(9.16±2.12)pg/ml,(2.88±0.73)pg/ml,(411.50±50.27)ng/ml,all P<0.05].Statistical increments were observed in the observation group after intervention in terms of QF peak torque value,total muscular work and average muscular power than before intervention and in the control group after intervention[(70.22±14.11)vs(52.14±10.36)and(63.28±13.06)N.m;(418.94±73.15)vs(249.28±67.30)and(355.24±70.27)J;(42.57±11.19)vs(30.69±8.25)and(38.14±10.26)W;P<0.05].During rehabilitation treatment,adverse reactions occurred only in the observation group,including subcutaneous hematoma in one case and needle stagnation in two cases.All these symptoms disappeared after symptomatic treatment,and no pain or swelling of knee joint was observed.Conclusion Acupuncture to“relative point”combined with QF isometric contraction training can alleviate pain and improve joint function in elderly KOA patients.
作者
胡华
李连泰
刘艳伟
王书君
谢双喜
孙建君
Hu Hua;Li Liantai;Liu Yanwei;Wang Shujun;Xie Shuangxi;Sun Jianjun(Department of Orthopedics and Traumatology,Affiliated Hospital of Chengde Medical College,Chengde 067000,Hebei Province,China)
出处
《中华老年多器官疾病杂志》
2024年第7期528-531,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
河北省中医药管理局科研计划项目(2022154)。
关键词
老年人
膝骨关节炎
针刺
关节功能
aged
knee osteoarthritis
acupuncture
joint function
作者简介
通信作者:李连泰,E-mail:liliantai369@163.com。
