筋膜链理论指导的冲击波预处理联合富血小板血浆注射治疗中早期膝骨关节炎的疗效观察：一项随机对照研究

Observation on the Efficacy of Shock Wave Pretreatment Guided by Fascia Chain Theory Combined with Platelet-Rich Plasma Injection in the Treatment of Early-to-Mid-Stage Knee Osteoarthritis: A Randomized Controlled Study

摘要: 目的：探讨基于筋膜链理论的体外冲击波(radial extracorporeal shockwave therapy, rESWT)预处理联合富血小板血浆(platelet-rich plasma, PRP)注射对膝骨关节炎(knee osteoarthritis, KOA)患者疼痛及关节功能的临床疗效。方法：将80例中重度KOA患者按随机数字表法分为观察组与对照组，每组40例。对照组仅接受关节腔内PRP注射治疗；观察组在PRP注射前接受基于筋膜链评估的rESWT治疗(每周1次，连续3周)。分别于治疗前及治疗后，采用视觉模拟评分(Visual Analogue Scale, VAS)、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC)、Berg平衡量表(Berg Balance Scale, BBS)、计时起立–行走测试(Timed Up and Go test, TUG)、膝关节活动度(range of motion, ROM)、测定60˚/s角速度下膝关节屈伸肌峰力矩值(PT)、总做功(TW)、屈/伸肌肌力比值(H/Q)进行评估。结果：治疗前，2组患者VAS评分、WOMAC评分、BBS评分、TUG评分、屈曲ROM比较，差异均无统计学意义(P > 0.05)；治疗后，2组患者VAS评分、WOMAC评分、TUG评分均低于治疗前，BBS评分及屈曲ROM高于治疗前，且观察组上述指标均优于对照组，差异均有统计学意义(P < 0.05)。治疗前，2组患者膝关节伸膝肌群PT、TW比较，差异均无统计学意义(P > 0.05)；治疗后，2组患者膝关节伸膝肌群PT、TW均高于治疗前，且观察组上述2指标均优于对照组，差异均有统计学意义(P < 0.05)。治疗前，2组患者膝关节屈膝肌群PT、TW比较，差异均无统计学意义(P > 0.05)；治疗后，2组患者膝关节屈膝肌群PT、TW均高于治疗前，且观察组上述2指标均优于对照组，差异均有统计学意义(P < 0.05)。治疗前，2组患者H/Q比较，差异均无统计学意义(P > 0.05)；治疗后，2组患者H/Q均低于治疗前，且观察组优于对照组，差异均有统计学意义(P < 0.05)。结论：以筋膜链理论为指导的rESWT预处理能有效缓解KOA患者疼痛，改善关节功能与平衡能力，增强PRP疗效，其作用机制可能与优化下肢力学链及调节疼痛–运动控制环路有关。

Abstract: Objective: To investigate the clinical efficacy of radial extracorporeal shockwave therapy (rESWT) preconditioning based on fascial chain theory, followed by intra-articular platelet-rich plasma (PRP) injection, for knee osteoarthritis (KOA). Methods: Eighty patients with moderate to severe KOA were randomly assigned to either the observation group (n = 40) or the control group (n = 40) using a random number table. The control group received PRP injection alone. The observation group received rESWT based on fascial chain assessment (once weekly for 3 weeks) prior to PRP injection. Before and after the treatment, evaluations were conducted using the Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), the range of motion (ROM) of the knee joint, the peak torque values of the knee flexion and extension muscles at 60˚/s (PT), total work (TW), and the ratio of flexor to extensor muscle strength (H/Q). Results: Before treatment, there were no statistically significant differences in VAS scores, WOMAC scores, BBS scores, TUG scores, and flexion ROM between the two groups (P > 0.05). After treatment, the VAS scores, WOMAC scores, and TUG scores of both groups were lower than those before treatment, while the BBS scores and flexion ROM were higher than those before treatment. Moreover, the above indicators in the observation group were better than those in the control group, and the differences were statistically significant (P < 0.05). Before treatment, there were no statistically significant differences in the PT and TW of the knee extensor muscles between the two groups (P > 0.05). After treatment, the PT and TW of the knee extensor muscles in both groups were significantly higher than those before treatment, and both indicators in the observation group were significantly better than those in the control group (all P < 0.05). Before treatment, there were no statistically significant differences in the PT and TW of the knee flexor muscles between the two groups (P > 0.05); after treatment, the PT and TW of the knee flexor muscles in both groups were significantly higher than those before treatment, and both indicators in the observation group were significantly better than those in the control group (all P < 0.05). Before treatment, there were no statistically significant differences in H/Q between the two groups (P > 0.05). After treatment, the H/Q of both groups was lower than that before treatment, and the observation group was better than the control group, and the differences were statistically significant (P < 0.05). Conclusion: rESWT preconditioning guided by fascial chain theory can effectively enhance the efficacy of PRP in treating KOA by optimizing the lower limb biomechanical chain and improving neuromuscular control, demonstrating a synergistic effect of “mechanical intervention-biological repair”. This integrated strategy provides a new approach for KOA rehabilitation.