电针对膝关节骨性关节炎患者登梯活动时下肢动力学影响的临床研究

发布时间：2018-06-29 20:30

  本文选题：膝关节骨性关节炎 + 针刺　； 参考：《中国针灸》2017年10期

【摘要】：目的:采用三维运动分析观察电针治疗对膝关节骨性关节炎(KOA)患者登梯活动时动力学即不同平面关节负荷的影响,为研究针灸康复疗法的生物力学机制提供参考。方法:根据随机数字表法将40例KOA患者随机分成观察组和对照组,每组20例,最终各18例完成研究。观察组穴取内膝眼、犊鼻、阳陵泉、阴陵泉、血海、梁丘、足三里,对照组于经穴旁开约2 cm处浅刺。观察组于内膝眼和阴陵泉、梁丘和阳陵泉连接电针仪,对照组在其相应穴旁处连接电针仪。观察组采用频率为2 Hz的连续方波,对照组无电流输出。两组各治疗11次,共3周。于治疗前后进行登梯步态检测,分析上、下梯步速及登梯动力学参数(矢状面髋、膝、踝关节屈伸峰力矩及冠状面膝内收外力矩)的变化。结果:治疗后,观察组上、下梯步速均较治疗前明显增加(P0.05,P0.01),上、下梯时踝关节跖屈肌峰力矩、上梯时第二膝内收外力矩峰值(PEKAM2)均明显增大(P0.05,P0.01)。对照组治疗后,下梯时第一膝内收外力矩峰值(PEKAM1)和PEKAM2均较治疗前减小(P0.05,P0.01)。观察组上梯时步速差值与踝跖屈肌群力矩差值呈正相关(r=0.598,P0.01)。排除步速的影响后,上梯时踝跖屈肌峰力矩的组内差异无统计学意义(P0.05)。结论:电针能提高KOA患者的上下梯速度,对登梯过程中矢状面和冠状面的关节负荷均有一定的影响,改善了关节负荷的能力,但上梯的关节负荷改变可能与步速的增加有关。电针与最小针刺对关节负荷的效应不同,但具体机制不够明确,有待进一步深入探讨。
[Abstract]:Objective: to observe the effect of electroacupuncture (EA) on escalator motion in patients with knee osteoarthritis (KOA) by three dimensional motion analysis, and to provide a reference for studying the biomechanical mechanism of acupuncture and moxibustion rehabilitation therapy. Methods: 40 patients with KOA were randomly divided into observation group (n = 20) and control group (n = 20). In the observation group, the internal knee eye, calf nose, Yangling spring, Yin Ling spring, blood sea, Liang Qiu, Zusanli were taken from the observation group, and the superficial prickles were opened about 2 cm beside the meridians in the control group. In the observation group, the electroacupuncture apparatus was connected with the eyes of the inner knee and Yin Ling Quan, Liang Qiu and Yang Ling Quan, and the control group connected with the electroacupuncture apparatus at the side of the corresponding acupoints. The observation group was treated with 2 Hz continuous square wave, while the control group had no current output. The two groups were treated for 11 times for 3 weeks. Step velocity and dynamic parameters (sagittal hip, knee, ankle joint flexion and extension peak moment and coronal knee adduction moment) were analyzed before and after treatment. Results: after treatment, the descending step speed of the observation group was significantly higher than that of the control group (P0.05 / P0.01). The peak moment of the ankle metatarsal flexor muscle and the peak value of the second knee adductive moment (PEKAM2) in the upper and lower ankle joints were significantly increased (P0.05 / P0.01). In the control group, the peak value of adductive moment (PEKAM1) and PEKAM2 in the first knee were decreased after treatment (P0.05 / P0.01). In the observation group, there was a positive correlation between the difference of walking speed and the moment difference of metatarsal flexor muscle group (r = 0.598p 0.01). After removing the effect of step speed, there was no significant difference in peak torque of flexor metatarsus muscle on ladder (P0.05). Conclusion: electroacupuncture can improve the ascending and descending speed of KOA patients, which has certain influence on the joint load of sagittal plane and coronal plane, and improves the ability of joint load, but the change of joint load may be related to the increase of step speed. The effects of electroacupuncture and minimal acupuncture on joint load are different, but the specific mechanism is not clear enough.
【作者单位】： 福建中医药大学康复医学院;福建中医药大学附属第三人民医院康复科;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
【分类号】：R246.9
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本文编号：2083283