热敏灸及康复训练治疗膝骨关节炎急性痛慢性化的临床研究

目的:观察热敏灸能否抑制膝关节骨性关节炎(KOA)患者急性痛的慢性化及是否对受损的弥漫性伤害抑制性控制(DNIC)功能具有调制作用,并与康复训练作对比,为临床推广提供理论依据。方法:将60名KOA患者随机分为热敏灸组和康复训练组,每组30例,分别进行热敏灸治疗和康复训练治疗,比较2组治疗前、中、后的视觉模拟疼痛量表(VAS)、弥漫性伤害抑制性控制(DNIC)及临床疗效。结果:2组患者VAS评分在治疗前、治疗10d及20d后均呈持续下降趋势(P<0.05,0.01),且热敏灸组各时间点VAS评分均低于康复训练组(P<0.01)。热敏灸组DNIC功能评分在治疗前、治疗10d及20d后均呈持续上升趋势(P<0.05,0.01),且热敏灸组在治疗后各时间点DNIC功能评分明显高于康复训练组(P<0.01)。康复训练组DNIC功能评分治疗前后各时间点比较差异无统计学意义。治疗20d后,2组患者膝关节Lysholm功能评分均较治疗前明显提高(P<0.01,0.05),且热敏灸组明显高于康复训练组(P<0.01)。结论:热敏灸能修复膝关节骨性关节炎(KOA)患者急性痛慢性化过程中受损的DNIC功能,从而阻止本病急性痛慢性化的发生。

Clinical research on thermomoxibustion and rehabilitation training for inhibiting the chronification of the acute pain of knee osteoarthriti

Objective:To observe whether thermomoxibustion can inhibit the chronification of the acute pain in patients with knee osteoarthritis (KOA) and whether it has modulation effect on the impaired diffuse noxious inhibitory controls (DNIC) function, and compare it with rehabilitation training to provide a theoretical basis for clinical promotion. Methods:All 60 KOA patients were randomly divided into thermomoxibustion group and rehabilitation training group, 30 cases in each group. The visual analog scale (VAS), DNIC and the clinical curative effect were compared between two groups before, during and after the treatments.Results:There were significant differences in VAS scores before, during and after treatment in thermomoxibustion group (P<0.01). DNIC was significantly different before and after treatment (P<0.01). There was significant difference during and after the treatment (P<0.05). The VAS scores in the rehabilitation training group were significantly different before and after treatment (P<0.01), and there was significant difference before and during the treatment (P<0.05). There were significant differences between the first treatment course and the second treatment course (P<0.01). There was no significant difference in DNIC function during the whole treatment of the rehabilitation training group (P>0.05). There was no significant difference in DNIC function between the two groups before and during the treatment (P>0.05). There was significant difference between the two groups after the treatment (P<0.05).Conclusion: Thermomoxibustion can fix the impaired DNIC function during the chronification of the acute pain of KOA patients and can prevent the chronification of the acute pain of KOA.