文章摘要
李娟,薛俊强,腾兆伟,赵银娇,李铁山.增生疗法联合经颅直流电刺激治疗膝骨性关节炎疼痛的临床疗效观察[J].中国康复,2023,38(1):9-13
增生疗法联合经颅直流电刺激治疗膝骨性关节炎疼痛的临床疗效观察
Clinical observation of prolotherapy combined with transcranial direct current stimulation in the treatment of knee osteoarthritis pain
  
DOI:
中文关键词: 膝骨性关节炎  增生疗法  高渗葡萄糖  经颅直流电刺激  神经异常可塑  超声引导
英文关键词: Knee osteoarthritis  Prolotherapy  Dextrose  Transcranial direct current stimulation  Neuroplastic changes  Ultrasound guidance
基金项目:国家重点研发计划项目(2021YFC2009200)
作者单位
李娟 青岛大学附属医院康复医学二科山东 青岛 266000 
薛俊强 青岛大学附属医院康复医学二科山东 青岛 266000 
腾兆伟 青岛大学附属医院康复医学二科山东 青岛 266000 
赵银娇 青岛大学附属医院康复医学二科山东 青岛 266000 
李铁山 青岛大学附属医院康复医学二科山东 青岛 266000 
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中文摘要:
  目的:观察增生疗法联合经颅直流电刺激治疗膝骨性关节炎疼痛的效果并探讨其作用机制。方法:选取膝骨性关节炎患者42例作为研究对象,随机分成观察组和对照组各21例。2组各有1例脱落,最终各20例完成研究。2组均给予增生治疗,即20%高渗葡萄糖8ml关节内注射,每周1次,共3次。观察组再给以电流强度为2mA的经颅直流电刺激治疗,每天1次,每次20min,持续2周;对照组也给予电刺激治疗。但每次仅在治疗开始和结束时各提供15s的2mA电流刺激以模拟真刺激的体感知觉,其余时间无电流刺激,每天1次,每次20min,持续2周。分别于治疗前、第1次增生治疗后2、4、6周,采用视觉模拟评分(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、压痛阈(PPT)和条件性疼痛调制(CPM)对患者的膝关节功能活动及疼痛情况进行评估。结果:治疗前,2组患者的VAS、WOMAC、PPT及CPM比较均无统计学差异。在第1次增生治疗后的2、4、6周,观察组患者的VAS评分较同时间点对照组降低,CPM较同时间点对照组升高(均P<0.05);2组患者的VAS、WOMAC均较治疗前降低(均P<0.05),PPT均较治疗前升高(均P<0.05),观察组患者的 CPM较治疗前升高(P<0.05)。结论:增生疗法联合tDCS的镇痛疗效优于单纯的增生疗法,既可以解决由于组织结构病变而引发的疼痛,又可以解决由于神经异常可塑导致的疼痛。
英文摘要:
  Objective: To observe the effect of prolotherapy combined with transcranial direct current stimulation in the treatment of knee osteoarthritis pain and explore its mechanism. Methods: Totally, 40 patients with knee osteoarthritis were selected according to the inclusion criteria. According to the different treatment methods, 40 patients were randomized to prolotherapy + active tDCS group and prolotherapy + sham tDCS group, 20 patients in each group. Both groups were given injection of 8 mL of 20% dextrose, once a week for a total of 3 times. At the same time, the prolotherapy + active tDCS group was subjected to a constant current intensity of 2 mA for 20 min once a day for 2 weeks. For the prolotherapy + sham tDCS, the electrodes were placed in the identical positions as for active tDCS, but included only 15-s of 2 mA of stimulation at the beginning and the end to mimic somatosensory perception of active tDCS. The outcome measures included the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pressure pain threshold (PPT) and conditioned pain modulation (CPM) which were obtained from patients before the first injection at the base line and 2, 4, 6 weeks after the first injection. Results: In the prolotherapy + active tDCS group, scores of the VAS and WOMAC were significantly reduced and PPT and CPM increased at 2, 4, 6 weeks after the first injection (P<0.05). In the prolotherapy + sham tDCS group, scores of the VAS and WOMAC were significantly reduced and PPT increased at 2, 4, 6 weeks after the first injection (P<0.05). The CPM in the prolotherapy + sham tDCS group had no significant change at different time points after injection (P>0.05). The VAS score in the prolotherapy + active tDCS group was significantly lower than that in the control group at 2, 4 and 6 weeks after the first injection. There was no significant difference in WOMAC and PPT between the two groups. The CPM in the prolotherapy + active tDCS group was significantly higher than that in the control group at 2, 4 and 6 weeks after the first injection. Conclusion: Prolotherapy combined with tDCS has a higher magnitude of effect than prolotherapy alone. The combined therapy can not only solve the pain caused by tissue structural lesions, but also solve the pain caused by neuroplastic changes.
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