伴OP的KOA患者TKA术前整体针联合运动处方临床应用的前瞻性研究及其对Wnt/β-catenin通路的影响

来源期刊：广州医药 | 19-25 发布时间：2024-01-10 收稿时间：2025/11/13 18:27:51 阅读量：76

作者：: 郑伟坤,

汤俊芬,

林国伟,

关键词：: 骨质疏松症膝骨关节炎整体针运动处方 Wnt/β-catenin通路; osteoporosis knee osteoarthritis holistic acupuncture exercise prescription Wnt/β-catenin pathway

DOI：: 10.3969/j.issn.1000-8535.2023.12.003

收稿时间：: 2023-08-21
修订日期：
接收日期：
引用总数：: 0

目的探索整体针联合运动处方应用于伴骨质疏松症（OP）的膝骨关节炎（KOA）患者全膝关节置换术（TKA）术前预康复的可行性、有效性及其对Wnt/β-catenin通路的影响。方法 2021年5月—2022年4月在广州市第一人民医院南沙医院骨科住院治疗的伴OP的KOA患者随机入组,分3组：A组予常规术前宣教和准备;B组在A组基础上,术前应用标准化运动处方3周;C组在A组基础上,术前联合应用整体针和运动处方3周。比较术前3周、术前1天、术后8周视觉模拟疼痛评分（VAS）、关节活动度（ROM）、膝关节功能评分（HSS）的组间差异,并比较术中关节液β连环蛋白（β-catenin）、基质金属蛋白酶-13（MMP-13）、重组人Dickkopf相关蛋白-1（DKK-1）含量的组间差异。结果共纳入50例受试者,A组15例,B组18例,C组17例。术前1天组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术后8周组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术中关节液标志物含量组间方差分析显示：B、C组β-catenin、MMP-13含量均低于A组（P<0.05）,C组β-catenin、MMP-13含量均低于B组（均P<0.05）;B、C组DKK-1含量均高于A组（均P<0.05）,C组DKK-1含量高于B组（P<0.05）。结论整体针联合运动处方在OP患者TKA术前应用切实可行,可有效缓解疼痛、改善功能。整体针可增强运动处方的正向预康复作用,其作用机制可能与Wnt/β-catenin通路调节有关。

Objective To explore the feasibility,effectiveness and impact on the Wnt/β-catenin pathway of combined holistic acupuncture and exercise prescription for preoperative rehabilitation in knee osteoarthritis（KOA）patients with osteoporosis（OP）undergoing total knee arthroplasty（TKA）．Methods KOA patients with OP were divided into three groups randomly：Group A received conventional preoperative education and preparation,Group B received standardized exercise prescription for three weeks additionally,Group C received combined holistic acupuncture and exercise prescription for three weeks additionally．Between-group differences in visual analogue scale（VAS）pain scores,range of motion（ROM）and knee joint function scores（HSS）were compared at 3 weeks preoperatively,1 day preoperatively and 8 weeks postoperatively．Differences in intraoperative joint fluid levels of β-catenin,MMP-13 and DKK-1 were also compared．Results A total of 50 participants were included,with 15 in Group A,18 in Group B and 17 in Group C．Baseline conditions were comparable among the three groups．One-day preoperative analysis showed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM was higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Groups B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Eight-week postoperative analysis revealed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM were higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Group B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Intraoperative joint fluid biomarker analysis showed that β-catenin and MMP-13 levels were lower in Groups B and C compared to Group A（P<0.05）,and β-catenin and MMP-13 levels were lower in Group C compared to Group B（P<0.05）．DKK-1 levels were higher in Groups B and C compared to Group A（P<0.05）,and DKK-1 level was higher in Group C compared to Group B（P<0.05）．Conclusions Combined holistic acupuncture and exercise prescription is feasible and effective for preoperative rehabilitation in TKA for KOA patients with OP．Holistic acupuncture enhances the positive pre-rehabilitation effect of exercise prescription,and its mechanism may be related to the regulation of the Wnt/β-catenin pathway．

1、 BULTINK I E M.Bone disease in connective tissue disease/systemic lupus erythematosus[J].Calcif Tissue Int,2018,102(5):575-591.

2、 HUYBRECHTS Y,MORTIER G,BOUDIN E,et al.WNT signaling and bone:lessons from skeletal dysplasias and disorders[J].Front Endocrinol,2020(11):165.

3、丁婷婷,江超,李季青,等.骨关节炎合并骨质疏松患者血清β-catenin、DKK-1和MMP-9的水平变化及其与临床指标的相关性[J].山西医科大学学报,2018,49(3):289-293.

4、丁小芬,周友龙,田明月,等.Wnt/β-catenin信号通路与膝关节骨性关节炎软骨代谢[J].中国老年学杂志,2022,42(23):5917-5921.

5、郭迪,高志攀,张亚平,等.针刺通过Wnt信号通路对绝经后骨质疏松骨折大鼠骨密度和骨代谢的作用研究[J].中国骨质疏松杂志,2023,29(3):349-355,384.

6、陶李,周颖,李卿卿,等.针刺联合骨痛组方熏蒸治疗糖尿病性骨质疏松症的临床观察[J].广州中医药大学学报,2023,40(5):1168-1172.

7、张冲,王开龙,周宾宾.缪刺法加cpm机治疗膝关节术后早期功能障碍的临床研究[J].中国伤残医学,2015(12):5-6.

8、陈志刚,董超,梁程亮,等.董氏奇穴巨刺法治疗膝骨关节炎[J].中医正骨,2014,26(11):12-14.

9、黄红. “左病治右”法临床运用概况[J].中医外治杂志,2006,15(5):54-56.

10、王文远. 平衡针灸学最新理论研究[J].中国中医药现代远程教育,2004,2(12):18-21.

11、 AYTEKIN E,SUKUR E,OZ N,et al.The effect of a 12 week prehabilitation program on pain and function for patients undergoing total knee arthroplasty:A prospective controlled study[J].J Clin Orthop Trauma,2019,10(2):345-349.

12、祁文静,杨延砚,周谋望.全膝关节置换术前康复的研究进展[J].中国康复医学杂志,2019,34(8):980-983.

13、雷玮,梁静娟,朱俞岚.术前预康复在老年全膝关节置换术患者中的应用研究[J].老年医学与保健,2021,27(5):966-968,986.

14、李敏清,张广清.术前功能锻炼对全膝关节置换患者术后康复效果影响的Meta分析[J].中国老年学杂志,2018,38(15):3676-3679.

15、 Al SALEH J,SAYED M E,MONSEF N,et a1.The prevalence and the determinants of musculoskeletal diseases in Emirates attending primary health care clinics in Dubai[J].Oman Med J,2016,31(2):117-123.

16、李埴,邓志博,李程程,等.骨关节炎与骨质疏松症的相互关系[J].中华骨质疏松和骨矿盐疾病杂志,2021,14(1):94-99.

17、黎迎春,黄健.依“治未病”理论用补肾强骨中药治疗糖尿病骨量减少妇女骨密度改善观察[J].中华中医药学刊,2016,34(4):996-999.

18、 FISCHER C R,VASUDEVA E,BEAUBRUN B,et al.Osteoporosis knowledge among spine surgery patients[J].Int J Spine Surg,2018,12(6):689-694.

19、郑伟坤,汤俊芬,肖文德,等.理念下中医透药联合整体针法在全膝关节置换围术期的应用[J].广州医药,2021,52(1):22-25.

20、 ANDERSON A M,COMER C,SMITH T O,et al.Consensus on preoperative total knee replacement education and pre-habilitation recommendations:a UK- based modified Delphi study[J].BMC Musculoskelet Disord,2021,22(1):352.

21、梁艳彩,崔健,杨旭,等.北京地区全膝关节置换术患者术前预康复实施现状及影响因素分析:多中心横断面调查研究[J].中华骨与关节外科杂志,2021,14(11):954-957.

22、 ZHANG X,YANG J,CHEN X,et al.Enhanced recovery after surgery on multiple clinical outcomes:umbrella review of systematic reviews and meta-analyses[J].Medicine(Baltimore),2020,99(29):e20983.

23、 SUGITANI K,ARAI Y,TAKAMIYA H,et al.Factors affecting range of motion after total knee arthroplasty in patients with more than 120 degrees of preoperative flexion angle[J].Int Orthop,2015,39(8):1535-1540.

24、张恒岩,崔立强,翁习生.影响全膝关节置换术疗效的术前因素分析[J].中华医学杂志,2016,96(17):1345-1348.

25、周宗科,翁习生,曲铁兵,等.中国髋、膝关节置换术加速康复--围术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(1):1-9.

26、徐健,王文志,范雪,等.男性骨关节炎与骨质疏松的相关性研究[J].四川大学学报(医学版),2023,54(2):439-443.