摘要
目的:探讨电针足少阳经穴在膝关节前交叉韧带(anterior cruciate ligament,ACL)损伤术后康复中的应用价值。方法:纳入膝关节ACL部分损伤患者50例。由同一组医生行膝关节镜下腓骨长肌腱单束ACL重建术,术后第2天开始电针患侧足少阳经的悬钟、阳陵泉、膝阳关、环跳4穴。每天1次,连续治疗6d为1个疗程,2个疗程间隔1d,共治疗6个疗程。比较治疗前及治疗开始后2周、4周、6周时双侧膝关节的被动活动察觉阈值(threshold to detection of passive motion,TTDPM)、关节位置觉(joint position sense,JPS)以及体感诱发电位(somatosensory evoked potentials,SEPs)P40起始潜伏期、波幅和运动神经传导速度(motor nerve conduction velocity,MCV)潜伏期、波幅。结果:①TTDPM。时间因素和分组因素存在交互效应(F=312.586,P=0.000)。双侧膝关节TTDPM总体比较,差异有统计学意义,即存在分组效应(F=406.942,P=0.000)。治疗前后不同时间点间膝关节TTDPM的差异有统计学意义,即存在时间效应(F=334.592,P=0.000)。患侧膝关节TTDPM随时间呈下降趋势(3.57°±0.53°,2.61°±0.47°,2.21°±0.39°,1.92°±0.28°,F=349.201,P=0.000),健侧随时间无明显变化(1.44°±0.10°,1.42°±0.12°,1.40°±0.10°,1.41°±0.07°,F=2.772,P=0.052)。治疗前后各时间点,患侧膝关节TTDPM均较健侧高(t=29.528,P=0.000;t=21.642,P=0.000;t=16.658,P=0.000;t=13.642,P=0.000)。②JPS。时间因素和分组因素存在交互效应(F=201.439,P=0.000)。双侧膝关节JPS总体比较,差异有统计学意义,即存在分组效应(F=532.141,P=0.000)。治疗前后不同时间点间膝关节JPS的差异有统计学意义,即存在时间效应(F=209.843,P=0.000)。患侧膝关节JPS随时间呈改善趋势(4.31°±0.71°,3.62°±0.65°,3.23°±0.60°,2.64°±0.54°,F=211.272,P=0.000),健侧随时间无明显变化(1.49°±0.13°,1.47°±0.11°,1.48°±0.10°,1.47°±0.10°,F=1.333,P=0.277)。治疗前后各时间点,患侧膝关节JPS均较健侧差(t=28.782,P=0.000;t=23.278,P=0.000;t=20.698,P=0.000;t=15.864,P=0.000)。③SEPsP40起始潜伏期。时间因素和分组因素存在交互效应(F=740.633,P=0.000)。双侧膝关节SEPsP40起始潜伏期总体比较,差异有统计学意义,即存在分组效应(F=12153.958,P=0.000)。治疗前后不同时间点间膝关节SEPsP40起始潜伏期的差异有统计学意义,即存在时间效应(F=817.474,P=0.000)。患侧膝关节SEPsP40起始潜伏期随时间呈缩短趋势[(49.23±1.95)ms,(43.87±1.81)ms,(38.33±1.91)ms,(34.68±1.39)ms,F=1406.798,P=0.000],健侧随时间无明显变化[(30.78±0.92)ms,(30.42±1.15)ms,(30.41±0.98)ms,(30.39±1.10)ms,F=1.680,P=0.173]。治疗前后各时间点,患侧膝关节SEPsP40起始潜伏期均较健侧长(t=64.829,P=0.000;t=51.154,P=0.000;t=26.471,P=0.000;t=18.256,P=0.000)。④SEPsP40波幅。时间因素和分组因素存在交互效应(F=540.382,P=0.000)。双侧膝关节SEPsP40波幅总体比较,差异有统计学意义,即存在分组效应(F=1309.833,P=0.000)。治疗前后不同时间点间膝关节SEPsP40波幅的差异有统计学意义,即存在时间效应(F=619.578,P=0.000)。患侧膝关节SEPsP40波幅随时间呈增高趋势[(1.36±0.10)mv,(1.67±0.11)mv,(1.83±0.10)mv,(1.97±0.09)mv,F=926.454,P=0.000],健侧随时间无明显变化[(2.27±0.08)mv,(2.29±0.09)mv,(2.28±0.06)mv,(2.29±0.07)mv,F=2.258,P=0.084]。治疗前后各时间点,患侧膝关节SEPsP40波幅均较健侧低(t=-69.500,P=0.000;t=-42.342,P=0.000;t=-30.748,P=0.000;t=-22.211,P=0.000)。⑤MCV潜伏期。时间因素和分组因素存在交互效应(F=647.733,P=0.000)。双侧膝关节MCV潜伏期总体比较,差异有统计学意义,即存在分组效应(F=828.428,P=0.000)。治疗前后不同时间点间膝关节MCV潜伏期的差异有统计学意义,即存在时间效应(F=673.718,P=0.000)。患侧膝关节MCV潜伏期随时间呈缩短趋势[(20.63±1.37)ms,(17.94±1.49)ms,(16.67±1.30)ms,(14.36±0.99)ms,F=866.063,P=0.000];健侧随时间无明显变化[(12.27±0.39)ms,(12.24±0.44)ms,(12.22±0.49)ms,(12.21±0.39)ms,F=0.282,P=0.839]。治疗前后各时间点,患侧膝关节MCV潜伏期均较健侧长(t=44.622,P=0.000;t=26.899,P=0.000;t=27.612,P=0.000;t=15.341,P=0.000)。⑥MCV波幅。时间因素和分组因素存在交互效应(F=2208.831,P=0.000)。双侧膝关节MCV波幅总体比较,差异有统计学意义,即存在分组效应(F=3582.216,P=0.000)。治疗前后不同时间点间膝关节MCV波幅的差异有统计学意义,即存在时间效应(F=2362.807,P=0.000)。患侧膝关节MCV波幅随时间呈增高趋势[(3.76±0.10)mv,(4.26±0.13)mv,(4.58±0.11)mv,(4.78±0.09)mv,F=4397.711,P=0.000],健侧随时间无明显变化[(5.23±0.07)mv,(5.24±0.06)mv,(5.23±0.06)mv,(5.24±0.05)mv,F=2.144,P=0.098]。治疗前后各时间点,患侧膝关节MCV波幅均较健侧低(t=-171.500,P=0.000;t=-63.024,P=0.000;t=-48.938,P=0.000;t=-40.251,P=0.000)。结论:对于膝关节ACL部分损伤患者,在ACL重建术后采用电针足少阳经穴,膝关节本体感觉可有一定程度的改善,但术后短期内并不能完全恢复。
Objective:To explore the applied value of electroacupuncture(EA)at points of foot Shaoyang meridian in postoperative rehabilitation of anterior cruciate ligament(ACL)injuries.Methods:Fifty patients with partial ACL injuries were enrolled in the study, and they were treated with arthroscopic ACL reconstruction with single-bundle peroneus longus tendon by the same surgeons.The EA was performed at points of Xuanzhong(GB39),Yanglingquan(GB34),Xiyangguan(GB33)and Huantiao(GB30)at affected side from the postoperative day 2,once a day for consecutive 6 courses of treatment, 6 days for each course with a 1-day rest-insertion between courses.The threshold to detection of passive motion(TTDPM),joint position sense(JPS),onset latency(OL)and amplitude of somatosensory evoked potentials(SEPs)P40 as well as latency and amplitude of motor nerve conduction velocity(MCV)were compared between affected knee and unaffected knee before the treatment and at 2,4 and 6 weeks after the beginning of the treatment respectively.Results:(1)There was interaction between time factor and group factor in knee TTDPM(F=312.586,P=0.000).There was statistical difference in TTDPM between affected knee and unaffected knee in general, in other words, there was group effect(F=406.942,P=0.000).There was statistical difference in TTDPM between different timepoints before and after the treatment, in other words, there was time effect(F=334.592,P=0.000).The TTDPM presented a downward trend over time in affected knee(3.57±0.53,2.61±0.47,2.21±0.39,1.92±0.28 degrees, F=349.201,P=0.000),whereas it displayed no evident change over time in unaffected knee(1.44±0.10,1.42±0.12,1.40±0.10,1.41±0.07 degrees, F=2.772,P=0.052).The TTDPM was higher in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=29.528,P=0.000;t=21.642,P=0.000;t=16.658,P=0.000;t=13.642,P=0.000).(2)There was interaction between time factor and group factor in knee JPS(F=201.439,P=0.000).There was statistical difference in JPS between affected knee and unaffected knee in general, in other words, there was group effect(F=532.141,P=0.000).There was statistical difference in knee JPS between different timepoints before and after the treatment, in other words, there was time effect(F=209.843,P=0.000).The JPS presented an improving trend over time in affected knee(4.31±0.71,3.62±0.65,3.23±0.60,2.64±0.54 degrees, F=211.272,P=0.000),whereas it displayed no evident change over time in unaffected knee(1.49±0.13,1.47±0.11,1.48±0.10,1.47±0.10 degrees, F=1.333,P=0.277).The JPS was poorer in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=28.782,P=0.000;t=23.278,P=0.000;t=20.698,P=0.000;t=15.864,P=0.000).(3)There was interaction between time factor and group factor in OL of SEPsP40(F=740.633,P=0.000).There was statistical difference in OL of SEPsP40 between affected knee and unaffected knee in general, in other words, there was group effect(F=12 153.958,P=0.000).There was statistical difference in OL of SEPsP40 of knee between different timepoints before and after the treatment, in other words, there was time effect(F=817.474,P=0.000).The OL of SEPsP40 presented a shortening trend over time in affected knee(49.23±1.95,43.87±1.81,38.33±1.91,34.68±1.39 ms, F=1 406.798,P=0.000),whereas it displayed no evident change over time in unaffected knee(30.78±0.92,30.42±1.15,30.41±0.98,30.39±1.10 ms, F=1.680,P=0.173).The OL of SEPsP40 was longer in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=64.829,P=0.000;t=51.154,P=0.000;t=26.471,P=0.000;t=18.256,P=0.000).(4)There was interaction between time factor and group factor in amplitude of SEPsP40(F=540.382,P=0.000).There was statistical difference in amplitude of SEPsP40 between affected knee and unaffected knee in general, in other words, there was group effect(F=1 309.833,P=0.000).There was statistical difference in amplitude of SEPsP40 of knee between different timepoints before and after the treatment, in other words, there was time effect(F=619.578,P=0.000).The amplitude of SEPsP40 presented an increasing trend over time in affected knee(1.36±0.10,1.67±0.11,1.83±0.10,1.97±0.09 mv, F=926.454,P=0.000),whereas it displayed no evident change over time in unaffected knee(2.27±0.08,2.29±0.09,2.28±0.06,2.29±0.07 mv, F=2.258,P=0.084).The amplitude of SEPsP40 was lower in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=-69.500,P=0.000;t=-42.342,P=0.000;t=-30.748,P=0.000;t=-22.211,P=0.000).(5)There was interaction between time factor and group factor in latency of MCV(F=647.733,P=0.000).There was statistical difference in latency of MCV between affected knee and unaffected knee in general, in other words, there was group effect(F=828.428,P=0.000).There was statistical difference in latency of MCV of knee between different timepoints before and after the treatment, in other words, there was time effect(F=673.718,P=0.000).The latency of MCV presented a shortening trend over time in affected knee(20.63±1.37,17.94±1.49,16.67±1.30,14.36±0.99 ms, F=866.063,P=0.000),whereas it displayed no evident change over time in unaffected knee(12.27±0.39,12.24±0.44,12.22±0.49,12.21±0.39 ms, F=0.282,P=0.839).The latency of MCV was longer in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=44.622,P=0.000;t=26.899,P=0.000;t=27.612,P=0.000;t=15.341,P=0.000).(6)There was interaction between time factor and group factor in amplitude of MCV(F=2 208.831,P=0.000).There was statistical difference in amplitude of MCV between affected knee and unaffected knee in general, in other words, there was group effect(F=3 582.216,P=0.000).There was statistical difference in amplitude of MCV of knee between different timepoints before and after the treatment, in other words, there was time effect(F=2 362.807,P=0.000).The amplitude of MCV presented an increasing trend over time in affected knee(3.76±0.10,4.26±0.13,4.58±0.11,4.78±0.09 mv, F=4 397.711,P=0.000),whereas it displayed no evident change over time in unaffected knee(5.23±0.07,5.24±0.06,5.23±0.06,5.24±0.05 mv, F=2.144,P=0.098).The amplitude of MCV was lower in affected knee compared to unaffected knee at each timepoint before and after the treatment(t=-171.500,P=0.000;t=-63.024,P=0.000;t=-48.938,P=0.000;t=-40.251,P=0.000).Conclusion:EA at points of foot Shaoyang meridian can improve the knee proprioception to some extent in patients who underwent ACL reconstruction for partial ACL injuries, but the knee proprioception cann’t be completely recovered in the short term after surgery.
作者
张磊
熊鹿静
李炳坤
唐小高
喻林
周鑫
ZHANG Lei;XIONG Lujing;LI Bingkun;TANG Xiaogao;YU Lin;ZHOU Xin(The Affliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou 646000.Sichuan,China;The Clinical Medical College of Southwest Medical University,Luzhou 646000,Sichuan,China)
出处
《中医正骨》
2022年第6期9-16,共8页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
泸州市人民政府-西南医科大学科技战略合作项目(2018LZXNYD-ZK43)
西南医科大学-西南医科大学附属中医医院联合项目(2018XYLH-001)。
关键词
膝损伤
前交叉韧带
电针
胆经
本体感觉
穴
悬钟
穴
阳陵泉
穴
膝阳关
穴
环跳
knee injuries
anterior cruciate ligament
electroacupuncture
gallbladder meridian
proprioception
Point GB39(Xuanzhong)
Point GB34(Yanglingquan)
Point GB33(Xiyangguan)
Point GB30(Huantiao)
