基于人体生物力学研究石氏伤科手法治疗膝骨关节炎的临床效应机制

doi:10.3969/j.issn.1006-5725.2026.05.006

Abstract

Abstract:

Objective To observe the alterations in the clinical condition and biomechanical parameters of medial compartment knee osteoarthritis （KOA） treated with manipulation， and to explore the mechanism underlying the clinical biomechanical effect of manipulation on KOA. Methods Sixty-two eligible subjects with KOA in the medial compartment were recruited from the Orthopedic Center of the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine and Shi's Trauma Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. The control group received basic therapy for 8 weeks， whereas the experimental group was treated with Shi's "eight methods of regulating muscles and bones and treating knees"， with each session lasting 20 minutes， twice a week for 8 weeks. The Western Ontario and McMaster University Osteoarthritis Index （WOMAC） scores were employed to assess the subjects' conditions before and after the intervention. The VICON 3D gait analysis system and NORAXON wireless surface electromyograph were utilized to collect gait parameters in terms of time-space， kinematics， dynamics， and motor aspects. Results Compared with the control group， there were statistically significant differences in pain， stiffness， function， and total score between the observation group and the control group （P < 0.05）. In terms of time-space parameters， the observation groups showed significant differences in step size （P < 0.05）. The peak angles of internal rotation and external rotation of the control group before and after the intervention were statistically significant （P < 0.05）， and the same was true for the observation group before and after the intervention （P < 0.05）. There were no statistically significant differences in the kinetic parameters between the two groups before and after the intervention （P > 0.05）. There were significant changes in the parameters of VMM/MG and VM/ST in the early and middle supporting phases after the intervention in the observation group （P < 0.05）. Conclusion Based on the application of Hot Compress No.1， Shi's traumatology manipulation can significantly improve the condition of patients with medial compartment KOA. Meanwhile， the spatio-temporal， kinematic， dynamic， and motor parameters related to the knee joints of the lower limbs are improved to a certain extent. This suggests that the previously deteriorated biomechanical environment has been improved， revealing part of the biomechanical mechanism of manipulation in treating KOA.

Key words: knee osteoarthritis, Shi's traumatology, manipulation, gait analysis, surface electromyography, biomechanics

CLC Number:

R274.9

Fuwei PAN,Min ZHANG,Zhengyan LI,Jiehang LU,Yuqi CHEN,Pei LI,Hongsheng ZHAN. Study on clinical therapeutic effect mechanism of Shi's trauma manipulation on knee osteoarthritis based on human biomechanics[J]. The Journal of Practical Medicine, 2026, 42(5): 768-776.

Figures/Tables 6

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References 30

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人口学特征	对照组（n = 30）	观察组（n = 30）	χ²/t值	P值
性别/［例（%）］			0.082	0.774
男	9（30.00）	8（26.67）
女	21（70.00）	22（73.33）
年龄/岁	57.77 ± 7.15	57.63 ± 7.23	0.072	0.943
身高/m	1.63 ± 0.07	1.62 ± 0.07	0.534	0.595
体质量/kg	62.84 ± 9.06	62.00 ± 8.47	0.371	0.712
体质量指数/（kg/m²）	23.69 ± 2.66	23.71 ± 2.79	-0.024	0.981
病程/年	4.78 ± 2.87	4.77 ± 3.06	0.022	0.983
患肢/［例（%）］			0.067	0.796
右膝	15（50.00）	14（46.67）
左膝	15（50.00）	16（53.33）
K?L分级/［例（%）］			0.000	1.000
2级	19（63.33）	19（63.33）
3级	11（36.67）	11（36.67）

组别	例数	疼痛积分		t值	P值	僵硬积分		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	22.47 ± 4.14	15.28 ± 4.04	9.039	0.000	6.54 ± 2.19	4.73 ± 2.09	3.572	0.001
观察组	30	22.84 ± 3.92	6.54 ± 2.70	18.041	0.000	6.63 ± 2.11	3.66 ± 1.34	5.982	0.000
t值		-0.355	9.859			-0.162	2.350
P值		0.724	0.000			0.872	0.023
组别	例数	功能积分		t值	P值	总分		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	93.39 ± 16.87	70.39 ± 21.00	5.514	0.000	122.30 ± 19.34	90.43 ± 22.31	6.850	0.000
观察组	30	93.71 ± 16.85	53.71 ± 18.73	8.322	0.000	123.23 ± 18.53	63.93 ± 19.36	11.935	0.000
t值		-0.073	3.245			-0.191	4.914
P值		0.942	0.002			0.849	0.000

组别	例数	步速/（m/s）		t值	P值	步长/m		t值	P值	步频/（步/min）		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	1.13 ± 0.14	1.16 ± 0.10	-0.516	0.608	0.60 ± 0.05	0.61 ± 0.04	-1.354	0.181	112.89 ± 9.50	112.26 ± 7.16	-0.085	0.932
观察组	30	1.15 ± 0.14	1.19 ± 0.19	-0.784	0.436	0.62 ± 0.06	0.64 ± 0.05	-2.456	0.017	113.10 ± 9.44	112.79 ± 8.74	-0.254	0.800
t值		-0.755	-0.996			-1.513	-1.616			0.282	0.158
P值		0.457	0.328			0.141	0.117			0.780	0.876

组别	例数	首次触地角		t值	P值	支撑相屈曲峰值角		t值	P值	矢状面活动度		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	6.00 ± 4.35	5.82 ± 4.69	0.178	0.859	16.87 ± 4.55	16.45 ± 5.27	0.144	0.886	10.86 ± 3.53	10.62 ± 3.65	-0.039	0.969
观察组	30	5.81 ± 4.25	5.87 ± 4.56	-0.037	0.971	16.70 ± 4.31	17.92 ± 4.88	-1.124	0.266	10.90 ± 3.28	12.05 ± 3.43	-1.565	0.123
t值		0.188	-0.055			0.425	-1.088			0.283	-1.425
P值		0.852	0.957			0.674	0.285			0.779	0.165
组别	例数	外翻峰值角		t值	P值	内翻峰值角		t值	P值	冠状面活动度		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	3.52 ± 2.89	2.94 ± 3.42	0.061	0.952	-2.40 ± 3.46	-2.82 ± 3.38	0.375	0.709	5.92 ± 2.39	5.75 ± 2.91	-0.465	0.644
观察组	30	3.48 ± 2.52	4.11 ± 2.21	-1.586	0.119	-2.74 ± 3.63	-2.23 ± 3.26	-0.678	0.500	6.22 ± 2.64	6.35 ± 2.59	-0.841	0.404
t值		0.854	-1.135			0.658	-0.635			0.259	-0.159
P值		0.400	0.266			0.516	0.531			0.797	0.875
组别	例数	内旋峰值角		t值	P值	外旋峰值角		t值	P值	水平面活动度		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	-2.23 ± 4.06	0.73 ± 5.18	0.531	0.598	-11.79 ± 4.92	-8.74 ± 6.43	0.243	0.809	9.56 ± 3.84	9.41 ± 3.34	0.322	0.749
观察组	30	-2.90 ± 5.54	1.76 ± 5.51	-0.744	0.460	-12.13 ± 5.68	-9.20 ± 4.75	0.310	0.758	9.23 ± 4.16	10.95 ± 4.55	-1.499	0.139
t值		-2.274	-3.702			-1.960	-2.085			0.172	-1.500
P值		0.031	0.001			0.060	0.046			0.864	0.144

组别	例数	屈力矩/ （Nm/kg）		t值	P值	伸力矩/ （Nm/kg）		t值	P值	内收力矩第1峰值/ （Nm/kg）		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	0.50 ± 0.23	0.56 ± 0.23	-0.165	0.870	-0.24 ± 0.12	-0.22 ± 0.20	-0.360	0.720	0.45 ± 0.11	0.46 ± 0.10	-0.356	0.723
观察组	30	0.51 ± 0.24	0.56 ± 0.25	-0.032	0.975	-0.23 ± 0.15	-0.18 ± 0.17	-0.881	0.382	0.47 ± 0.13	0.45 ± 0.10	0.226	0.822
t值		-1.084	-0.761			-0.626	-1.353			-0.013	0.737
P值		0.287	0.453			0.536	0.187			0.990	0.467
组别	例数	内收力矩第2峰值/ （Nm/kg）		t值	P值	内收角冲量/ ［Nm/（kg·s）］		t值	P值	内旋力矩/ （Nm/kg）		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	0.34 ± 0.13	0.33 ± 0.12	0.322	0.748	0.17 ± 0.05	0.16 ± 0.04	-0.018	0.986	0.16 ± 0.06	0.17 ± 0.07	0.045	0.964
观察组	30	0.33 ± 0.12	0.32 ± 0.11	0.493	0.624	0.17 ± 0.07	0.16 ± 0.05	-0.058	0.954	0.16 ± 0.07	0.15 ± 0.05	0.695	0.490
t值		0.481	0.670			0.930	0.791			-0.128	0.568
P值		0.634	0.508			0.360	0.435			0.899	0.575
组别	例数	外旋力矩/ （Nm/kg）		t值	P值	GRF第1峰值/ BW		t值	P值	GRF第2峰值/ BW		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	-0.10 ± 0.04	-0.10 ± 0.04	0.030	0.976	1.13 ± 0.07	1.14 ± 0.07	0.274	0.785	1.11 ± 0.05	1.12 ± 0.04	-1.011	0.316
观察组	30	-0.10 ± 0.06	-0.10 ± 0.05	-0.695	0.490	1.12 ± 0.09	1.13 ± 0.07	0.740	0.462	1.12 ± 0.06	1.13 ± 0.05	-1.337	0.186
t值		0.464	-0.344			-0.608	-0.229			-0.510	-0.542
P值		0.646	0.734			0.548	0.820			0.614	0.592

Study on clinical therapeutic effect mechanism of Shi's trauma manipulation on knee osteoarthritis based on human biomechanics

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组别	例数	VM/MG支撑相早期		t值	P值	VM/MG支撑相中期		t值	P值	VM/MG支撑相晚期		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	25.05 ± 7.82	21.82 ± 6.04	0.172	0.864	16.47 ± 5.67	16.10 ± 4.58	0.872	0.387	15.19 ± 4.60	14.76 ± 4.76	-0.049	0.961
观察组	30	24.69 ± 8.32	19.19 ± 5.98	1.693	0.096	15.25 ± 5.13	12.64 ± 3.75	3.201	0.002	15.25 ± 5.13	15.00 ± 4.53	-0.199	0.843
t值		1.810	2.548			0.276	2.189			0.346	0.189
P值		0.081	0.016			0.784	0.037			0.732	0.852
组别	例数	VM/ST支撑相早期		t值	P值	VM/ST支撑相中期		t值	P值	VM/ST支撑相晚期		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	30	49.68 ± 13.10	49.40 ± 12.97	0.122	0.904	17.35 ± 4.37	16.37 ± 3.49	0.434	0.666	13.50 ± 4.29	12.23 ± 3.47	0.081	0.936
观察组	30	49.25 ± 14.23	39.94 ± 7.97	3.402	0.001	16.81 ± 5.13	12.71 ± 3.21	4.226	0.000	13.41 ± 4.47	11.69 ± 3.52	0.590	0.558
t值		0.086	2.837			0.965	3.985			1.519	1.788
P值		0.932	0.008			0.343	0.000			0.140	0.084