本文選題：膝骨性關節(jié)炎 + 針刺/電針/淺刺　； 參考：《中國中醫(yī)基礎醫(yī)學雜志》2017年08期

【摘要】：目的:觀察電針治療前后膝骨性關節(jié)炎(KOA)患者登梯活動時空參數(shù)及關節(jié)炎指數(shù)的變化,分析針刺對患者登梯能力的影響。方法:36名來自社區(qū)的KOA患者在2周等待排除預期的影響后隨機分為電針組和非經(jīng)非穴淺刺組各18例,分別治療3周共11次后進行功能狀況(骨關節(jié)炎指數(shù)WOMAC評分)及登梯步態(tài)檢測,分析登梯時空參數(shù)及其與WOMAC評分的相關性。結果:等待前2組基線數(shù)據(jù)除步長時間有差異采用一般線性模型校正外,其他基線齊。治療前與等待前的各參數(shù)比較差異無統(tǒng)計學意義,2組間治療前各參數(shù)比較差異無統(tǒng)計學意義;電針和淺刺治療后,WOMAC的總分和3個亞量表的評分均較治療前下降;電針治療后,KOA患者的上下梯步速和步頻均較治療前明顯增加,而步長時間、支撐時間、擺動時間、步行周期及初次雙側支撐時間均較治療前縮短,但步寬、步長和跨步長治療前后比較差異無統(tǒng)計學意義;淺刺組治療后與治療前上下梯各時空參數(shù)比較差異無統(tǒng)計學意義;2組治療后WOMAC評分及上下梯時空參數(shù)比較差異無統(tǒng)計學意義;電針治療前后WOMAC總分差值、WOMAC疼痛、僵硬、軀體功能3個亞量表評分的差值與上下梯時步寬差值均呈正相關,軀體功能改善程度與上下梯步頻的改善程度均呈負相關,與步行周期的改善呈正相關,軀體功能改善和WOMAC總體癥狀及功能的改善程度與下梯的擺動期改變呈正相關,其余時空參數(shù)差值之間比較無明顯相關;淺刺對照組WOMAC各評分差值與上下梯時空參數(shù)差值之間比較均無明顯相關。結論:患者預期在本研究未體現(xiàn)對針刺療效的影響,電針和非經(jīng)非穴淺刺均能緩解KOA患者的疼痛和僵硬癥狀,改善功能狀況,但電針還能提高KOA患者的上下梯速度、頻率及縮短時間參數(shù),而且電針對KOA患者的癥狀及功能的改善效應與上下梯步寬及步行效率的提高有關。下梯步寬的改善與電針后疼痛、僵硬、軀體功能的改善均相關,下梯時穩(wěn)定性及步行效率的改善均與軀體功能改善相關。淺刺雖然在一定程度上可以改善KOA患者的癥狀及功能,但未對登梯穩(wěn)定性及步行效率的改變產(chǎn)生明顯影響,電針作為治療KOA的有效康復療法,能提高患者的登梯活動能力。
[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.
【作者單位】： 福建中醫(yī)藥大學康復醫(yī)學院;福建省康復技術重點實驗室;福建省康復產(chǎn)業(yè)研究院;福建中醫(yī)藥大學附屬康復醫(yī)院;
【基金】：國家自然科學基金面上項目(81273819)-基于三維步態(tài)分析及動態(tài)有限元模型探討電針改善膝內(nèi)側間室骨性關節(jié)炎患者登梯負重功能的生物力學機制
【分類號】：R246.9

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