组织-骨平衡调控对膝骨关节炎患者步态和膝关节功能的疗效：一项随机对照试验。
Efficacy of tissue-bone homeostasis manipulation on the gait and knee function for the patients with knee osteoarthritis: a randomized controlled trial.
机构信息
Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China.
Shanghai Puxing Community Health-Care Center, Shanghai, 200136, China.
出版信息
BMC Musculoskelet Disord. 2024 Oct 8;25(1):794. doi: 10.1186/s12891-024-07896-y.
BACKGROUND
Knee osteoarthritis (KOA) was characterized by pain and limited joint function, which seriously affected the quality of life of patients. The vast majority of KOA was closely related to degeneration of the patellofemoral joint and abnormal patellar movement trajectory. Tissue-bone homeostasis manipulation (TBHM) could correct abnormal patellar movement trajectory on the basis of loosening soft tissue. However, there was little strong evidence to verify its efficacy on the patients with KOA. The study objective was to explore the efficacy of the TBHM on gait and knee function in the patients with KOA.
METHODS
Sixty KOA patients were randomly assigned to either the joint mobilization (n = 30) or TBHM (n = 30) group. The joint mobilization group received joint mobilization, while the TBHM group received TBHM. For two groups, the patients participated in 30 min rehabilitation sessions thrice per week for 12 weeks. The primary outcome was biomechanical gait outcomes during walking, including step length, step velocity, double support, knee range of motion (ROM), and knee adduction moment (KAM). The secondary outcomes were the Western Ontario and McMaster Index (WOMAC) and 36-Item short- form health survey (SF-36), which reflected improvements in knee function and quality of life, respectively. At baseline and 12 weeks, evaluations were conducted and compared between groups.
RESULTS
After a 12-week intervention, significant group differences were observed in KAM (p = 0.018), WOMAC-Pain (p = 0.043) and WOMAC-Stiffness (p = 0.026). A noteworthy finding was the presence of a significant interaction effect between group and time specifically observed in step velocity during gait (p = 0.046), WOMAC-Function (p = 0.013) and SF-36 (p = 0.027). Further analysis revealed a significant difference in step velocity (p = 0.034), WOMAC-Function (p = 0.025) and SF-36 (p = 0.042) during post-assessment between the two groups. Moreover, a significant time effect was observed across all outcomes of the two groups (p < 0.05).
CONCLUSION
The TBHM intervention has better improved the gait, knee function, and quality of life in the patients with KOA.
TRIAL REGISTRATION
ITMCTR, ITMCTR2200005507. Registered 06/01/2022, http://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=09cdadad-0aef-41ee-81bd-a8dceb63f7f5 .
背景
膝骨关节炎（KOA）的特征是疼痛和关节功能受限，严重影响患者的生活质量。绝大多数 KOA 与髌股关节退变和髌骨运动轨迹异常密切相关。组织-骨稳态调控（TBHM）可在松解软组织的基础上纠正髌骨运动轨迹异常。然而，对于 KOA 患者，其疗效的有力证据很少。本研究旨在探讨 TBHM 对 KOA 患者步态和膝关节功能的疗效。
方法
将 60 例 KOA 患者随机分为关节松动术（n=30）或 TBHM（n=30）组。关节松动术组接受关节松动术，TBHM 组接受 TBHM。两组患者每周 3 次，每次 30 分钟康复治疗，共 12 周。主要结局是步行时的生物力学步态指标，包括步长、步速、双支撑、膝关节活动度（ROM）和膝关节内收力矩（KAM）。次要结局是 Western Ontario 和 McMaster 指数（WOMAC）和 36-Item 短表健康调查（SF-36），分别反映膝关节功能和生活质量的改善。在基线和 12 周时，对两组进行评估并进行比较。
结果
干预 12 周后，KAM（p=0.018）、WOMAC-疼痛（p=0.043）和 WOMAC-僵硬（p=0.026）方面组间差异有统计学意义。值得注意的是，在步态时的步速（p=0.046）、WOMAC-功能（p=0.013）和 SF-36（p=0.027）方面，存在显著的组间和时间交互作用效应。进一步分析显示，两组在步速（p=0.034）、WOMAC-功能（p=0.025）和 SF-36（p=0.042）方面的后评估差异有统计学意义。此外，两组所有结局均观察到显著的时间效应（p<0.05）。
结论
TBHM 干预能更好地改善 KOA 患者的步态、膝关节功能和生活质量。
试验注册
ITMCTR，ITMCTR2200005507。注册于 2022 年 6 月 1 日，网址：http://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=09cdadad-0aef-41ee-81bd-a8dceb63f7f5。
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