收稿日期: 2024-05-24
网络出版日期: 2024-09-13
基金资助
河北省重点研发计划项目—中医药创新专项(223777125D);河北省中医药管理局科研计划项目(2023319)
Evaluation of the curative effect of traditional Chinese medicine bone-setting technique in the treatment of knee osteoarthritis
Received date: 2024-05-24
Online published: 2024-09-13
目的 观察运用脊柱-骨盆-下肢力线中医正骨手法治疗膝骨关节炎（KOA）患者的临床疗效。 方法 426例KOA患者均来自河北中医药大学第一附属医院，采用计算机生成序列随机分为观察组（384例，剔除、脱落、中止57例） ，运用脊柱-骨盆-下肢力线中医正骨手法（分为腰椎定点旋转复位、髋关节推摇拔伸及膝关节复筋三部分组成 每3日1次，共计2周） 治疗；对照组为等待治疗组（48例，剔除、脱落、中止6例）仅作为期2周的临床观察；主要结局指标为WOMAC疼痛积分；次要结局指标为WOMAC僵硬积分、功能积分、标准化积分以及生活质量评分（SF-12）；检测时间点观察组为基线、入组后2周及随访时（入组后14周）。对照组为基线和入组后2周。 结果 与基线相比，入组后2周两组患者WOMAC疼痛积分、僵硬积分、功能积分、标准化积分均较前下降（P < 0.05），但观察组较对照组下降显著（P < 0.001）；SF-12生活质量评分均较前升高（P < 0.001），但观察组较对照组升高显著（P＜0.001）。随访时，与入组后2周相比，观察组患者WOMAC疼痛积分升高（P < 0.001），WOMAC僵硬、关节功能及标准化积分均降低（P < 0.001），SF-12积分升高（P < 0.001）。 结论 运用脊柱-骨盆-下肢力线正骨手法治疗KOA，在改善患者膝关节功能、提高患者生活质量方面疗效显著，但对于疼痛的缓解短期疗效较好，长期疗效欠佳。其安全性良好，在临床中针对关节功能障碍为主要表现的KOA患者可考虑应用此法。
关键词： 膝骨关节炎; 脊柱-骨盆-下肢力线; 手法治疗
李锡 , 张健 , 刘郭辉 , 刘云昊 , 张泽坤 , 高天慈 , 王静西 , 张永旺 , 尹世林 , 刘路 , 齐立卿 , 杜双庆 . 脊柱-骨盆-下肢力线正骨手法治疗膝骨关节炎的疗效评价[J]. 实用医学杂志, 2024 , 40(17) : 2495 -2502 . DOI: 10.3969/j.issn.1006-5725.2024.17.024
Objective To observe the clinical effect of traditional Chinese medicine bone-setting technique using spinal， pelvi-lower extremity line to treat patients with knee osteoarthritis （KOA）. Methods 426 patients with KOA were all from the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine. They were randomly divided into experimental group （384 cases， 57 cases of elimination， shedding and termination） by computer generated sequence. Traditional Chinese bone setting techniques were applied with spinal-pelvic-lower limb force line （divided into three parts： lumbar fixed point reduction method， hip joint push-pull and extension method and knee peripheral tendon recovery method every 3 days. 2 weeks） treatment； The control group was the waiting treatment group （48 cases， 6 cases were eliminated， abscission， termination）， which was only used for clinical observation for 2 weeks. The main outcome index was WOMAC pain score. Secondary outcome measures were WOMAC stiffness score， functional score， standardized score and quality of life score （SF-12）. The test time points were baseline， 2 weeks after enrollment， and follow-up （14 weeks after enrollment）. The control group was at baseline and 2 weeks after enrollment. Results Compared with baseline， WOMAC pain score， stiffness score， functional score and standardized score were all decreased in 2 groups 2 weeks after enrollment （P < 0.05）， but the experimental group was significantly decreased compared with the control group （P < 0.001）. SF-12 quality of life scores were all higher than before （P < 0.001）， but the experimental group was significantly higher than the control group （P < 0.001）. At follow-up， compared with 2 weeks after enrollment， WOMAC pain scores were increased （P < 0.001）， WOMAC stiffness， joint function and standardized scores were decreased （P < 0.001）， and SF-12 scores were increased （P < 0.001）. Conclusion The use of spinal - pelvi-lower extremity line of traditional Chinese medicine bone-setting technique in the treatment of KOA is effective in improving the knee joint function and improving the quality of life of patients， but the short-term effect of pain relief is good， and the long-term effect is not good. Its safety is good， and it can be considered in clinical application for KOA patients with joint dysfunction as the main manifestation.
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