电针对膝骨性关节炎患者功能活动及登梯时空参数的影响

发布时间：2018-05-09 05:02

本文选题：膝骨性关节炎 + 针刺/电针/浅刺　；参考：《中国中医基础医学杂志》2017年08期

【摘要】：目的:观察电针治疗前后膝骨性关节炎(KOA)患者登梯活动时空参数及关节炎指数的变化,分析针刺对患者登梯能力的影响。方法:36名来自社区的KOA患者在2周等待排除预期的影响后随机分为电针组和非经非穴浅刺组各18例,分别治疗3周共11次后进行功能状况(骨关节炎指数WOMAC评分)及登梯步态检测,分析登梯时空参数及其与WOMAC评分的相关性。结果:等待前2组基线数据除步长时间有差异采用一般线性模型校正外,其他基线齐。治疗前与等待前的各参数比较差异无统计学意义,2组间治疗前各参数比较差异无统计学意义;电针和浅刺治疗后,WOMAC的总分和3个亚量表的评分均较治疗前下降;电针治疗后,KOA患者的上下梯步速和步频均较治疗前明显增加,而步长时间、支撑时间、摆动时间、步行周期及初次双侧支撑时间均较治疗前缩短,但步宽、步长和跨步长治疗前后比较差异无统计学意义;浅刺组治疗后与治疗前上下梯各时空参数比较差异无统计学意义;2组治疗后WOMAC评分及上下梯时空参数比较差异无统计学意义;电针治疗前后WOMAC总分差值、WOMAC疼痛、僵硬、躯体功能3个亚量表评分的差值与上下梯时步宽差值均呈正相关,躯体功能改善程度与上下梯步频的改善程度均呈负相关,与步行周期的改善呈正相关,躯体功能改善和WOMAC总体症状及功能的改善程度与下梯的摆动期改变呈正相关,其余时空参数差值之间比较无明显相关;浅刺对照组WOMAC各评分差值与上下梯时空参数差值之间比较均无明显相关。结论:患者预期在本研究未体现对针刺疗效的影响,电针和非经非穴浅刺均能缓解KOA患者的疼痛和僵硬症状,改善功能状况,但电针还能提高KOA患者的上下梯速度、频率及缩短时间参数,而且电针对KOA患者的症状及功能的改善效应与上下梯步宽及步行效率的提高有关。下梯步宽的改善与电针后疼痛、僵硬、躯体功能的改善均相关,下梯时稳定性及步行效率的改善均与躯体功能改善相关。浅刺虽然在一定程度上可以改善KOA患者的症状及功能,但未对登梯稳定性及步行效率的改变产生明显影响,电针作为治疗KOA的有效康复疗法,能提高患者的登梯活动能力。
[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.
【作者单位】：福建中医药大学康复医学院;福建省康复技术重点实验室;福建省康复产业研究院;福建中医药大学附属康复医院;
【基金】：国家自然科学基金面上项目(81273819)-基于三维步态分析及动态有限元模型探讨电针改善膝内侧间室骨性关节炎患者登梯负重功能的生物力学机制
【分类号】：R246.9

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