[1]尹世林,孙志鹏,白祎琮,等.腰髋同调手法治疗内翻型膝骨关节炎临床报道[J].中国中医骨伤科杂志,2024,32(12):65-69+74.[doi:10.20085/j.cnki.issn1005-0205.241212 ]
　YIN Shilin,SUN Zhipeng,BAI Yicong,et al.Clinical Report of Lumbar-Hip Bone-Setting Manipulation in the Treatment of Valgus Knee Osteoarthritis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(12):65-69+74.[doi:10.20085/j.cnki.issn1005-0205.241212 ]
点击复制

腰髋同调手法治疗内翻型膝骨关节炎临床报道()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年12期
页码:
65-69+74
栏目:
临床报道
出版日期:
2024-12-15

文章信息/Info

Title:
Clinical Report of Lumbar-Hip Bone-Setting Manipulation in the Treatment of Valgus Knee Osteoarthritis
文章编号:
1005-0205(2024)12-0065-05
作者:
尹世林1; 孙志鹏1; 白祎琮1; 陈连伟1; 李啸1; 张泽坤1; 杜双庆1△
1河北中医药大学第一附属医院(石家庄,050011)
Author(s):
YIN Shilin1; SUN Zhipeng1; BAI Yicong1; CHEN Lianwei1; LI Xiao1; ZHANG Zekun1; DU Shangqing1△
1First Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang 050011,China.
关键词:
腰髋同调手法;  内翻型膝骨关节炎;  腰椎前凸角;  下肢机械轴
Keywords:
lumbar-hip bone-setting manipulation;  osteoarthritis of the inversion type knee;  compensatory mechanism;  mechanical axis of lower limbs
分类号:
R684.2
DOI:
10.20085/j.cnki.issn1005-0205.241212
文献标志码:
B
摘要:
目的:探讨腰髋同调手法治疗内翻型膝骨关节炎的临床疗效及手法诊疗思路。方法:回顾性分析2023年3月至2023年7月,采用腰髋同调手法治疗内翻型膝骨关节炎的患者69例,女56例,男13例; 年龄为50～82岁,平均为(64.67±7.58)岁。患肢髋膝踝角(HKA)为161.8°～177.0°,平均为172.84°±3.56°。于治疗前和治疗后双下肢全长+腰椎摄影负重正侧位测量腰椎前凸角(LL)及健患侧机械轴偏移距离(MAD)的变化。依据治疗前、治疗后2周及3个月的西安大略与麦克马斯特大学(WOMAC)骨关节炎指数及疼痛视觉模拟量表(VAS)评分评估临床疗效。结果:69例患者均获得随访,膝关节疼痛WOMAC评分由治疗前(44.43±1.75)分下降至治疗后2周(25.28±1.52)分及治疗后3个月(24.90±1.42)分; VAS评分由治疗前(7.30±0.20)分下降至治疗后2周(3.98±0.16)分及治疗后 3个月(4.63±0.18)分; 治疗后腰椎前凸角由治疗前26.10°(15.00°,34.90°)提升至27.60°(17.60°,37.05°)(P<0.05); 健侧机械轴偏移距离由治疗前14.00(6.00,21.75)mm减小至13.00(6.00,22.00)mm,差异有统计学意义(P<0.05),而患侧机械轴偏移距离治疗前后比较,差异无统计学意义(P>0.05); 健患侧机械轴偏移距离差值由治疗前14.00(6.00,21.75)mm减小至7.50(4.25,13.00)mm,差异有统计学意义(P<0.05)。结论:腰髋同调手法可以减轻内翻型膝骨关节炎患者疼痛,改善关节功能。手法通过整体调整脊柱-骨盆-下肢力线,使机体建立新的代偿机制,从而达到治疗目的。
Abstract:
Objective:To explore the clinical efficacy and selection of lumbar-hip bone-setting manipulation in osteoarthritis of the inversion type knee.Methods:69 patients of varus knee osteoarthritis treated with waist-hip homology manipulation in March 2023 to July 2023,56 females and 13 male,age is(64.67±7.58)years old,ranging from 50 to 82 years old.The affected limb hip-knee ankle angle 172.84°±3.56° ranging from 161.8° to 177.0°.The changes of the lumbar lordosis angle(LL)and the mechanical axis offset distance(MAD)were measured before and after the full length of both lower limbs and lumbar weight photography.Clinical efficacy was assessed based on the Western Ontario and McMaster Universities(WOMAC)osteoarthritis index,pain visual analogue scale(VAS)score before treatment,2 weeks after treatment,and 3 months after treatment.Results:Follow-up was obtained in all 69 patients,WOMAC score for knee pain decreased from pre-treatment(44.43±1.75)points to 2 weeks(25.28±1.52)points and 3 months(24.90±1.42)points; VAS score decreased from pre-treatment(7.30±0.20)points to 2 weeks(3.98±0.16)points and 3 months(4.63±0.18)points.After treatment,lumbar lordosis angle increased from treatment premise to 27.60°(17.60°,37.05°)(P<0.05).The side MAD value decreased from pretreatment to 13.00(6.00,22.00)mm(P<0.05).Comparing the MAD values of the affected side before and after treatment,there was no significant difference(P>0.05).The MAD difference decreased from before treatment to 7.50(4.25,13.00)mm(P<0.05).Conclusion:Lumbar-hip bone-setting manipulation can reduce pain and improve joint function in patients with varus knee osteoarthritis.By adjusting the spine-pelvis-lower limb force line,the body can establish a new compensatory mechanism,so as to achieve the purpose of treatment.

参考文献/References:

[1] 许学猛,高良稳,周红海,等.膝痹病(膝骨关节炎)多民族医诊疗专家共识[J].中国中医骨伤科杂志,2024,32(4):81-88.
[2] SHARMA L,SONG J,DUNLOP D,et al.Varus and valgus alignment and incident and progressive knee osteoarthritis[J].Annals of the Rheumatic Diseases,2010,69(11):1940-1945.
[3] BROPHY R H,FILLINGHAM Y A.AAOS clinical practice guideline summary:management of osteoarthritis of the knee(Nonarthroplasty),third edition[J].The Journal of the American Academy of Orthopaedic Surgeons,2022,30(9):e721-e729.
[4] WAITEMAN M C,CHIA L,DUCATTI M H M,et al.Trunk biomechanics in individuals with knee disorders:a systematic review with evidence gap map and meta-analysis[J].Sports Med Open,2022,8(1):145.
[5] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.
[6] PAN S,HUANG C,ZHANG X,et al.Non-weight-bearing short knee radiographs to evaluate coronal alignment before total knee arthroplasty[J].Quant Imaging Med Surg,2022,12(2):1214-1222
[7] 国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:203-204.
[8] MENG Z Y,LIU J K,ZHOU N.Efficacy and safety of the combination of glucosamine and chondroitin for knee osteoarthritis:a systematic review and meta-analysis[J].Archives of Orthopaedic and Trauma Surgery,2023,143(1):409-421.
[9] 郭浩山,谢晓音,潘超,等.三种截骨保膝方案治疗膝内侧间室骨关节炎的疗效比较[J].中国中医骨伤科杂志,2024,32(4):39-43.
[10] 宋忱,张万喜.个性化开放楔形胫骨高位截骨术治疗膝骨关节炎的临床研究[J].中国中医骨伤科杂志,2023,31(10):29-34.
[11] 吴子光,何君源,唐剑邦,等.胫骨内侧开放楔形截骨术对膝内翻患者踝关节的影响[J].中国中医骨伤科杂志,2021,29(11):18-23.
[12] 吴俊学,李毓灵,陈路.关节镜下关节清理术联合开放楔形胫骨高位截骨治疗内翻性膝关节骨关节炎的临床价值[J].解放军医药杂志,2020,32(9):81-84.
[13] 马开好,苟凌云,郭海,等.三种微创术式治疗内侧型膝骨关节炎的疗效比较[J].中国中医骨伤科杂志,2020,28(6):10-15.
[14] ATALAY S.The effect of acupuncture and physiotherapy on patients with knee osteoarthritis:a randomized controlled study[J].Pain Physician,2021,24(3):E269-E278.
[15] KOLASINSKI S L,NEOGI T,HOCHBERG M C,et al.2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand,hip,and knee[J].Arthritis Care & Research,2020,72(2):149-162.
[16] 徐耀,刘国振,李腾飞.弹拨牵引松解三步疗法治疗膝骨关节炎50例[J].中国中医骨伤科杂志,2024,32(3):93-96.
[17] CELESTRE P C,DIMAR J R 2ND,GLASSMAN S D.Spinopelvic parameters:lumbar lordosis,pelvic incidence,pelvic tilt,and sacral slope:what does a spine surgeon need to know to plan a lumbar deformity correction?[J].Neurosurg Clin N Am,2018,29(3):323-329.
[18] 李啸,陈连伟,孙志鹏,等.腰-膝同调手法联合氟比洛芬凝胶贴膏治疗膝骨关节炎的临床研究[J].河北中医药学报,2024,39(2):41-45.
[19] 李锡,颜运涛,刘路,等.运用髋关节推摇拔伸手法治疗初、早期膝骨关节炎:随机对照研究[J].北京中医药大学学报,2023,46(12):1756-1762.
[20] 张永旺,薛炳鹤,范宇,等.腰-膝共治法治疗早中期膝关节骨性关节炎临床研究[J].河北中医药学报,2021,36(6):22-23.
[21] 陈连伟,李啸,尹世林,等.膝骨关节炎评分指数与冠状位生物力学的相关性研究[J].实用骨科杂志,2024,30(4):302-305.
[22] MOYER R F,BIRMINGHAM T B,BRYANT D M,et al.Biomechanical effects of valgus knee bracing:a systematic review and meta-analysis[J].Osteoarthritis and Cartilage,2014,23(2):178-188.

备注/Memo

备注/Memo:
基金项目:国家中医药管理局特色技术传承专项(GZY-KJS-2022-039)
河北省重点研发计划项目(223777125D)
河北中医药大学2024年研究生创新资助项目(XCXZZSS2024032)
△通信作者 E-mail:szdushuangqing@sina.com
更新日期/Last Update: 2024-12-05