超声波结合股四头肌肌力训练治疗老年膝骨关节炎

背景膝关节的疼痛和关节不稳是膝骨关节炎的主要症状表现.目的采用镇痛药物超声波透入疗法减轻局部疼痛症状的同时进行股四头肌肌力训练,并与单纯超声波物理治疗比较对膝关节疼痛及功能状态的改善效果.设计随机对照实验.单位泸州医学院附属医院康复医学科.对象选择2001-08/2004-08泸州医学院附属医院骨科和康复科门诊及住院的膝骨关节炎患者76例,男28例,女48例,共109膝.随机分为实验组和对照组,每组38例.干预①实验组采用绵阳产CZ-01型超声治疗机,声头直径3cm,以10g/L双氯芬酸乳胶剂(北京诺华制药有限公司生产)作耦合剂涂于患膝关节周围,0.75～1.25W/cm2,1次/d,8～10 min/次;同时进行膝关节伸直位的静力性等长收缩训练,使用股四头肌等张训练器进行Delorme渐增抵抗运动练习,每日一两次.②对照组超声波疗法同治疗组;超短波应用无热至微热量,患区对置,10～15min/次;中频电采用CM-518B型电脑中频治疗仪,给予耐受量,20min/次,各种电疗均1次/d.③两组患者均在治疗4周后评定疗效,治疗期间停用其他抗炎镇痛等药物.④应用目测类比评分法对患者患膝平地行走疼痛评分(0分为无痛,10分为极痛,比治疗前缓解40%以上为有效);选择下肢日常活动项目对患者膝关节日常活动能力评分(5个项目,总分10分,分值高为优,低为差);采用悬挂砝码法在股四头肌等张训练器上测定患膝伸直位最大负荷量.主要观察指标①两组患者治疗前后平地行走疼痛评分.②两组患者膝关节日常活动能力评分.③两组患者膝关节伸直位最大负荷量.结果按意向处理分析,76例患者均进入结果分析.①两组患者治疗前后平地行走疼痛评分结果疼痛评分均较治疗前明显减低(P＜0.01),但组间比较无显著差异(P＞0.05).②两组患者治疗前后膝关节日常活动能力比较治疗后均比治疗前明显增加,实验组效果好于对照组(9.61±1.82,8.77±2.28),但组间比较无显著差异(P＞0.05).③两组患者治疗前后膝关节伸直位最大负荷量评价结果治疗后实验组较治疗前及对照组均明显增强[(10.05±2.41)kg比(7.86±1.98)kg及(8.76±1.65)kg,P＜0.01).结论应用双氯芬酸钠乳胶剂作为超声耦合剂对老年膝关节骨关节炎患者进行超声波结合股四头肌肌力强化训练治疗,可以改善患者疼痛提高日常生活能力和增强膝关节伸直位最大负荷量和膝关节的稳定性.其效果好于单纯应用超声波治疗.

Ultrasonic wave incombination with quadriceps exercise for the treatment of senile knee osteoarthritis

BACKGROUND: The pain and the unstability of the knee joint are the main clinical manifestation of knee osteoarthritis.OBJECTIVE: To verify the efficacy of ultrasonic drug penetration combiued with quadriceps exercise in treating senile knee osteoarthritis.DESIGN: Randomized controlled study.SETTING: Rehabilitation Department of the Affiliated Hospital of Luzhou Medical College.PARTICIPANTS: Seventy-six in-patient and out-patient cases of the knee osteoarthritis, 28 males and 48 females and total 109 knees, were chosen in the Orthopaedic Department and Rehabilitation Department in the Affiliated Hospital of Luzhou Medical College in theperiod between August,2001 and August, 2004. The cases were randomly divided into the experimental group and the control group with 38 cases each.therapy apparatus made in Mianyang was adopted and the diameter of the handpiece was 3 cm. 10 g/L dichloride sodium emulsion (made by Beijing Nuohua Pharmaceutical co.,Ltd) was taken as the coupling agent to smear around the knee joint about 0.75 -1.25 W/cm2, once a day, and 8-10 minutes per time. Meanwhile the static isometric contraction exercise of the knee joint in the extension position was done. Using the quardriceps isometric exercise apparatus, the Delorme progressive resisThe same ultrasonic therapy was done as the therapy group. The nonthermal and microthermal ultrasonic wave was adopted on the suffered location 10 -15 minutes per time, and the tolerance dose of the mid-frequency current was given 20 minutes per time and once a day using the CM-efficacy was assessed in the two groups 4 weeks after the therapy. During the therapy period the anti-inflammatory and analgesic drugs were not patient's knee joint activities of daily life (0 score signifies no pain, 10 scores severe pain, the pain relief better than 40% that before the therapy means the effectiveness). The lower limb activity of daily life was chosen to evaluate the patient's knee joint activities of daily life (5 items,total 10 scores, high score means good, low score means poor). The maximal loading dose in the extension position of the knee joint was measured on the quadriceps isometric exercise apparatus using the suspension weight method.The maximal loading dose in the extension position of the knee joint in the two groups.result of the walking pain scale in the two groups before and after the therapy: The score of pain evaluation after therapy was significantly lower than that before the therapy (P ＜ 0.01), and there was no significant differs knee joint activities of daily life in the two groups before and after the therapy: the result after the therapy was siguifieantly better than that before the therapy, and the efficacy after the therapy was significantly higher than that before the therapy, the efficacy of the experiment group was better than that of the control group (9.61±1.82, 8.77±2.28), while there was tion results of the maximal loading dose in the extension position of the knee joint in the two groups: the result of the experimental group after the therapy was significantly better than that of the experimental group before the therapy and the control group [ (10.05±2.41) kg vs (7.86±1.98) kg and (8.76±1.65) kg, P ＜ 0.01 ].CONCLUSION: The ultrasonic wave using the dichloride sodium emulsion as the ultrasonic coupling agent in combination with quadriceps strengthening exercise in treating the senile knee osteoarthritis is efficacious in relieving pain and improving the ADL ability of the knee joint, increasing the maximal loading dose in the extension position of the knee joint and the stability of the knee joint. The efficacy of the combination therapy is better than the single ultrasonic therapy.