基于超聲多模態(tài)技術循經(jīng)筋病灶點針刀治療膝骨關節(jié)炎的療效觀察

基于超聲多模態(tài)技術循經(jīng)筋病灶點針刀治療膝骨關節(jié)炎的療效觀察基于超聲多模態(tài)技術循經(jīng)筋病灶點針刀治療膝骨關節(jié)炎的療效觀察

摘要：

目的：探討基于超聲多模態(tài)技術循經(jīng)筋病灶點針刀治療膝骨關節(jié)炎的臨床療效及其安全性。

方法：選取100例患有膝骨關節(jié)炎的患者，隨機分為治療組和對照組，兩組各50例。治療組應用超聲多模態(tài)技術定位循經(jīng)筋病灶點進行針刀治療，對照組應用傳統(tǒng)手法針刺治療，兩組均連續(xù)治療3次，每次治療間隔1周，觀察兩組治療前后患者膝關節(jié)疼痛、功能及生活質量評分變化。

結果：治療組和對照組患者治療前各項評分無差異。治療后，治療組患者VAS評分、WOMAC評分及SF-36評分均較治療前顯著降低，差異有統(tǒng)計學意義（P＜0.05）;對照組患者VAS評分、WOMAC評分及SF-36評分治療后也有所改善，但改善程度不如治療組，差異達到了統(tǒng)計學意義（P<0.05）。

結論：基于超聲多模態(tài)技術循經(jīng)筋病灶點針刀治療膝骨關節(jié)炎具有療效顯著、作用持久的優(yōu)點，且操作簡單，安全可靠，值得在臨床上推廣應用。

關鍵詞：超聲多模態(tài)技術；循經(jīng)筋病灶點；針刀；膝骨關節(jié)炎；療效觀察

Abstract:

Objective:Toexploretheclinicalefficacyandsafetyofusingtheultrasoundmultimodaltechnologytolocatetheacupuncturepointandtreatkneeosteoarthritiswithneedleknifetherapy.

Method:Onehundredpatientswithkneeosteoarthritiswererandomlydividedintotwogroups:thetreatmentgroup(n=50)andthecontrolgroup(n=50).Thetreatmentgroupusedultrasoundmultimodaltechnologytolocateacupuncturepointsonthemeridianandtreatedthediseasewithneedleknifetherapy.Thecontrolgroupusedtraditionalacupuncturemethodfortreatment.Bothgroupsweretreatedcontinuouslyfor3timeswithaone-weekintervalbetweeneachtreatment.Changesinkneejointpain,function,andqualityoflifescoreswereobservedafterthetreatmentinbothgroups.

Result:Beforetreatment,therewasnodifferenceinthescoreofeachassessmentindexbetweenthetwogroups.Aftertreatment,theVASscore,theWOMACscore,andtheSF-36scoreofthetreatmentgroupweresignificantlyreducedcomparedwiththosebeforetreatment(P＜0.05);theVASscore,theWOMACscore,andtheSF-36scoreofthecontrolgroupwerealsoimprovedaftertreatment,buttheimprovementwasnotassignificantasthatofthetreatmentgroup,andthedifferencewasstatisticallysignificant（P<0.05).

Conclusion:Theultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapyforkneeosteoarthritishassignificantandlong-lastingefficacy,issimpleandsafetooperate,andisworthpromotingandapplyinginclinicalpractice.

Keywords:ultrasoundmultimodaltechnology,acupuncturepointonthemeridian,needleknife,kneeosteoarthritis,efficacyobservatioKneeosteoarthritisisacommondisablingconditionthataffectsmillionsofpeopleworldwide.Therearevarioustreatmentoptionsavailableforkneeosteoarthritis,includingconservativeandsurgicalinterventions.However,theseinterventionshavelimitationsandmaynotprovidelong-termbenefits.Therefore,thereisaneedformoreeffectiveandsafetreatmentoptionsforkneeosteoarthritis.

Inrecentyears,ultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapyhavegainedpopularityasatreatmentoptionforkneeosteoarthritis.Thisapproachinvolvestheuseofultrasoundtoaccuratelylocateacupuncturepointsonthemeridiansandtheuseofaneedleknifetostimulatethesepoints.

Severalstudieshavebeenconductedtoevaluatetheefficacyofthisapproach,andthefindingshavebeenpromising.Inarandomizedcontrolledtrial,patientswhounderwentultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapyforkneeosteoarthritisshowedsignificantimprovementinpain,function,andqualityoflifecomparedtothosewhoreceivedconventionaltreatment.Theimprovementwassustainedoverarelativelylongperiod.

Theapproachissimpleandsafetooperate,anditdoesnotinvolvetheuseofdrugsorsurgery.Therefore,itisarelativelyaffordableandlessinvasiveapproachforkneeosteoarthritisthatcanbeeasilyadoptedinclinicalpractice.

Inconclusion,ultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapyisapromisingtreatmentoptionforkneeosteoarthritis.Ithassignificantandlong-lastingefficacy,anditissimpleandsafetooperate.Hence,itisworthpromotingandapplyinginclinicalpracticeFurthermore,thistreatmentapproachalsohaspotentialeconomicbenefits.Kneeosteoarthritisisacommonandchronicconditionthatimposesaconsiderableburdenonhealthcaresystemsworldwide.IntheUnitedStatesalone,thetotalannualcostofkneeosteoarthritisexceeds$27billion,includinghealthcareexpendituresandlostproductivity(6).Byprovidingacost-effectivetreatmentthatcanreducetheneedfordrugsandsurgery,ultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapycouldpotentiallyreducetheeconomicburdenassociatedwithkneeosteoarthritis.

Anotheradvantageofthistreatmentapproachisthatitislessdependentontheskillleveloftheacupuncturist.Traditionalacupuncturetechniquesrelyheavilyontheacupuncturist'ssubjectiveassessmentofthepatient'sconditionandtheirownexperienceinchoosingtherightacupointsandmanipulatingtheacupunctureneedles.Ultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapy,ontheotherhand,usesobjectiveandquantitativemeasures,suchasultrasoundimagingandelectromyography,toguidetheacupuncturistinselectingacupointsandinsertingtheneedles.Thisreducesthevariationbetweendifferentacupuncturistsandensuresconsistencyandreproducibilityofthetreatment.

Despitethepromisingresultsofultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapyforkneeosteoarthritis,therearesomelimitationstothisstudy.Firstly,thesamplesizeofthestudywasrelativelysmall,whichmayhavelimitedthegeneralizabilityoftheresults.Largerandmorediversesamplesareneededtofurtherverifytheefficacyandsafetyofthistreatmentapproach.Secondly,thestudydidnotincludeacontrolgroupthatreceivedaplacebotreatment,whichmakesitdifficulttoruleoutthepotentialplaceboeffect.Futurestudiesshouldincludeaplacebocontrolgrouptobetterevaluatethespecificeffectsofultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapy.

Insummary,ultrasoundmultimodaltechnology-basedacupuncturepointlocationandneedleknifetherapyisapromisingtreatmentoptionforkneeosteoarthritis.Itssignificantandlong-lastingefficacy,simplicity,safety,andpotentialeconomicbenefitsmakeitanattractivealternativetoconventionaldrugandsurgicaltherapies.However,morestudiesareneededtofullyevaluatetheeffectivenessandsafetyofthistreatmentapproach,andtooptimizethetreatmentprotocolandparametersKneeosteoarthritis(KOA)isacommondegenerativejointdiseasethataffectsalargeportionoftheelderlypopulationworldwide.Itischaracterizedbythelossofarticularcartilage,subchondralbonesclerosis,osteophyteformation,andsynovialinflammation,leadingtojointpain,stiffness,andfunctionalimpairment.Despitetheavailabilityofvariousconventionaltreatmentoptionssuchasnonsteroidalanti-inflammatorydrugs(NSDs),corticosteroids,hyaluronicacidinjections,andtotalkneereplacement(TKR)surgery,manypatientsstillsufferfrominadequatepainrelief,adversesideeffects,orhighcosts.Therefore,thereisagrowinginterestinexploringalternativeorcomplementarytherapiesforKOA,includingacupuncture.

Acupuncture,asanancientTraditionalChineseMedicine(TCM)technique,involvestheinsertionoffineneedlesintospecificpointsonthebodytostimulatetheenergyflowandbalanceofthebody.Ithasbeenwidelyusedforpainmanagementandrehabilitationofmusculoskeletaldisorders,includingKOA.However,thepreciselocationofacupuncturepoints,especiallyinobeseorhighlyvariableindividuals,remainsachallengeforacupuncturists,andmayaffectitsefficacyandreproducibility.

Toovercomethischallenge,ultrasound(US)multimodaltechnologyhasbeenappliedtoimprovetheaccuracyandprecisionofacupuncturepointlocationandneedleinsertion.TheUSimagingcanprovidereal-timevisualizationoftheunderlyinganatomy,suchasthejointspace,cartilagethickness,andsynovialfluid,andguidetheselectionanddepthoftheacupunctureneedles.Moreover,theUScanalsodeliverpulsedhigh-intensityfocusedultrasound(pHIFU)toenhancethepenetrationanddistributionoftheacupunctureneedlealongthetargetedtissuelayers,resultinginamoreefficientandeffectivetherapy.

InadditiontotheUS-guidedacupuncture,needleknifetherapy(NKT)hasbeencombinedtofurtheraugmentthetherapeuticeffectofacupunctureinKOA.NKT,alsoknownasthreadembeddingtherapy,involvestheinsertionofmultiplesmallneedlesconnectedbyathreadintothesubcutaneoustissueoverthetargetedacupoints,andthengentlytwistingandliftingthethreadtoinducemicrotraumaandpromotetissueregeneration.Ithasbeenshowntoimprovepain,function,andqualityoflifeinpatientswithKOA,withfeweradverseeventsthanconventionaltherapies.

SeveralclinicalstudieshaveinvestigatedtheefficacyandsafetyofUS-guidedacupuncturecombinedwithNKTforKOA,withpromisingresults.Forexample,arandomizedcontrolledtrial(RCT)involving90patientswithKOAshowedthattheUS-guidedacupunctureplusNKTgrouphadasignificantlygreaterdecreaseinpain,stiffness,andphysicalfunctionscores,andahigheroverallresponseratethanthecontrolgroupreceivingacupuncturealoneorNSDmedication.Similarly,anotherRCTinvolving80KOApatientsfoundthattheUS-guidedacupunctureplusNKTgrouphadasuperioranalgesiceffectandlongerdurationthanthegroupreceivingconventionalacupunctureorshamacupuncture.

Moreover,US-guidedacupuncturecombinedwithNKThasseveraladvantagesthatmakeitapotentialalternativetoconventionalKOAtherapies.Firstly,itcanachieveahighlevelofprecisioninacupointlocationandneedleinsertion,regardlessofpatientvariabilityorobesity.Secondly,itcanreducetheriskofadverseeventssuchasinfection,bleeding,ornerveinjury,byavoidingthevitalstructuresandensuringtheproperdepthandangleoftheneedles.Thirdly,itcaninducealong-lastingtherapeuticeffectbybothstimulatingthelocaltissuerepairandmodulatingthecentralpainprocessingmechanism.

Despitethesepromisingfindings,morestudiesareneededtooptimizethetreatmentprotocolandparametersofUS-guidedacupuncturecombinedwithNKTforKOA.Forexample,theoptimalfrequencyanddurationofthetreatment,thechoiceofacupointsandneedles,theselectionofpatientswithdifferentKOAstagesorseverity,andtheevaluationoflong-termoutcomesandcost-effectiveness.Inaddition,