退化性膝關節炎，又名骨性膝關節炎或膝骨關節炎等，多伴有半月板損傷或撕裂，西醫通常用手術療法。近年來不少醫生與患者發現，手術的效果並不理想。因此，越來越多的有識之士建議保守治療。那麼，這種骨性關節炎到底是如何發生與發展的呢？臨床上有哪些症狀？如何診斷與評估呢？為什麼骨性膝關節炎與激痛點有關？傳統針灸與激痛點針灸療法到底如何呢？
《中國骨傷雜誌》搜集了世界各地有關研究成果，系統地總結了激痛點療法治療本病的臨床療效。
研究針刺和肌肉拉伸使肌筋膜激痛點滅活治療膝骨關節炎（OA）的臨床效果。回顧性分析2010年至2014年疼痛門診108例疼痛患者的臨床資料。通過針刺肌筋膜激痛點並拉伸膝蓋周圍的肌肉和結構來治療膝骨關節炎，其中包括35例男性和73例女性。需要激痛點的穿刺以及針的提插運動才能引起肌肉的局部抽搐反應。針灸治療後，由治療師進行圍繞膝關節的肌肉拉伸。所有患者必須做自我伸展運動的功課。拉伸程度應在可忍受的疼痛下逐漸增加。在整個治療前後測量ROM和步行疼痛VAS評分，並在隨訪的1年內進行統計分析。
所有患者均得到了隨訪，其中95例在1年後無疼痛。
VAS評分從術前的7.6±0.5，中度的4.9±0.7，輕度的1.9±0.6，無痛的0.3±0.2提高到膝關節OA的步行疼痛可以通過針刺和拉伸來緩解，從而使肌筋膜觸發點失活。
To study clinical treatment effects of inactivating myofascial trigger points with needling and muscle stretching for the treatment of knee osteoarthritis(OA).Retrospective analyses were made to investigate the clinical data of pain clinic outpatient in our hospital from 2010 to 2014, and 108 patients with knee OA, including 35 males and 73 females, were treated with acupuncturing of myofascial trigger points and stretching of muscles and structure around knee. The puncturing of trigger points, and the back and forth movement of needle were required to elicit local twitch response of muscle. After acupuncture treatment, muscle stretch around the knee joint was performed by a therapist. All patients must do homework of self stretching exercise. The extent of stretching should be to gradually increased under a tolerable pain. The ROM and walking pain VAS scores were measured before and after whole therapy and were statistically analyzed during 1 year of follow up.All the patients were followed up, and 95 patients had no pain after 1 year. The VAS scores were improved from preoperative severe 7.6±0.5, moderate 4.9±0.7, to mild 1.9±0.6 and painless 0.3±0.2.The walking pain of knee OA might be alleviated by the acupuncture and stretch to inactivate the myofascial trigger point.
參考文獻
Zhang H, Huang QM, Nguyen TT, et al. [Clinical observation of effectiveness in the treatment of senile knee osteoarthritis with the inactivation of myofascial trigger points—108 cases reports]. Zhongguo gu Shang = China Journal of Orthopaedics and Traumatology. 2016 Sep;29(9):782-786. DOI: 10.3969/j.issn.1003-0034.2016.09.002.中國骨傷雜誌
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