李敏++袁桂平++王丽

[摘要] 目的 观察温针疗法配合穴位注射臭氧治疗髌股疼痛综合征（PFPS）的临床效果。 方法 将十堰市太和医院2015年1月～2016年2月收治的206例PFPS患者随机分为常规治疗组和联合治疗组，各103例。常规治疗组采用肌力训练、针刺、玻璃酸钠注射等常规治疗方案，联合治疗组在此基础上采用温针疗法配合臭氧“梁丘、膝眼”穴位注射。测试两组患者治疗前后股四头肌肌力和股四头肌耐力指数，股内侧肌（vM）和股外侧肌（vL）肌电信号，并计算vM/vL达峰值时限差值（ΔTBP），检测关节积液中透明质酸（HA）和白细胞介素-1β（IL-1β）的含量。采用膝关节功能评分（LKS）和视觉模拟评分（VAS）评定患者关节功能及疼痛程度，并计算总有效率和愈显率评价临床疗效。 结果 联合治疗组治疗15 d后，患者股四头肌肌力、股四头肌耐力指数和vL均较治疗前显著提高（P < 0.05），ΔTBP和IL-1β均较治疗前显著降低（P < 0.05），且与常规治疗组治疗15 d后比较，差异均有统计学意义（P < 0.05）。两组治疗15 d后vM和HA与治疗前比较，差异均有统计学意义（P < 0.05），但两组组间比较，差异无统计学意义（P > 0.05）。两组LKS、VAS评分、愈显率和总有效率比较，差异均有统计学意义（P < 0.05）。 结论 温针疗法配合穴位注射臭氧治疗PFPS效果显著，具有一定的临床应用价值。

[关键词] 温针疗法；臭氧；髌股疼痛综合征；股四头肌；肌力；耐力指数；肌电信号

[中图分类号] R684 [文献标识码] A [文章编号] 1673-7210（2016）10（a）-0083-04

Clinical efficacy of warm needling therapy combined with acupoint injection of ozone in the treatment of patellofemoral pain syndrome

LI Min1 YUAN Guiping1 WANG Li2

1.Department of Pain， Taihe Hospital of Shiyan City Affiliated Hospital of Hubei University of Medicine， Hubei Province， Shiyan 442000， China； 2.Outpatient Department of Pediatrics， Shiyan People's Hospital， Hubei Province， Shiyan 442000， China

[Abstract] Objective To observe the clinical efficacy of warm needling therapy combined with acupoint injection of ozone in the treatment of patellofemoral pain syndrome （PFPS）. Methods Total 206 hospitalized patients with PFPS admitted to Taihe Hospital of Shiyan City from January 2015 to February 2016 were randomly divided into conventional treatment group and combined treatment group， with 103 cases in each group. The conventional treatment group was treated with strength training， sodium hyaluronate injection， besides these conventional treatment， combined group was treated with warm needling therapy combined with injection of ozone into the acupoint of "liángqiū， xīyǎn". The myodynamia of quadriceps femoris and endurance index of quadriceps femoris were tested before and after the treatment， as well as the electromyographic signal of vastus medialis （vM） and vastus lateralis （vL）， pAd-Ad of vM/vL （ΔTBP） was calculated， and the hyaluronic acid （HA） in joint fluid and leukocyte interleukin-1 beta （IL-1β） were detected as well. The Lysholm of knees （LKS） and visual analogue scale （VAS） were used to evaluate the joint function of the patients and the degree of pain. The total effective rate and the cured and markedly effective rate were calculated to appraise clinical efficacy. Results After treatment for 15 days， myodynamia of quadriceps femoris， endurance index of quadriceps femoris and vL of combined treatment group were all increased compared with those before treatment （P < 0.05）， while ΔTBP and IL-1β were significantly reduced compared with those before treatment （P < 0.05）， which also had statistically significant differences compared with those of conventional treatment group after treatment for 15 days （P < 0.05）. The vM and HA of the two groups after treatment for 15 days had statistically significant differences compared with those before treatment （P < 0.05）， but there were no statistically significant differences between the two groups （P > 0.05）. There were all statistically significant differences of LKS， VAS， the cured and markedly effective rate and the total effective rate between the two groups （P < 0.05）. Conclusion Warm needling therapy combined with acupoint injection of ozone in the treatment of PFPS is effective， which has a certain clinical application value.

[Key words] Warm needling therapy； Ozone； Patellofemoral pain syndrome； Quadriceps femoris； Myodynamia； Endurance index； Electromyographic signal

髌股疼痛综合征（PFPS）是膝骨性关节炎（KOA）的早期临床表现，感染、髌股关节劳损、外伤及“风、寒、湿”邪外侵膝关节后均会发病[1]。PFPS常见于运动创伤和青少年，特别以女性患者居多，常出现膝前、髌后或髌周疼痛[2]。PFPS多采用保守治疗如足部矫形器支架矫正、髌骨包扎技术、口服镇痛药物、理疗、热疗、针灸、中药外敷等[3]。如治疗不及时或疗效不佳，PFPS会发展成KOA而影响到日常生活与工作[4]。本研究在保守治疗的……