张娟 王懿 周谋望 李筱雯

摘    要：研究目的：明確低强度聚焦超声波结合运动治疗髌骨软化症的临床疗效。选择2018年7-12月在北京大学第三医院康复科门诊就诊患者60例，按就诊时间顺序入组，均分为3组。治疗方法：1）常规组：使用常规理疗中的超声波治疗于患处，为期4周;2）治疗组：使用低强度聚焦超声波治疗于患处，为期4周;3）结合运动治疗组：使用低强度聚焦超声波治疗于患处，并同时结合运动康复治疗，为期4周。分别在患者治疗前、疗程中期、疗程结束后当天、疗程结束后15 d、疗程结束后30 d对各组患者患侧膝关节进行NRS评分和Lysholm评分，并统计疗程结束后15 d和治疗结束后30 d的随访数据来评价远期疗效。研究结果：3组患者在疗程结束后当天的NRS评分与Lysholm评分均显著优于治疗前，差异均有统计学意义（P<0.05）;治疗组和结合运动治疗组的患者在疗程中期的NRS评分与Lysholm评分均显著优于常规组，差异均有统计学意义（P<0.05）;结合运动治疗组患者在疗程结束后15 d的总有效率为90%、在疗程结束后3 0 d的总有效率为85%，组间差异有统计学意义（P<0.05）。3种治疗方法在疗程结束时均有效，低强度聚焦超声波结合运动治疗后总有效率有所提高，并具有显著性差异。研究结论： 低强度聚焦超声波由于解决了治疗剂量和“治疗头”贴合度及治疗深度的问题，所以快速达到了治疗效果，对于临床来说，更快地缓解了患者的疼痛。静力性直抬腿练习、靠墙静蹲练习、夹球训练、推髌练习符合髌骨软化症患者的运动强度。低强度聚焦超声波结合运动治疗可增加膝关节的稳定性，比单一使用超声波进行治疗的常规组和治疗组产生了更好的治疗效果。在髌骨软化症的临床治疗中，要充分重视与运动疗法的结合。

关键词：低强度聚焦超声波;运动疗法;髌骨软化症;临床疗效

中图分类号：G 804.5          学科代码：040302           文献标识码：A

Abstract： Objective： To determine the clinical effect of low-intensity focused ultrasound （LFU） combined with exercise therapy on chondromalacia patellae. From July to December 2018， 60 outpatients in the Department of Rehabilitation， Third Hospital of Peking University were selected and divided into three groups according to the order of visiting time. Treatment： 1）Conventional group： use the ultrasonic therapy of conventional physical therapy on the affected part， for 4 weeks; 2）Treatment Group： The affected part was treated with low intensity focused ultrasound for 4 weeks; 3）exercise therapy group： use low-intensity focused ultrasound to treat the affected part， and at the same time cooperate with exercise rehabilitation， for 4 weeks. The NRS pain score and Lysholm score were evaluated before treatment， in the middle of treatment， after treatment， 15 days after treatment and 30 days after the treatment. The long-term efficacy was evaluated by the follow-up data of 15 days and 30 days after the treatment. Results： The NRS score and Lysholm score of the three groups on the day after the end of treatment were significantly better than those before treatment ， and the differences were statistically significant（P<0.05）; the NRS score and Lysholm score of the treatment group and the combined exercise treatment group at the middle of the course were significantly better than those of the conventional group， and the differences were statistically significant（P<0.05）; the total effective rate of combined exercise therapy group was 90% on the 15th day and 85% on the 30th day after the end of the course of treatment（P<0.05）. All three treatments were effective at the end of the course， where the total effective rate of low intensity focused ultrasound combined with exercise therapy was improved， and the difference was significant. Conclusion： Low intensity focused ultrasound solves the problems of treatment dose， fitting degree of “treatment head” and treatment depth， so it can achieve treatment effect quickly， and relieve the pain of patients more quickly. Static straight leg lifting exercise， static squatting against the wall， ball clamping training and patellar pushing exercise are consistent with the exercise intensity of patients with chondromalacia patella. Low intensity focused ultrasound combined with exercise therapy can increase the stability of the knee joint， which has a better therapeutic effect than the conventional group and treatment group treated with ultrasound alone. In the clinical treatment of chondromalacia patellae， we should pay attention to the combination of exercise therapy.

Keywords：low-intensity focused ultrasound; exercise therapy; chondromalacia patellae; clinical curative effect

髌骨软化症又称髌骨软骨软化症（简称“CMP”），在运动损伤中较为常见，女性发病率高于男性。患者多因膝关节疼痛就诊，以软腿、假绞锁、膝关节反复肿胀伴积液为主要症状。在剧烈运动后疼痛加重，病情加重者下蹲困难，夜间疼痛明显，严重影响患者睡眠[1]。多种原因引起髌骨软骨发生肿胀、侵蚀、龟裂、破碎、脱落等一系列病理变化，股骨髁也发生相同病理改变从而形成CMP。因CMP的病因、病理尚不完全明确，目前也无有效诊治方法。临床上以保守治疗为主，制动膝关节1～2周，避免病情加重。必要时可应用药物镇痛，但疗程较长，且效果并不十分明显。……