中医正骨推拿治疗早中期膝骨性关节炎随机对照研究

作者	单位
宋石龙,薛明新,陶琦,万兴,方云,洪若洋,岳涛	1.南京中医药大学附属医院推拿科（南京 210000）；2.南京中医药大学第一临床医学院（南京 210000）

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中文摘要:

目的观察中医正骨推拿治疗早中期膝骨性关节炎（KOA）患者的临床疗效。方法 263例为2019年3月—2020年7月于江苏省中医院推拿科门诊或住院就诊的KOA患者，符合纳入标准80例，采用随机数字表法分为治疗组和对照组，每组40例。分别行中医正骨推拿和传统推拿治疗，每周3次，共治疗2周。两组均在治疗前后行西安大略麦马斯特大学骨性关节炎指数可视化量表（WOMAC）评分、膝关节主被动活动度及表面肌电图评估，并随访3个月。结果治疗过程中两组各脱落2例，最终76例纳入统计分析。与本组治疗前比较，治疗后及末次随访时两组患者WOMAC评分、膝关节主被动活动度及表面肌电图值均改善（P<0.05）。治疗2周后，治疗组患者疼痛、关节功能、WOMAC总评分、膝关节主被动活动度及股内侧肌和股外侧肌平均肌电图（AEMG）比较均显著低于对照组（P<0.05），关节僵硬评分及股内侧肌和股外侧肌平均功率斜率（MPFs）比较，差异无统计学意义（P>0.05）。末次随访时，治疗组患者疼痛、僵硬、关节功能、总评分及膝关节主被动活动度均显著低于对照组（P<0.05）。两组患者总有效率相当（P>0.05），治疗组治疗后及末次随访时的愈显率[47.5%（19/40）、80.0%（32/40）]明显优于同期对照组[5.0%（2/40）、35.0%（14/40）]，差异均有统计学意义（P<0.05）。结论中医正骨推拿可以更有效的治疗早中期KOA患者，提高患膝关节活动度，改善股四头肌肌力和耐疲劳能力。

英文摘要:

Objective To observe the clinical effect of Chinese medicine （CM） bone-setting tuina in the treatment of early and middle stage knee osteoarthritis （KOA）. Methods A total of 263 KOA outpatients or inpatients at Department of Tuina， Jiangsu Provincial Hospital of Traditional Chinese Medicine were enrolled from March 2019 to July 2020. And 80 patients in line with inclusion standard were included in the study. They were randomly assigned to treatment group and control group by randomized digit table， 40 in each group. They were respectively treated with CM bone-setting tuina and traditional tuina， 3 times a week for 2 weeks in total. Western Ontario and McMaster Osteoarthritis Index （WOMAC） score， active and passive knee range of motion， and surface electromyography were evaluated before and after treatment in both groups， and follow-uped for 3 months. Results During the treatment 2 cases dropped off in each group， and 76 cases were included as statistical analyses. Compared with before treatment in the same group， WOMAC score， active and passive knee motion， and surface electromyography values in both groups were improved after treatment and at the last follow-up （P<0.05）. After 2 weeks of treatment pain， joint function， total WOMAC score， active and passive knee motion and mean electromyography （AEMG） of vastus medialis and vastus lateralis muscles in treatment group were significantly lower than those in control group （P<0.05）， but there was no significant difference in joint stiffness score or mean power frequency slope （MPFs） of vastus medialis and vastus lateralis muscles （P>0.05）. At the last follow-up，the score of pain，stiffness， joint function， total score， and active and passive knee motion in the treatment group were significantly lower than those in the control group （P<0.05）. The total effective rate of the two groups was similar （P>0.05）. The markedly-effective rate after treatment and at the last follow-up in the treatment group [47.5% （19/40）， 80.0%（32/40）] were significantly better than those of the control group [5.0% （2/40）， 35.0%（14/40）] （P<0.05）. Conclusion CM bone-setting tuina can be more effective in the treatment of early and middle KOA，improve patients' knee activity， and improve quadriceps muscle strength and fatigue resistance.

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