膝关节镜微创术后臭氧配合玻璃酸钠关节腔内注射治疗中重度单膝关节骨性关节炎78＇f~lJ短期疗效观察

目的 观察膝关节镜微创术后臭氧（O3）配合玻璃酸钠（SH）关节腔内注射治疗中重度单膝关节骨性关节炎（OA）的临床疗效并探讨其机理.方法 回顾性分析216例行膝关节镜微创术后中重度单膝关节OA患者的临床资料,按术后辅助治疗策略分为联合治疗组 （O3 ＋SH） 78例、O3组66例及SH组72例.采用WOMAC骨关节炎指数评分评估三组治疗前及治疗后30d、90d及180d的临床疗效.结果 治疗30d后,与O3组和SH组比较,联合治疗组WOMAC总分、疼痛评分均显著降低（P均〈0.01）;O3组僵直评分较SH组显著降低（P〈0.01）,但与联合治疗组比较无显著差异（P〉0.05）;而三组间功能丧失评分无显著差异（P〉0.05）.治疗90d后,与O3组和SH组比较,联合治疗组WOMAC总分、疼痛评分、功能丧失评分均显著降低（P均〈0.01）;与SH组比较,O3组疼痛评分、僵直评分显著降低（P均〈0.01）;联合治疗组僵直评分也较SH组显著降低（P〈0.01）,但联合治疗组和O3组僵直评分无显著差异;而SH组功能丧失评分较O3组显著降低（P〈0.05）.治疗180d后,与O3组和SH组比较,联合治疗组WOMAC总分、疼痛评分、僵直评分、功能丧失评分均显著降低（P均〈0.01）;与SH组比较,O3组僵直评分显著降低（P〈0.01）.结论 膝关节镜微创术后对中重度单膝关节OA患者进行关节腔内O3配合SH注射治疗能尽早显著减轻患者膝部疼痛、改善膝关节整体功能,提高关节活动度,改善预后,远期获益显著.

Contribution of Intra-articular Injection of Oxygen-Ozone and Sodium Hyaluronate for the Treatment of 78 Patients with Moderate to Severe Knee Osteoarthritis after Arthroscope

Objective To determine the cooperative effect of intra-articular injection of oxygen-ozone and sodium hyaluronate for the treatment of 78 patients with moderate to severe knee osteoarthritis after arthroscope and explore its mechanism. Methods Clinical records of 216 cases with moderate to severe knee osteoarthritis after arthroscope in Foshan Hospital of TCM affiliated to Guangzhou University of TCM from November 2007 to April 2010 were retrospectively reviewed.AU patients were randomly divided into cooperative treatment group,O3 group and SH group according the different strategy.Knee arthroscope was performed to all patients before observation.Intra-articular injection of oxygen-ozone and sodium hyaluronate was applied in cooperative treatment group,and oxygen-ozone and sodium hyaluronate were respectively injected in 03 group and SH group.Clinical outcomes were evaluated by using Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC） score at 30-day,90-day and 180-day after treatment. Results Compared with 03 group and SH group, global and pain scores in cooperative treatment group significantly decreased at 30-day after treatment（all P〈0.01）.Stiff scores in 03 group markedly decreased than SH group（P〈0.01）.However, there was no significant difference regarding functional disability scores in 3 groups.Global,pain and functional disability scores in cooperative treatment group significantly decreased at 90-day after treatment in comparison with 03 group and SH group（all P〈0.01）.Both of pain and stiffness scores in O3 group were markedly lower than SH group at 90-day after treatment（all P〈0.01）. And stiffness scores in cooperative treatment group were markedly lower than SH group as well（P〈0.01） but no significant difference between cooperative treatment group and 03 group.Moreover, functional disability scores in SH group were markedly declined compared to 03 group at 90-day after treatment（P〈0.05）.Global,pain, stiffness and functional disability scores in cooperative treatment group significantly decreased at 180-day after treatment in comparison with O3 group and SH group（all P〈0.01）.Additionally, stiffness scores in O3 group were markedly lower than SH group at 180-day after treatment（P〈0.01）. Conclusions Intra-articular injection of oxygen-ozone and sodium hyaluronate has a cumulative effect that enhances the overall outcome of treatment for moderate to severe knee osteoarthritis.It is beneficial to improving joint function, stiffness and range of motion, and seems to be a viable option as an adjunct after arthroscope even to more conventional treatment modalities.