早期推拿对全膝关节置换患者术后股四头肌表面肌电影响的随机对照研究

背景：全膝关节置换是晚期膝关节疾病常用的手术方法，如何促进患者术后早期康复，提高膝关节功能，对提高手术疗效和患者的满意度有重要意义。目的：观察类风湿关节炎患者全膝关节置换术后早期进行推拿康复对股四头肌表面肌电的影响。设计、场所、对象和干预措施：研究病例为复旦大学附属华山医院骨科和上海市长宁区光华中西医结合医院骨科2010年6月～2011年9月行全膝关节置换的类风湿关节炎患者，采用随机对照试验设计方法，将66名接受全膝关节置换术的患者随机分为对照组和推拿组，每组33例。对照组行持续被动活动训练（continue passivemotion，CPM），推拿组行CPM结合推拿康复，共治疗4周。主要结局指标：在术前和术后4周，采用美国Western Ontario和McMaster大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC）问卷进行评分，采用等速肌力下表面肌电图测试来评价早期推拿治疗后膝关节功能和膝关节周围肌肉的生物电特性。结果：经过4周的推拿综合康复干预后，推拿组的WOMAC问卷评分较对照组下降（P〈0．01）；推拿组股直肌、股内侧肌表面肌电图中位频率、积分肌电较对照组显著升高（P〈0．01）。结论：推拿可促进全膝关节置换患者恢复，通过提高股四头肌肌电募集水平，延缓肌肉疲劳。

Effects of early application of Tuina treatment on quadriceps surface myoelectricity in patients after total knee arthroplasty: a randomized controlled trial

BACKGROUND： Total knee replacement surgery is commonly used in end-stage diseases of the knee. It is important for improving surgical efficacy and patient satisfaction by promoting early rehabilitation of patients and improving knee function. OBJECTIVE： To observe the effects of early application of Tuina treatment on quadriceps surface electromyography （EMG） in patients with rheumatoid arthritis having undergone total knee arthroplasty, DESIGN, SETTING, PARTICIPANTS AND INTERVENTION： The study was performed at the Orthopedic Department of Huashan Hospital, Fudan University, and the Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine from June 2010 to September 2011. A total of 66 patients with rheumatoid arthritis who had undergone total knee replacement surgery were randomly divided into control group and observation group, 33 cases in each. The patients in the control group were administered with continuous passive training （CPM）, and the patients in the observation group were treated with CPM combined with Tuina, from prior surgery to four weeks post-surgery. MAIN OUTCOME MEASURES： The knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） questionnaire at baseline and 4 weeks after the surgery. Quadriceps surface EMG was also detected at the same time points. RESULTS： After 4 weeks of Tuina and comprehensive rehabilitation intervention, the WOMAC questionnaire score of the observation group was decreased compared with the control group （P〈0.01） ; median frequency and integrated electromyography of the rectus femoris and vastus medialis muscles, which were recorded by EMG, in the observation group were higher than those in the control group （P〈0.01）. CONCLUSION： Tuina can improve the recovery of patients who have undergone total knee replacement by increasing quadriceps EMG.