针刀干预膝骨关节炎的疗效及三维有限元分析
发布时间：2019-02-15 07:01
【摘要】：目的：通过比较针刀与关节腔注射玻璃酸钠注射液治疗膝骨关节炎对关节功能、临床症状及关节间隙的改变,分析两种治疗方法的疗效差异,并从生物力学水平探讨针刀干预膝骨关节炎的可能作用机制。方法：1、将120例患者随机分为治疗组60例和对照组60例,最后完成实验的治疗组53例,对照组52例。治疗组取血海、梁丘、阴陵泉、阳陵泉、鹤顶穴及髌周压痛点、内外侧副韧带、髌韧带起止点进行针刀松解剥离粘连挛缩,1周1次,5次为1个疗程；对照组行关节腔内注射玻璃酸钠注射液治疗,1周1次,5次为1个疗程。两组治疗前后关节功能、临床症状进行对比观察。2、分别从两组患者中随机选择10例X线分级为Ⅱ级的患者,在治疗前进行膝关节MRI扫描,一个疗程结束3个月后再进行一次膝关节MRI复查。对比治疗前后关节间隙的变化情况。3、选取1名正常男性青年进行膝关节横断MRI扫描,图像经计算机处理后,按三维有限元网格划分原则,划分1716个节点,1215个单元,运用Super-Sap有限元计算程序,分别建立对照组(针刀未干预髌韧带止点及肌腱纤维粘连)、模拟针刀组1(针刀剥离髌韧带止点粘连)、模拟针刀组2(针刀疏通肌腱纤维间的粘连)、模拟针刀组3(针刀疏通剥离髌韧带止点及肌腱纤维粘连)三维有限元模型。按各组不同治疗方法模拟出膝部实际受力大小和方向,对模型加载相同载荷,计算得出模型中各节点及单元的应力值。结果：1、膝关节运动功能比较：1个疗程结束后,两组患者各期膝关节运动功能评分均明显高于治疗前(P0.01)；治疗组Ⅰ期、Ⅱ期膝关节运动功能评分增加程度明显高于同期对照组(P0.01),Ⅲ期治疗组虽高于同期对照组,但差异无统计学意义(P0.05)。2、临床症状分析比较：1个疗程结束后,两组各期膝关节临床症状评分均明显低于治疗前(P0.01)；治疗组Ⅰ期、Ⅱ期膝关节临床症状评分降低程度明显高于同期对照组(P0.01),Ⅲ期治疗组虽高于同期对照组,但差异无统计学意义(P0.05)。3、关节间隙比较：1个疗程结束3个月后治疗组关节间隙增大程度明显高于对照组(P0.01)。4、膝关节三维有限元分析：模拟针刀组1、模拟针刀组2、模拟针刀组3的髌韧带及内外侧半月板、软骨Mises应力值均较对照组减小,关节内侧软骨及半月板比外侧更容易遭到破坏。结论：1、针刀疗法治疗膝骨关节炎在关节运动功能、临床症状及关节间隙变化上均较关节腔注射玻璃酸钠注射液具有更好的疗效。2、针刀干预膝骨关节炎的可能作用机制是针刀能够松解膝关节周围软组织粘连,改善关节内部力学环境,从而延缓关节软骨退变,改善临床症状。3、针刀能通过松解剥离髌周软组织粘连及韧带挛缩,改善膝关节软组织生物力学,重建关节内力学平衡状态。
[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，
本文编号：2423084
[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，
本文编号：2423084
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