拔伸松动法对早中期KOA患者关节腔积液和滑膜的影响

王春林 向勇 田启东 段连海 尹学智 矣溪娴

摘要：目的 研究“拔伸松动手法”对早中期膝骨性关节炎（Knee Oteoarthritis，KOA）患者关节腔积液和滑膜的影响，为临床上应用“拔伸松动手法”治疗早中期KOA提供客观依据。方法 选用60例符合纳入标准的早中期KOA患者，随机分为治疗组和对照组，治疗组采用拔伸松动手法干预，对照组采用传统推拿手法干预，10次为1个疗程，共治疗2个疗程，通过肌骨超声检查关节内滑膜以及关节腔积液的变化情况，数据采用统计软件分析。结果 治疗后，2组膝关节积液walther分级与滑膜厚度较治疗前降低（P<0.01），且治疗组降低程度显著优于对照组（P<0.01）。结论 在临床中采用手法治疗早中期KOA患者，均能促进关节积液的吸收和降低滑膜厚度，但拔伸松动手法优于传统推拿手法，同时通过肌骨超声的检测手段，为临床手法治疗早中期KOA患者提供了客观依据，为手法的广泛推广提供了理论依据。

关键词：拔伸松动手法;膝关节骨性关节炎;关节腔积液;肌骨超声;滑膜

中图分类号：R684.3 文献标志码：A 文章编号：1007-2349（2021）06-0013-04

【Abstract】Objective： To study the effect of “pulling-stretching-loosening technique” on joint cavity effusion and synovium in patients with early and mid-stage knee osteoarthritis （KOA） and provide an objective basis for the clinical application of this technique in the treatment of early and mid-term KOA patients. Methods： 60 early and mid-stage KOA patients who met the inclusion criteria were selected and randomly divided into a treatment group and a control group. The treatment group was intervened by pulling-stretching-loosening technique and the control group was intervened by traditional massage manipulation， 10 times as a course of treatment and 2 courses of treatment. The musculoskeletal ultrasound was used to examine the changes in the synovial membrane and joint cavity effusion and the data was analyzed by statistical software. Results： After treatment， the Walther classification and synovial thickness of knee joint effusion in the two groups were lower than those of prior treatment （P<0.01）， and the reduction in the treatment group was significantly better than that in the control group （P<0.01）. Conclusion： In the clinical treatment of early and mid-stage KOA patients， the technique can promote the absorption of joint effusion and reduce the thickness of synovial membrane. The “pulling-stretching-loosening technique” is better than the traditional massage manipulation. At the same time， the technique provides an objective basis for the early and mid-stage KOA patients by the detection method of musculoskeletal ultrasound and also a theoretical basis for the wide application of the technique.

【Key words】Pulling-stretching-loosening Technique; Knee Osteoarthritis; Joint Cavity Effusion; Musculoskeletal Ultrasound; Synovium

膝骨性關节炎（KOA）是中老年常见疾病之一，其发病多与劳损、肥胖、外伤及遗传等有关[1]。其发病率比其它负重关节高，主要的病理变化是由于随着年龄的增长膝关节软骨发生退变，继而引发滑膜炎症反应、膝关节骨质增生等病理变化。在KOA患者中常见轻度或中度的膝关节积液，其关节滑膜炎和关节腔积液间断发作或持续存在[2]。现代医学认为 KOA 与膝关节积液的形成两者互相影响，关系密切。在膝关节退变过程中脱落的软骨及骨赘等因素会刺激膝关节滑膜层，使滑膜异常增生渗出，渗出液形成的关节积液又会加速膝关节软骨细胞的退变，加重 KOA 的症状。本研究对早中期KOA患者运用拨伸松动手法，通过肌骨超声检查可以较好地显示关节内滑膜病变情况以及关节腔积液的变化情况，为临床上应用“拔伸松动手法”治疗早中期KOA提供客观依据。……