推拿对膝骨关节炎患者膝屈伸肌肌张力的影响

目的：观察推拿对膝骨关节炎（knee osteoarthritis,KOA）患者膝屈伸肌肌张力的影响及其与临床疗效的关系。方法：观察2009年6月至2010年3月KOA患者20例,男7例,女13例;年龄42～72岁,平均61岁;单膝8例,双膝12例。推拿手法：滚法（操作频率120～140次/分）、按揉法、拿法、擦法。每周治疗3次,10次为1个疗程。分别于治疗前和1个疗程结束后测量双侧膝关节股直肌、腘绳肌肌张力,得出500g压力时该点的位移大小（L500g）;在治疗前后分别用骨关节炎指数（WOMAC）量表（包括疼痛、僵硬、功能活动等）进行疗效评定。结果：患膝治疗后屈伸肌（股直肌和腘绳肌）L500g较治疗前增加,WOMAC总评分较治疗前降低,差异均有统计学意义（P〈0.01）;患膝治疗后股直肌L500g、腘绳肌L500g改善率与临床疗效改善率呈线性正相关（P〈0.01,r2=0.764）、（P〈0.01,r2=0.533）。结论：推拿可有效改善KOA患者膝屈伸肌肌张力,从而改善患者的临床症状。

Effects of Tuina on muscular tension of flexor and extensor in patients with knee osteoarthritis

Objective: To study the effects of Tuina on muscular tension of flexor and extensor in patients with knee osteoarthritis(KOA). Methods: From June 2009 to March 2010,20 patients with KOA were observed,including 7 males and 13 females,the age ranged from 42 to 72 years with an average of 61 years. Eight patients were ailed with single knee,12 patients were ailed with double knee. The maneuver of Tuina were Gun maneuvers(120 to 140 times per minute),An maneuvers, Na maneuvers and Ca maneuvers. The patients were treated 3 times every week,and 10 times were 1 course of treatment. The muscular tension of flexor and extensor were measured before and after treatment,and the press force of the point reached largest of L 500 g when the press was 500 g. The therapeutic effects were assessed by WOMAC(including pain,stiffness,functional activity and overall score)scale before and after treatment. Results: There was significant increase in the ill knee on L 500 g (P<0.01). There was significant decrease after treatment in WOMAC (P<0.01). There was significant positive correlation between the improvement rate of extensor and the improvement rate of therapeutic effects(P<0.01,r²=0.764). There was significant positive correlation between the improvement rate of flexor and the improvement rate of therapeutic effects(P<0.01,r²=0.533). Conclusion: Tuina can improve muscular tension of flexor and extensor in patients with knee osteoarthritis,thus can improve the therapeutic effects.