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目的:评价推拿手法结合马裆势练习治疗膝骨关节炎(KOA)的疗效,以优化组合方案.方法:采用2×2析因设计,将120例符合纳入标准的KOA患者随机分为手法组(A1B2组),手法结合马裆势组(A1B1组),坐位调膝组(A2B2组)和坐位调膝结合马裆势组(A2B1组),每组30例.患者每周干预3次,持续4周.主要疗效评价指标为西安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分(包括疼痛、僵硬、日常功能3项评分和总分),次要疗效评价指标为步态分析(包括步长、步幅、步速和膝关节屈曲角度)和等速肌力测试(60°/s和180°/s角速度下的屈肌和伸肌峰力矩).结果:四组WOMAC疼痛、僵硬、日常功能3项评分和总分治疗前后组内差异均具有统计学意义(P<0.05).四组治疗后WOMAC僵硬评分有统计学差异(P<0.05).A1B1组治疗前后步长、步幅、步速及膝关节屈曲角度的差异有统计学意义(P<0.05);A1B2组治疗前后步长具有统计学差异(P<0.05),A2B1组治疗前后步速具有统计学差异(P0.05).A1B2组治疗前后180°/s角速度伸肌峰力矩有统计学差异(P0.05).手法主效应对于WOMAC疼痛评分及总分的改变有统计学意义(P<0.05);马裆势练习主效应对WOMAC疼痛和僵硬评分的改变具有统计学意义(P<0.05).结论:四种治疗方案均可以改善KOA症状,如缓解疼痛和僵硬,增强日常功能.A2B1组关节僵硬减轻效果最佳.手法治疗和马裆势练习在缓解疼痛方面都起主效应作用.马裆势练习在减轻关节僵硬方面起主效应作用.“,”Objective: To evaluate the efficacy of Tuina (Chinese therapeutic massage) manipulation plus horse-riding squat exercise in treating knee osteoarthritis (KOA) and optimize the combining protocol. Methods: Based on a 2×2 factorial design, 120 eligible KOA patients were randomized into a manipulation group (group A1B2), a manipulation plus horse-riding squat group (group A1B1), a sitting knee-adjustment group (group A2B2 group), and a sitting knee-adjustment plus horse-riding squat group (group A2B1), with 30 cases in each group. The intervention was conducted three times a week, lasting for four weeks. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was taken as the major measure for efficacy evaluation (including three component scores, pain, stiffness, and daily function, and total score). Results: The three component scores (pain, stiffness, and daily function) and the total score of WOMAC showed significant differences after the intervention in the four groups (P<0.05). There were significant inter-group differences in the WOMAC stiffness score amongst the four groups after the intervention (P<0.05). In group A1B1, the step length, stride, walking speed, and knee joint flexion angle changed significantly after treatment (P<0.05). After the intervention, the step length changed significantly in group A1B2 (P<0.05), and the walking speed changed significantly in group A2B1 (P0.05). The extensor peak torque at 180 °/s changed significantly in group A1B2 after treatment (P0.05). The main effect of manipulation showed significant in affecting the WOMAC pain and total scores (P<0.05). The main effect of horse-riding squat exercise showed significant in affecting the WOMAC pain and stiffness scores (P<0.05). Conclusion: The four treatment protocols all can improve the symptoms of KOA, for instance, relieving pain and stiffness, and enhancing daily function. Group A2B1 produces the most eminent effect in relieving joint stiffness. The main effects of both manipulation and horse-riding squat exercise are significant in reducing pain. Besides, the main effect of horse-riding squat exercise is significant in relieving joint stiffness.