超声可视下射频针刺治疗早中期膝骨关节炎的步态特征研究

Study of gait characteristics on the treatment of radiofrequency acupuncture under ultrasound visualization for early and middle knee osteoarthritis

关键词:  膝骨关节炎  经筋  射频热凝  步态

Key words:  knee osteoarthritis  meridians  radiofrequency thermocoagulation  gait

摘要:

[目的] 观察超声可视引导下射频针刺治疗和传统电针治疗对早中期膝骨关节炎（KOA）患者步态参数的影响，并与正常受试者进行比较。[方法] 60例单膝早中期膝骨关节炎患者随机分为射频组和电针组，每组30例。两组患者均予以推拿和中药塌渍基础治疗，并指导功能锻炼，每日1次，射频组在超声引导下射频针刺患肢髋膝踝周围的经筋病灶点，每次选4～8个治疗点，每周1次，共治疗2周；电针组选取患膝局部阿是穴、梁丘、血海、内膝眼、外膝眼、阳陵泉、足三里，平补平泻手法得气后令3组连接电针仪，每日20 min，每日1次，每周连续治疗6次，共治疗2周。对30例正常受试者和两组患者治疗前后、治疗结束后1个月采用动态步态体态分析系统（型号：Right Gait Posture-Medical 3.0）测量步态对称性、标准度、平均步幅、最大步高、摆动速度、最大冲击力差值、双支撑相、着地仰角、离地仰角。[结果] 治疗后及治疗结束后1个月，两组患者对称性和标准度均优于本组治疗前（P<0.05），两组患者对称性和标准度的等级分布低于正常组（P<0.05）；较同时间电针组，射频组的对称性等级分布更优（P<0.05），标准度等级分布差异无统计学意义（P>0.05）。治疗后和治疗结束后1个月，两组患者的平均步幅、最大步高、摆动速度、着地仰角、离地仰角较本组治疗前增大（P<0.05），两组患者的平均步幅、最大步高、摆动速度、着地仰角、离地仰角小于正常组（P<0.05）；较同时间电针组，射频组的平均步幅、最大步高、摆动速度、着地仰角、离地仰角显著增大（P<0.05）。治疗后和治疗结束后1个月，两组患者的冲击力差值、双支撑相较本组治疗前减小（P<0.05），两组患者的冲击力差值、双支撑相大于正常组（P<0.05）；较同时间电针组，射频组的冲击力差值显著减小（P<0.05），双支撑相差异无统计学意义（P>0.05）。[结论] 在推拿、中药塌渍和功能锻炼的基础上予以超声引导下射频治疗和传统电针治疗均能改善早中期膝骨关节炎患者的步行能力，射频治疗改善更显著，但治疗后及治疗结束后1个月两组患者的步行能力仍较正常组差。

Abstract:

[Objective] To observe the effects of radiofrequency acupuncture under ultrasound visual guidance and traditional electro acupuncture on the gait parameters of patients with knee osteoarthritis (KOA) in the early and middle stages,and then to compare with the normal group.[Methods] Sixty knee osteoarthritis patients were randomly divided into radiofrequency group and electro acupuncture group,30 cases in each group. Patients in both groups were treated with massage and traditional Chinese medicine for basic treatment,and functional exercises were instructed once a day. In the RF group,using radiofrequency acupuncture to puncture the meridian lesions around the hip,knee and ankle of the affected limbunder ultrasound visual guidance and choosing 4 to 8 treatment points each time,once a week,for a total of 2 weeks. In the electro acupuncture group,Ashi point,Liangqiu,Xuehai,Neixiyan,Waixiyan,Yanglingquan and Zusanli were selected in the local area of the affected knee. After getting qi,the three groups were connected with the electro acupuncture instrument,20 minutes a day and 6 times a week for 2 weeks. Before and after treatment and one month after treatment,30 normal subjects and two groups of patients were measured gait symmetry,standard degree,average stride length,maximum step height,swing speed,maximum impact force difference,double support phase,landing elevation and ground elevation with dynamic gait and posture analysis system (model:Right Gait Posture-Medical3.0).[Results] After treatment and 1 month after treatment,the symmetry and standard degree of the two groups of patients were better than those before treatment (P<0.05),and the grade distribution of the symmetry and standard degree of the two groups were worse than the normal group (P<0.05). Compared with the electro acupuncture group at the same time,the symmetrical grade distribution of the RF group was better (P<0.05),and the difference in standard grade distribution was not statistically significant (P>0.05). After treatment and 1 month after the treatment,the average stride length,maximum step height,swing speed,ground elevation angle,and ground elevation angle of the two groups of patients were increased by comparing with those before the treatment (P<0.05),and were less than those of the normal group (P<0.05). Compared with the electro acupuncture group at the same time,the average stride length,maximum step height,swing speed,ground elevation angle,and ground elevation angle of the radio frequency group were increased significantly(P<0.05). After treatment and 1 month after the end of treatment,the impact force difference and double support of the two groups of patients were reduced by comparing with the group before treatment(P<0.05),and were greater than those of the normal group (P<0.05). Compared with the electro acupuncture group at the same time,the impact force difference of the radiofrequency group was significantly reduced (P<0.05),and the difference in the dual support phase was not statistically significant (P>0.05).[Conclusion] On the basis of massage,Chinese medicine collapse and functional exercise,ultrasound-guided radiofrequency therapy and traditional electro acupuncture can improve the walking ability of patients with knee osteoarthritis in the early and mid-term and radiofrequency treatment improved more significantly,but the walking ability of the two groups was still worse than the normal group after treatment and 1 month after the treatment.