电针对膝骨性关节炎患者功能活动及登梯步态的影响

发布时间：2018-01-02 05:13

本文关键词：电针对膝骨性关节炎患者功能活动及登梯步态的影响　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本课题采用严格的随机对照临床研究设计,以中老年膝骨性关节炎(knee osteoarthritis,KOA)患者为研究对象,观察电针对KOA患者功能活动及登梯步态的影响,并探讨两者之间的关系,及电针对KOA的可能生物力学作用机制,为电针对KOA患者的康复疗效提供客观依据。方法于福建中医药大学附属康复医院门诊及福建中医药大学屏山校区周边社区招募36名符合课题要求的受试者,等待2周后随机分为电针组、非经非穴浅刺组,分别接受为期3周共计11次针刺治疗。于等待前、治疗前及治疗后进行结局指标的评测。采用SPSS20.0统计分析软件进行统计学分析。所有的统计学检验均采用双侧检验,P0.05被认为差异具有统计学意义。结果1.功能活动评估(WOMAC评分)方面,等待前、治疗前未见显著性差异(P0.05)。电针组及非经非穴浅刺组受试者治疗后均优于治疗前(P0.05)。两组治疗后组间对比未见显著性差异(P0.05)。2.在上下梯步态距离-时间参数方面,治疗前下梯支撑相、首次双支撑相均较等待前缩短(P0.05)。电针组受试者治疗后上下梯步速、步频均较治疗前明显增加(P0.05),摆动相、支撑相、步行周期、步长时间、首次双支撑相均明显减小(P0.05),步宽、步长、跨步长均未见显著性差异(P0.05);非经非穴浅刺组受试者治疗前后未见显著性差异(P0.05)。治疗后两组组间对比,上下梯步态各距离-时间参数均未见显著性差异(P0.05)。3.在上下梯步态动力学参数方面,治疗前下梯踝跖屈肌力矩较等待前增加(P0.05)。电针组受试者治疗后上梯时,第二膝内收峰外力矩(second peak external knee adduction moment,PEKAM2)较治疗前增加(P0.05);下梯时踝跖屈力矩较治疗前增加(P0.05)。非经非穴浅刺组受试者治疗后下梯时第一膝内收峰外力矩(first peak external knee adduction moment,PEKAM1)、PEKAM2 较治疗前降低(P0.05)。治疗后两组组间对比,上下梯步态各动力学参数均未见显著性差异(P0.05)。结论1.等待过程产生对针灸的心理预期效应可能存在,主要反映在下梯步态的变化。2.电针治疗可能可以改善KOA患者的功能活动。3.电针治疗可能改善KOA患者的登梯步行效率。4.电针治疗对KOA患者登梯时踝关节矢状面及膝关节冠状面上的关节负荷可能有一定影响,在上梯和下梯过程中影响可能不同。
[Abstract]:Objective to study the clinical study of knee osteoarthritis (KOAA) in middle-aged and elderly patients with knee osteoarthritis by a strict randomized controlled clinical study. To observe the effect of electroacupuncture on functional activity and step gait of patients with KOA, and to explore the relationship between them and the possible biomechanical mechanism of electroacupuncture on KOA. Methods 36 subjects were recruited from outpatient clinic of Rehabilitation Hospital affiliated to Fujian University of traditional Chinese Medicine and surrounding community of Pingshan Campus of Fujian University of traditional Chinese Medicine to provide objective basis for rehabilitation of KOA patients. . After waiting for 2 weeks, they were randomly divided into electroacupuncture group and non-meridian non-acupoint superficial needling group, which received 11 acupuncture treatments for 3 weeks. The outcome indexes were evaluated before and after treatment. SPSS20.0 statistical analysis software was used for statistical analysis. All statistical tests were carried out by bilateral test. P0.05 was considered to have statistical significance. Results 1.Functional activity Assessment (WOMAC score), wait before. 2. There was no significant difference before treatment (P 0.05). There was no significant difference between the two groups after treatment in electroacupuncture group and non-acupoint shallow needling group (P 0.05). There was no significant difference between the two groups after treatment. P0.05. 2. Gait distance-time parameter of up and down ladder. Before treatment, the first double support phase was shorter than that before waiting. In the electroacupuncture group, the up and down step speed and the step frequency were significantly increased compared with those before treatment, and the swing phase was significantly increased. The supporting phase, walking period, step length and the first double support phase were all significantly reduced, and there was no significant difference in step width, step length and stride length. There was no significant difference before and after treatment in non-meridian non-point shallow needling group (P 0.05). There was no significant difference in the distance and time parameters of the upper and lower ladder gait. The torque of metatarsal flexor in lower ankle before treatment was higher than that before treatment (P 0.05). When the subjects in the electroacupuncture group went up the ladder after treatment. Second peak external knee adduction moment. PEKAM2) was significantly higher than that before treatment (P 0.05). The torque of ankle metatarsal flexion in descending ladder was higher than that before treatment (P 0.05). First peak external knee adduction moment. PEKAM1 / PEKAM2 was significantly lower than that before treatment (P 0.05). There was no significant difference in the dynamic parameters of the upper and lower ladder gait. Conclusion 1. The psychological anticipatory effect of the waiting process on acupuncture and moxibustion may exist. 2. Electroacupuncture treatment may improve the functional activity of KOA patients .3. electroacupuncture treatment may improve the walking efficiency of KOA patients. 4. Electroacupuncture treatment on KOA patients. The joint load on the sagittal and coronal surfaces of the ankle and knee joint may have an effect on the joint load. The effects may be different in the process of going up and down the ladder.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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