[摘要] 目的 評价夹胫推肘牵膝推拿法治疗膝骨性关节炎、改善屈曲挛缩的疗效。 方法 选择2017年1月至2018年12月在杭州市中医院就诊的合并屈曲挛缩的膝骨性关节炎患者80例，其中男19例、女61例，年龄47～74岁，平均（60.54±8.12）岁。采用区组随机法分为观察组及对照组各40例。观察组采用夹胫推肘牵膝推拿法治疗，对照组采用塞来昔布胶囊口服治疗，治疗周期12周。随访52周，比较两组疼痛（VAS评分）、躯体功能（WOMAC-PF）、自我效能（OA-SES）。采用手持式压痛仪测定膝关节后方压痛阈值。 结果 共67例患者完成随访。在第12周随访，两组患者VAS评分比较差异无统计学意义（P>0.05），但观察组的WOMAC-PF、OASES、压痛阈值均优于对照组（P<0.05）。在第52周随访，观察组以上指标均优于对照组（P<0.05），且观察组仅有14%患者仍存在屈曲挛缩，而对照组屈曲挛缩病例达到60%（P<0.05）。此外，膝关节后方压痛阈值与膝关节屈曲挛缩严重等级存在负相关（P<0.05）。 结论 夹胫推肘牵膝推拿法治疗屈曲挛缩型膝骨性关节炎，其近期止痛效果与塞来昔布相似，但其改善屈曲挛缩的远期效果优于塞来昔布。

[关键词] 膝骨性关节炎;屈曲挛缩;推拿;中医药;非药物治疗

[中图分类号] R684.3          [文献标识码] B          [文章编号] 1673-9701（2021）11-0129-05

Therapeutic effect evaluation of tibia clipping and elbow pushing and knee pulling massage in the treatment of knee osteoarthritis of flexion contracture

TANG Jun

Department of Massage， Hangzhou Hospital of Traditional Chinese Medicine， Hangzhou   310007， China

[Abstract] Objective To evaluate the curative effect of tibia clipping and elbow pushing and knee pulling massage in the treatment of knee osteoarthritis and improvement of flexion contracture. Methods Eighty patients with knee osteoarthritis combined with flexion contraction treated in Hangzhou Hospital of Traditional Chinese Medicine from January 2017 to December 2018 were selected， including 19 males and 61 females， aged 47-74 years old，with the average age of （60.54±8.12） years old. They were divided into an observation group and a control group， with 40 cases in each group. The observation group was treated with tibia clipping and elbow pushing and knee pulling massage， while control group was treated with celecoxib capsules orally for 12 weeks. The patients were followed up for 52 weeks. The pain （VAS score）， physical function（WOMAC-PF） and self-efficacy（OASES） were compared. A hand-held tenderness meter was used to determine the threshold of tenderness behind the knee joint. Results A total of 67 patients completed follow-up. At the 12th week of follow-up， the VAS scores of the two groups were not statistically different（P>0.05）， but the WOMAC-PF， OASES， and tenderness thresholds of the observation group were better than those of the control group（P<0.05）. At the 52th week of follow-up， the above indicators in the observation group were superior to those of the control group（P<0.05）. Only 14% of patients in the observation group still had flexion contracture， while the cases of flexion contracture in the control group reached 60%（P<0.05）. In addition， the posterior knee tenderness threshold was negatively correlated with the severity of knee flexion contracture（P<0.05）. Conclusion The effect of tibia clipping and elbow pushing and knee pulling massage in the treatment of flexion contracture-type knee osteoarthritis is similar to that of celecoxib， but its long-term effect of improving flexion contracture is better than that of celecoxib.

[Key words] Knee osteoarthritis; Flexion contracture; Massage; Chinese medicine; Non-pharmacological treatment

屈曲挛缩是膝骨性关节炎（KOA）的常见病理改变，其原因包括膝关节及周围软组织的变性、挛缩、僵硬，最终产生屈曲畸形、关节功能障碍[1]。发生屈曲挛缩后，由于站立时承重力线后移，挛缩病情轻者可引起步态异常，严重者需在扶助下行走，甚至难以直立。即便全膝关节置换是治疗严重膝骨性關节炎的妥当办法，但是合并屈曲挛缩的全膝关节置换术的手术难度大，效果不甚满意。同时近期临床研究支持采用手法松解挽救性治疗全膝关节置换术后出现的屈曲挛缩[2，3]。

临床实践中存在大量未能接受手术治疗的屈曲挛缩型膝骨性关节炎患者。屈曲挛缩常伴随着更严重的关节疼痛症状。针对屈曲挛缩，单纯的手法治疗是否有助于缓解疼痛症状，值得临床关注。前期……