观察针刺灸法联合运动疗法治疗膝关节前交叉韧带断裂后行关节镜下单纯前交叉韧带重建术后膝关节功能康复的临床研究。

选取2019年1月至2019年6月天津医院运动损伤与关节镜二病区门诊及病房收治的单纯前交叉韧带断裂的40例患者，采用随机数字表法分为观察组与对照组各20例，对照组予以运动疗法治疗，观察组在对照组治疗的基础上加以针刺及温和灸法治疗，术后第3周开始，每周5次，连续治疗6周。观察2组患者治疗前及治疗后第2、4、6周膝关节主动最大屈曲度、视觉模拟疼痛指数评估(VAS)、Lysholm膝关节功能评分及大、小腿健侧与患侧周径差值变化的情况。以上指标组间比较采用两独立样本t检验，组内治疗前后不同时间点比较采用重复测量的方差分析。

(1)观察组与对照组患者治疗前与治疗后第2、4、6周相比，2组患者的膝关节主动屈曲度、Lysholm评分随着治疗时间的增长均呈升高趋势，且同组各个时间点之间比较差异有统计学意义(F＝1 924.721、1 720.125，P均<0.05；F＝241.928、188.692，P均<0.001)。随着治疗时间的延长，2组组内VAS评分及大、小腿健侧与患侧的差值均呈逐渐降低趋势，且同组各个时间点之间比较差异均有统计学意义[F＝128.913、48.702，F(△1)＝205.625、109.898，F(△2)＝108.806、58.334，5，all P<0.001]。(2)观察组患者治疗后膝关节主动屈曲度、Lysholm评分在第2、4、6周的升高均优于对照组，差异有统计学意义(t＝4.172、5.489、4.645，P均<0.05；t＝5.434、6.213、4.756，P均<0.05)；观察组患者治疗后VAS评分在第2、4、6周的降低均优于对照组，差异有统计学意义(t＝-2.674、-5.570、-2.604，P均<0.05)；观察组患者治疗后大、小腿健侧与患侧周径差值在第2周的降低与对照组比较，差异无统计学意义(P均>0.05)，但在治疗后第4周和第6周大、小腿健侧与患侧周径差值的降低均优于对照组，差异有统计学意义[t(△1)＝-4.775、-5.659，P均<0.05；t(△2)＝-3.361、-3.773，P均<0.05]。

单纯运动疗法与针刺温和灸联合运动疗法对单纯前交叉韧带重建术后膝关节功能康复治疗均有改善作用，且针刺温和灸联合运动疗法优于单纯运动疗法。

To observe the efficacy of acupuncture-moxibustion combined with kinesitherapy in knee joint rehabilitation after arthroscopic simple reconstruction of anterior cruciate ligament (ACL) rupture.

Forty patients with simple anterior cruciate ligament rupture admitted to the outpatient clinic and ward of the Sports Injury and Arthroscopy Department II of Tianjin Hospital from January 2019 to June 2019 were selected and divided into 20 cases each in an observation group and a control group using the random number table method. The control group was treated with exercise therapy and the observation group was treated with acupuncture and mild-warm moxibustion on the basis of the treatment of the control group, starting from the 3rd week after surgery, 5 times a week for 6 weeks. Active maximum knee flexion, visual analogue scale (VAS), Lysholm knee function scores and change in circumference difference between the healthy and affected sides of the thigh and lower leg were observed before and at weeks 2, 4 and 6 after treatment in both groups. The above indicators were compared between groups using two independent samples t-test and within groups at different time points before and after treatment using repeated measures ANOVA.

(1) In the observation group and the control group, the active knee flexion and Lysholm scores tended to increase with the increase of treatment time, and there was a statistically significant difference between the time points of the same group (F=1 924.721, 1 720.125, all P<0.05; F=241.928, 188.692, all P<0.001). The VAS scores and the difference between the circumference of the healthy side and the affected side of the thigh and calf tended to decrease with the increase of treatment time. There was a statistically significant difference between the time points of the same group [F=128.913, 48.702, F(△1)=205.625, 109.898, F(△2)=108.806, 58.334, all P<0.001]; (2) The increase in active knee flexion and Lysholm scores at weeks 2, 4 and 6 after treatment was better in the observation group than in the control group, and the difference was statistically significant (t=4.172, 5.489, 4.645, all P<0.05; t=5.434, 6.213, 4.756, all P<0.05); the decrease in VAS scores at weeks 2, 4 and 6 after treatment was better in the observation group than in the control group, and the difference was statistically significant (t=-2.674, -5.570, -2.604, all P<0.05); the decrease in the difference between the circumference of the healthy side and the affected side of the thigh and calf at weeks 2 after treatment was not statistically significant in the observation group compared with the control group (P>0.05). But the reduction in the difference between the circumference of the healthy side and the affected side of the upper and lower legs at weeks 4 and 6 after treatment was better than that of the control group, and the difference was statistically significant [t(△1)=-4.775, -5.659, all P<0.05; t(△2)=-3.361, -3.773, all P<0.05].

Both simple exercise therapy and acupuncture-moxibustion combined with exercise therapy can improve the rehabilitation of knee joint function after anterior cruciate ligament reconstruction, and acupuncture-moxibustion combined with exercise therapy is better than simple exercise therapy.