亚洲免费av电影一区二区三区,日韩爱爱视频,51精品视频一区二区三区,91视频爱爱,日韩欧美在线播放视频,中文字幕少妇AV,亚洲电影中文字幕,久久久久亚洲av成人网址,久久综合视频网站,国产在线不卡免费播放

        ?

        Clinical observation of acupuncture combined with sitting-position knee-adjustment manipulations for patellofemoral arthritis

        2022-12-28 07:53:08ZHANGKaiyong張開勇Peng劉鵬XUSiwei徐斯偉ZHANGBimeng張必萌ZHANHongsheng詹紅生
        關(guān)鍵詞:高峰中醫(yī)藥

        ZHANG Kaiyong (張開勇), LⅠU Peng (劉鵬), XU Siwei (徐斯偉), ZHANG Bimeng (張必萌),ZHAN Hongsheng (詹紅生)

        1 SHⅠ’s Center of Orthopedics and Traumatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine,Shanghai 201203, China

        2 Ⅰnstitute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China

        3 ZHAN Hongsheng Shanghai Famous Traditional Chinese Medicine Experience Research Studio, Shanghai 201203, China 4 Shanghai General Hospital, Shanghai 200080, China

        Abstract

        Keywords: Acupuncture Therapy; Manual Therapies; Tuina: Massage; Pain Measurement; Visual Analog Scale;Osteoarthritis, Knee; Patellofemoral Osteoarthritis

        Knee osteoarthritis (KOA) is a widespread degenerative joint disease in the middle-aged and aged population. Its pathological features mainly include hyperostosis in the tibiofemoral and patellofemoral joints, subchondral bone degeneration, synovial proliferation, ligament laxity or contracture, and muscle atrophy[1]. KOA can be classified into three types, i.e.,simple tibiofemoral osteoarthritis (TFOA), simple patellofemoral osteoarthritis (PFOA), and a mix of the two. Due to the crucial mechanical role of tibiofemoral joint, the existing literature focuses more on TFOA,while the clinical study of PFOA is relatively lagging.Nevertheless, investigations have revealed a high prevalence and increasing incidence of PFOA among the aged[2-3]. For example, in China, almost 1/4 of the people aged over 50 years have PFOA, and the incidence is higher in females than in males[4].

        PFOA usually happens before TFOA, and over half of those who suffer from knee pain have PFOA.Nevertheless, prompt treatment reduces KOA’s incidence[5].

        Acupuncture can alleviate knee pain and improve knee joint motor function, with efficacy lasting for more than six months[6-9]. Besides, acupuncture can accelerate topical blood circulation, raise the pain threshold, and boost the healing of injuries[10-11].Knee-adjustment manipulations in a sitting position have been found effective in improving muscles around the knee joint and ligament balance, correcting force line, promoting blood circulation, and enhancing joint mobility in KOA[12-13].

        This study observed the efficacy of acupuncture plus sitting-position knee-adjustment manipulations in treating PFOA. The report is summarized as follows.

        1 Clinical Materials

        1.1 Sample size estimate[12-14]

        This trial was a test of superiority. We adopted this formula to estimate sample size:N= 2 × {(uα+uβ) ×σ/δ}2. Based on the previous research, we determinedα=0.05 andβ=0.10 took a one-tailedt-table withuα=1.645,uβ=1.282,δ=88.1,σ=186.0 (a comparatively larger standard deviation). When we applied these values to the formula, we obtainedN=76. The estimated sample size was 92 when the dropout rate was assumed to be 20%.

        1.2 Diagnostic criteria

        We made the diagnostic criteria of PFOA according to theGuidelines for the Diagnosis and Treatment of Osteoarthritis (2007)[15]. Anterior knee joint pain occurs while walking stairs or flexing-stretching the knee joint,or rub of the patellofemoral joint; X-ray examination reveals degenerative changes such as patellofemoral hyperostosis and subchondral osteosclerosis.

        1.3 Inclusion criteria

        Conformed to the diagnostic criteria for PFOA; aged 18-60 years; the joint disorders defined as mild-tomoderate, and the disease condition radiologically graded Ⅰ-Ⅱ (by Kellgren-Lawrence score)[16]; written informed consent and completed the trial as required.

        1.4 Exclusion criteria

        Coupled with conditions that cannot tolerate acupuncture or Tuina (Chinese therapeutic massage)manipulations, such as cardio-cerebrovascular diseases and diabetes; knee joint dysplasia, arthritis induced by immune disorders, knee fracture, severe meniscus injuries, or limited joint function; skin lesions, swelling pain, or inflammatory reactions around the knee joint;with bleeding tendency; with other contraindications for acupuncture or Tuina manipulations.

        1.5 Dropout and elimination criteria

        Those who withdrew from the trial due to personal reasons; those who showed poor compliance and failed to follow the treatment protocol or presented significant adverse reactions; those who took other treatments or drugs not permitted by the trial, which would interfere with efficacy evaluation; with the disease condition deteriorated through the course of the trial and had to be admitted to a hospital.

        1.6 Statistical methods

        We used the SPSS version 23.0 software for statistical analysis. The measurement data that satisfied normal distribution and homogeneity of variance were expressed as mean ± standard deviation (±s) and checked by thet-test. Those not distributed normally were described as median (interquartile range) [M (IQR)]and checked by the nonparametric test. The enumeration data were expressed as case numbers or percentages and analyzed by the Chi-square test.P<0.05 indicated statistical significance.

        1.7 General data

        This study recruited 92 patients between July 2019 and June 2020 from the outpatient of Shanghai General Hospital. The statistical staff adopted the SPSS version 23.0 software to run complete randomization to generate random numbers. In ascending order,numbers 1-46 were allocated to the observation group,and 47-92 were allocated to the control group. The subjects were assigned to the corresponding group according to their recruitment sequence. The two groups were statistically equal in comparing their general data, suggesting comparability (Table 1).

        Table 1 Comparison of the general data

        2 Treatment Methods

        The two groups received the same exercise, daily life guidance, and joint-muscle training, including losing weight, necessary knee bracing, quadriceps training,and restricting knee joint weight-bearing.

        2.1 Observation group

        Patients in the observation group received acupuncture treatment and sitting-position kneeadjustment manipulations.

        2.1.1 Acupuncture treatment

        Points: Liangqiu (ST34), Yanglingquan (GB34), Xuehai(SP10), Neixiyan (EX-LE4), Dubi (ST35), and Yinlingquan(SP9) on the affected side[17].

        Operation: The patient took a supine position with a cushion under the slightly bent knee (20-30°). After disinfecting the points with 75% alcohol cotton balls,the physician took sterile acupuncture needles of 0.25 mm in diameter and 40 mm in length to do the acupuncture treatment using the nail-pressing method.Liangqiu (ST34) and Xuehai (SP10) were perpendicularly punctured 15-20 mm in depth; Neixiyan (EX-LE4) and Dubi (ST35) were obliquely punctured to depths of 20-25 mm; Yinlingquan (SP9) and Yanglingquan (GB34)were also perpendicularly punctured, and the depth was 30-35 mm. After needle insertion, the physician evenly performed needling manipulations to obtain needling sensations (Deqi) and then retained the needles for 20 min.

        2.1.2 Sitting-position knee-adjustment manipulations

        The sitting-position knee-adjustment manipulations were performed following the acupuncture treatment.First, the patient was seated in a 45 cm high chair facing the doctor, who squatted or took a lower seat. Next, the doctor turned the patient’s foot on the affected side into the neutral position, ensuring a 90° angle between the calf and ground, pressed the lower patella edge upward with the thumbs, and encircled the popliteal fossa with the rest fingers. At the same time, the patient was asked to stand up and then sit down slowly.When standing up, the patient should keep the knee straight. The standing-up and sitting-down cycles were repeated three times, and the patient should try to complete them independently. This treatment was conducted every 2-3 d, 3 times a week for 8 weeks.

        2.2 Control group

        Patients in the control group took celecoxib capsules(State Food and Drug Administration Approval No.J20120063, Pfizer, USA) twice daily, 0.2 g per dose, for 8 consecutive weeks.

        3 Efficacy Observation

        3.1 Outcome measures

        3.1.1 Symptoms score We developed the symptoms scoring standard based on theGuiding Principles for Clinical Study of New Chinese Medicines[18]. The severity of knee joint symptoms was scored and recorded before and after treatment: <10 points, mild; 10-18 points,moderate; >18 points, severe.

        3.1.2 Pain score

        We took the short-form McGill pain questionnaire(SF-MPQ) to describe pain intensity, including the pain rating index (PRI) score, visual analog scale (VAS) score,and present pain intensity (PPI) score. The PRI was scored in the range of 0-45 points, the VAS score ranged from 0 to 100 points, and the PPI was rated on a scale of 0-5 levels and scored 0-5 points accordingly. For the three measures, a higher score means more intensive pain.

        3.1.3 Joint motor function score

        The Lysholm knee scoring scale (LKSS)[19]was adopted to evaluate knee joint motor function. The LKSS score ranges from 0 to 100 points; the higher the score, the better the knee joint function.

        3.2 Efficacy criteria

        The efficacy criteria were made according to the

        Guiding Principles for Clinical Study of New Chinese Medicines[18]and in consideration of the symptom score reduction rate. The symptom score reduction rate =(The symptom score before treatment - The symptom score after treatment) ÷ The symptom score before treatment × 100%.

        Controlled: Knee joint function was normal, the pain was completely gone, and the symptom score reduction rate ≥85%.

        Markedly effective: Knee joint motion was unlimited,the pain was gone, and the symptom score reduction rate ≥70% but <85%.

        Effective: Knee joint function was slightly limited, the pain was substantially gone, and the symptom score reduction rate ≥30% but <70%.

        Invalid: The improvements in knee joint function and pain were insignificant, and the symptom score reduction rate <30%.

        3.3 Results

        3.3.1 Comparison of the clinical efficacy

        As Table 2 presents, the total effective rate was 87.0%in the observation group, higher than 63.0% in the control group, and the between-group difference was statistically significant (P<0.05).

        Table 2 Comparison of the clinical efficacy Unit: case

        3.3.2 Comparison of the pain score

        We found no significant difference in the SF-MPQ scores between the two groups before treatment(P>0.05). After treatment, the PRI, VAS, and PPI scores dropped in both groups, all showing statistical significance (P<0.05). The three scores were lower in the observation group than in the control group,showing notable between-group differences (P<0.05).In addition, the post-treatment changes in the three scores were more significant in the observation group than in the control group, presenting statistical significance (P<0.05). The results suggest that both treatment protocols can reduce pain in the patients;however, acupuncture plus sitting-position knee adjustment manipulations can produce more significant efficacy than oral celecoxib capsules. The data are detailed in Tables 3-5.

        3.3.3 Comparison of the LKSS score

        There was no significant difference in the LKSS score between the two groups before treatment (P>0.05).After the intervention, the LKSS score rose markedly in both groups, showing statistical significance (P<0.05),and the score was higher in the observation group than in the control group, and the between-group difference was statistically significant (P<0.05). The post-treatment change in the LKSS score was also notably different between the two groups (P<0.05). The results indicate that the joint function shows more obvious improvements in the observation group than in the control group. The details are shown in Table 6.

        Table 3 Comparison of the PRI score before and after treatment ( ±s) Unit: point

        Table 3 Comparison of the PRI score before and after treatment ( ±s) Unit: point

        Note: PRⅠ=Pain rating index; compared with the same group before treatment, 1) P<0.05.

        Group n Pre-treatment score Post-treatment score Difference value Observation 46 24.76±8.30 12.13±5.961) 12.63±5.22 Control 46 24.69±7.24 15.74±6.881) 8.96±5.50 t-value 0.040 -2.690 3.288 P-value 0.968 0.009 0.010

        Table 4 Comparison of the VAS score before and after treatment ( ±s) Unit: point

        Table 4 Comparison of the VAS score before and after treatment ( ±s) Unit: point

        Note: ⅤAS=Ⅴisual analog scale; compared with the same group before treatment, 1) P<0.05.

        Group n Pre-treatment score Post-treatment score Difference value Observation 46 63.30±19.25 27.70±14.611) 35.61±10.04 Control 46 63.04±18.97 39.41±13.861) 23.63±10.57 t-value 0.065-3.946 5.573 P-value 0.948 <0.001 <0.001

        Table 5 Comparison of the PPI score before and after treatment ( ±s) Unit: point

        Table 5 Comparison of the PPI score before and after treatment ( ±s) Unit: point

        Note: PPⅠ=Present pain intensity; compared with the same group before treatment, 1) P<0.05.

        Group n Pre-treatment score Post-treatment score Difference value Observation 46 3.20±0.81 1.80±0.451) 1.39±0.68 Control 46 3.09±0.81 2.09±0.661) 1.00±0.60 t-value 0.644 -2.392 2.929 P-value 0.521 0.019 0.040

        Table 6 Comparison of the LKSS score before and after treatment ( ±s) Unit: point

        Table 6 Comparison of the LKSS score before and after treatment ( ±s) Unit: point

        Note: LKSS=Lysholm knee scoring scale; compared with the same group before treatment, 1) P<0.05.

        Group n Pre-treatment score Post-treatment score Difference value Observation 46 53.35±14.51 71.24±13.66 -17.91±8.18 Control 46 52.78±14.47 60.52±14.05 -7.74±6.47 t-value 0.180 3.709-6.614 P-value 0.858 <0.001 <0.001

        4 Discussion

        The chief target in treating PFOA is to ease pain,delay progression, improve and recover knee joint function, and enhance patients’ quality of life. The staged therapy for PFOA involves oral and external medications, rehabilitation, minimally invasive treatment, and surgery. Celecoxib is recommended by expert consensus to treat PFOA as its gastrointestinal adverse reactions are minor.

        As we age, Qi-blood deficiency, liver-kidney insufficiency, and tendon and bone malnutrition will gradually arise, with subsequent loss of the tendon-bone balance, manifesting as knee pain and difficulty flexing and extending the joint. Hence,Qi-blood deficiency and imbalanced tendons and bones are the core pathophysiological feature in the development of PFOA.

        It is the key to limbering tendons, activating collaterals, and supplementing Qi and blood in treating PFOA. Liangqiu (ST34) is the Xi-Cleft Point of the Stomach Meridian and is used to treat knee pain, low back pain, cold pain, numbness, difficulty bending the knee, etc. Xuehai (SP10) is an essential point for Qi-blood transportation and inpouring and can adjust and supplement Qi and blood. Yanglingquan (GB34) is one of the Eight Influential Points corresponding to tendons and is often used to treat tendon and bone diseases. Yinlingquan (SP9) can treat knee joint pain as the He-Sea Point of the Spleen Meridian. Also, Neixiyan(EX-LE4) and Dubi (ST35) are two points mainly used to treat knee pain. These points were used jointly to regulate and replenish Qi-blood, smooth and comfort tendons, and activate collaterals.

        During the sitting-position knee-adjustment treatment, patients actively move the knee. During standing up, the quadriceps contract to effectively increase muscle force and strengthen joint stability,similar to the purpose of kinesiotherapy in physical therapy[20]. The sitting-position knee-adjustment manipulations are rooted in the tendon-bone theory of traditional Chinese medicine, biomechanics, and modern rehabilitation. It combines the patient’s active movements and the physician’s targeted adjustments to achieve a dynamic balance amongst the joint, muscles,and ligaments, help modulate knee muscle tone, and reduce the concentration of stress in the knee joint.During treatment, the patella moves between femoral condyles, facilitated and adjusted by the physician’s force, which can help the patellofemoral joint’s movements back to the normal track, lessen the potential wear and tear on the joint surface, and recover the joint’s dynamic and static functions[21].

        The results here demonstrate that acupuncture combined with sitting-position knee-adjustment manipulations wins over oral celecoxib capsules in reducing pain and improving joint motor function and is a practical approach for PFOA. Furthermore, this integrated treatment is easy-to-operate and has no adverse reactions, thus worth applying and promoting.

        Conflict of Interest

        The authors declare that there is no potential conflict of interest in this article.

        Acknowledgments

        This work was supported by the Clinical Key Discipline Constructing Project of “Orthopedics of Chinese Medicine”in Shanghai Priority (上海市重中之重臨床重點(diǎn)學(xué)科建設(shè)項(xiàng)目“中醫(yī)骨傷科學(xué)”, No. 2017ZZ02024);New Cross Discipline of Traditional Chinese Medicine“Ergonomics of Tendons and Bones” in Shanghai (上海市中醫(yī)藥新興交叉學(xué)科“工效筋骨學(xué)”); High-peak High-plateau Ⅰnnovative Orthopedics Chinese Medicine Team Project of Shanghai University of Traditional Chinese Medicine High-peak Creating-top Action Plan (上海中醫(yī)藥大學(xué)高峰造尖行動計(jì)劃高峰高原創(chuàng)新中醫(yī)骨傷團(tuán)隊(duì)項(xiàng)目); Three-year Development Project for Traditional Chinese Medicine of Shanghai (2018-2020 Year): Shanghai School of Traditional Chinese MedicineⅠnheritance Project [上海市進(jìn)一步加快中醫(yī)藥事業(yè)發(fā)展三年行動計(jì)劃 (2018 年-2020 年)海派中醫(yī)流派傳承工程, No. ZY(2018-2020)-CCCX-1009]; National Science and Technology Major Project for Major New DrugⅠnnovation of Ministry of Science and Technology of the State (國家科技部重大新藥創(chuàng)制國家科技重大專項(xiàng), No.2015ZX09101021); Projects of National Natural Science Foundation of China (國家自然科學(xué)基金項(xiàng)目, No.81704103, No. 81774340, No. 81973874, No. 81973875);2019 Scientific and Technological Project of Songjiang District of Shanghai (2019 年度上海市松江區(qū)科技攻關(guān)項(xiàng)目, No. 19SJKJGG29).

        Statement of Informed Consent

        Ⅰnformed consent was obtained from all individual participants.

        Received: 23 February 2021/Accepted: 17 November 2021

        猜你喜歡
        高峰中醫(yī)藥
        病毒病將迎“小高峰”全方位布控巧應(yīng)對
        中醫(yī)藥在惡性腫瘤防治中的應(yīng)用
        中醫(yī)藥在治療惡性腫瘤骨轉(zhuǎn)移中的應(yīng)用
        重視中醫(yī)藥發(fā)展,發(fā)揮中醫(yī)藥作用
        兩會聚焦:中醫(yī)藥戰(zhàn)“疫”收獲何種啟示
        石慶云
        書香兩岸(2020年3期)2020-06-29 12:33:45
        從《中醫(yī)藥法》看直銷
        努力攀登文藝高峰
        中華詩詞(2017年1期)2017-07-21 13:49:54
        求真務(wù)實(shí) 開拓創(chuàng)新 不忘初心 再攀高峰
        中國核電(2017年1期)2017-05-17 06:09:54
        中醫(yī)藥立法:不是“管”而是“促”
        日韩精品免费在线视频| 日韩人妻无码一区二区三区| 亚洲天堂2017无码中文| 91福利精品老师国产自产在线| 国产一级黄色片一区二区| 午夜日本理论片最新片| 国产成人大片在线播放| 国产伦精品免编号公布| 国产精品一区二区久久| 一区二区特别黄色大片| 精品在线观看一区二区视频| 亚洲愉拍99热成人精品热久久| 国产午夜成人久久无码一区二区| 国产99精品精品久久免费| 一区二区亚洲熟女偷拍| 夜夜爽夜夜叫夜夜高潮| 九九99久久精品国产| 精品视频专区| 在线观看一区二区三区国产| 台湾佬中文网站| 天堂sv在线最新版在线| 谁有在线观看av中文| 青青草成人在线播放视频| 亚瑟国产精品久久| 国产白丝网站精品污在线入口| 人妻av中文字幕精品久久| av人摸人人人澡人人超碰下载 | 少妇被爽到高潮动态图| 亚洲国产精品综合福利专区 | 国产日产欧产精品精品| 日韩欧美专区| 日本成年少妇人妻中文字幕 | 亚洲成人观看| 亚洲一区二区三区在线观看蜜桃 | 男子把美女裙子脱了摸她内裤| 日出白浆视频在线播放| 久久婷婷成人综合色| 国产一起色一起爱| 国产一区白浆在线观看| 精品深夜av无码一区二区| 狠狠干视频网站|