基于表面肌电图的手法治疗对老年人膝骨关节炎效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.09.014

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (9): 1099-1106.doi: 10.3969/j.issn.1006-9771.2024.09.014

基于表面肌电图的手法治疗对老年人膝骨关节炎效果的随机对照试验

朱博文¹, 赵素红¹, 李苗秀¹, 张帅攀¹, 姚重界², 朱清广³^,⁴, 房敏¹^,³()

1.上海中医药大学附属曙光医院推拿科，上海市 201203
2.上海中医药大学针灸推拿学院，上海市 201203
3.上海市中医药研究院中医推拿研究所，上海市 200437
4.上海中医药大学附属岳阳中西医结合医院推拿科，上海市 200437

收稿日期:2024-07-22 修回日期:2024-08-30 出版日期:2024-09-25 发布日期:2024-10-15
通讯作者: 房敏(1965-)，男，博士，教授、主任医师，博士研究生导师，主要研究方向：手法对脊柱及四肢关节疾病的镇痛和生物力学机制研究。E-mail： fm-tn0510@shutcm.edu.cn
作者简介:朱博文(1992-)，男，汉族，山东威海市人，博士研究生，主要研究方向：手法治疗骨关节病的临床研究。
基金资助:
国家自然科学基金项目(82305424);老年筋骨病中医智能康复设备创新研发平台项目(SHDC2022CRT018);上海市创新医疗器械应用示范项目(23SHS05400);上海市科技启明星"扬帆专项"(22YF1449000);中华中医药学会青年托举人才项目(CACM-2023-QNRC2-B13);上海市东方英才青年项目(卫生平台);上海市申康中心示范性研究型病房建设项目(SHDC2022CRW010)

Effect of manual therapy based on surface electromyography on knee osteoarthritis for older people: a randomized controlled trial

ZHU Bowen¹, ZHAO Suhong¹, LI Miaoxiu¹, ZHANG Shuaipan¹, YAO Chongjie², ZHU Qingguang³^,⁴, FANG Min¹^,³()

1. Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
2. College of Acupuncture and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
3. Shanghai Institute of Traditional Chinese Medicine, Shanghai 200437, China
4. Department of Tuina, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

Received:2024-07-22 Revised:2024-08-30 Published:2024-09-25 Online:2024-10-15
Contact: FANG Min, E-mail: fm-tn0510@shutcm.edu.cn
Supported by:
National Natural Science Foundation of China(82305424);Innovative R & D Platform of Intelligent Rehabilitation Equipment for Aged Fascia and Bone Diseases in Chinese Medicine(SHDC2022CRT018);Shanghai Innovative Medical Device Application Demonstration Project(23SHS05400);Shanghai Science and Technology Qiming Star "Yangfan Special Project"(22YF1449000);China Association of Traditional Chinese Medicine(CACM-2023-QNRC2-B13);Shanghai Oriental Talent Youth Project(Health Platform);Shanghai Shenkang Centre Demonstration Research Ward(SHDC2022CRW010)

摘要/Abstract

摘要：

目的观察基于表面肌电图的手法治疗对老年人膝骨关节炎(KOA)的临床疗效。
方法选取2023年8月至2024年6月上海中医药大学附属曙光医院单侧KOA患者106例，随机分为对照组和试验组，各53例。对照组采用常规手法治疗，试验组采用基于平均肌电(AEMG)制定的手法，共4周。治疗前后采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、疼痛视觉模拟量表(VAS)、Tinetti平衡与步态评分和6分钟步行试验(6-MWT)距离进行评定。
结果两组各脱落1例。治疗前，试验组患侧股直肌、股内侧肌、腓肠肌内侧头AEMG显著低于健侧(|Z| > 8.647, P < 0.001)，患侧股外侧肌、半腱肌、股二头肌AEMG值显著高于健侧(|Z| > 4.808, P < 0.001)。治疗后两组WOMAC、VAS、Tinetti平衡与步态评分和6-MWT距离均较前显著改善(|t| > 3.987, P < 0.001)，除VAS评分外，试验组各项指标均优于对照组(|t| > 2.213, P < 0.05)。
结论基于表面肌电图结果，将激活股直肌、股内侧肌、腓肠肌内侧头，抑制股外侧肌、半腱肌、股二头肌和释放内、外侧副韧带张力作为手法操作重点，可缓解老年人KOA疼痛，改善膝关节活动能力。

关键词: 膝骨关节炎, 老年, 表面肌电图, 手法治疗, 随机对照试验

Abstract:

Objective To investigate the effect of manual therapy based on surface electromyography on knee osteoarthritis (KOA) in the older people.
Methods A total of 106 outpatient with unilateral KOA were selected from Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, from August, 2023 to June, 2024, and were randomly divided into control group (n = 53) and experimental group (n = 53). The control group accepted routine manual therapy, and the experimental group accepted manual therapy based on the analysis of average electromyography (AEMG). They were assessed with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, Tinetti Balance and Gait Score, and 6-minute walk test (6-MWT) distances before and after treatment.
Results One case dropped down in each group. Before treatment, AEMG decreased in the rectus femoris, medial femoris and medial head of gastrocnemius on the affected side in the experimental group (|Z| > 8.647, P < 0.001), and it increased in the lateral femoris, semitendinosus and biceps femoris (|Z| > 4.808, P < 0.001). The scores of WOMAC, VAS, Tinetti Balance and Gait Score, and distances of 6-MWT improved in both groups after treatment (|t| > 3.987, P < 0.001), and improved more in the experimental group than in the control group, except the VAS score (|t| > 2.213, P < 0.05).
Conclusion Manual therapy focusing on activation of rectus femoris, medial femoris and medial head of gastrocnemius, inhibition of the lateral femoris, semitendinosus and biceps femoris, and releasing the tension of the medial and lateral collateral ligaments, according to the results of surface electromyography, can alleviate the pain of the KOA in the older people and improve the mobility of the knee.

Key words: knee osteoarthritis, aged, surface electromyography, manual therapy, randomized controlled trial

中图分类号:

R684.3

朱博文, 赵素红, 李苗秀, 张帅攀, 姚重界, 朱清广, 房敏. 基于表面肌电图的手法治疗对老年人膝骨关节炎效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1099-1106.

ZHU Bowen, ZHAO Suhong, LI Miaoxiu, ZHANG Shuaipan, YAO Chongjie, ZHU Qingguang, FANG Min. Effect of manual therapy based on surface electromyography on knee osteoarthritis for older people: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1099-1106.

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组别	n	性别(男/女)/n	年龄/岁	病程/年	体质量指数/(kg·m^-2)	患侧(左/右)/n	Kellgren-Lawrence分级 (I级/II级)/n
对照组	53	17/36	60.89±7.39	5.90±2.28	23.68±2.54	22/31	13/40
试验组	53	15/38	61.79±7.09	5.38±2.55	24.25±2.43	24/29	14/39
χ²/t值		0.179	0.644	-1.120	1.180	0.154	0.050
P值		0.672	0.521	0.265	0.241	0.695	0.824

变量	组别	n	测试	$\bar{x}±s$	t值	P值
WOMAC疼痛	对照组	53	前测	12.43±3.82	7.533	< 0.001
			后测	7.72±2.53
	试验组	53	前测	12.94±4.15	10.931	< 0.001
			后测	5.36±2.30
	治疗前两组均值差			0.51±5.71	0.658	0.512
	治疗后两组均值差			-2.36±2.91	-5.026	< 0.001
WOMAC僵硬	对照组	53	前测	4.64±2.33	3.987	< 0.001
			后测	3.02±1.82
	试验组	53	前测	4.91±2.15	8.701	< 0.001
			后测	1.72±1.38
	治疗前两组均值差			0.26±3.05	0.607	0.545
	治疗后两组均值差			-1.30±2.66	4.146	< 0.001
WOMAC日常活动	对照组	53	前测	47.85±5.89	17.873	< 0.001
			后测	31.09±4.89
	试验组	53	前测	48.68±4.56	20.938	< 0.001
			后测	28.98±4.94
	治疗前两组均值差			0.83±7.45	0.812	0.419
	治疗后两组均值差			-2.11±8.17	-2.213	0.029
WOMAC总分	对照组	53	前测	64.92±8.56	16.890	< 0.001
			后测	41.83±6.09
	试验组	53	前测	66.52±5.27	28.353	< 0.001
			后测	36.06±5.40
	治疗前两组均值差			1.60±9.35	1.161	0.248
	治疗后两组均值差			-5.77±9.36	-5.165	< 0.001

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	53	前测	5.77±1.05	22.366	< 0.001
		后测	1.75±0.90
试验组	53	前测	5.94±1.81	21.684	< 0.001
		后测	1.68±0.76
治疗前两组均值差			0.16±1.20	0.788	0.433
治疗后两组均值差			0.57±0.84	0.350	0.727

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	53	前测	11.57±2.32	6.915	< 0.001
		后测	7.83±2.45
试验组	53	前测	11.32±2.29	13.051	< 0.001
		后测	5.87±2.18
治疗前两组均值差			-0.25±3.61	-0.547	0.586
治疗后两组均值差			-1.96±3.39	-4.355	< 0.001

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	53	前测	320.92±32.60	-28.456	< 0.001
		后测	561.08±60.00
试验组	53	前测	326.19±23.72	-32.055	< 0.001
		后测	611.94±58.45
治疗前两组均值差			5.26±40.37	0.951	0.344
治疗后两组均值差			50.87±71.72	-4.421	< 0.001

基于表面肌电图的手法治疗对老年人膝骨关节炎效果的随机对照试验

Effect of manual therapy based on surface electromyography on knee osteoarthritis for older people: a randomized controlled trial

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下肢肌	n	侧别	M(Q_L, Q_U)	Z值	P 值
股直肌	53	健侧	74.63(71.21, 78.04)	-8.849	< 0.001
		患侧	31.32(26.81, 35.84)
股内侧肌	53	健侧	78.64(73.57, 83.72)	-8.875	< 0.001
		患侧	20.56(19.26, 21.87)
股外侧肌	53	健侧	68.43(64.72, 72.14)	-5.519	< 0.001
		患侧	89.43(84.79, 94.07)
半腱肌	53	健侧	47.41(44.73, 50.09)	-5.134	< 0.001
		患侧	58.81(56.23, 61.39)
股二头肌	53	健侧	51.11(48.86, 53.35)	-4.808	< 0.001
		患侧	63.75(60.17, 67.32)
胫骨前肌	53	健侧	66.06(62.82, 69.30)	-1.071	0.284
		患侧	63.62(60.51, 66.72)
腓肠肌外侧头	53	健侧	39.89(39.06, 40.72)	-1.087	0.277
		患侧	40.46(39.46, 41.46)
腓肠肌内侧头	53	健侧	93.13(85.16, 101.09)	-8.647	< 0.001
		患侧	25.74(24.42, 27.07)

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