体外冲击波联合玻璃酸钠注射治疗膝关节骨关节炎的疗效观察

目的 探讨体外冲击波联合玻璃酸钠注射疗法治疗膝关节骨关节炎(KOA)的疗效。方法 前瞻性研究山东省立第三医院骨科2015年6月—2017年6月240例KOA患者,采用随机数字表法分成A、B、C三组,每组80例。A组采用玻璃酸钠注射治疗,B组采用体外冲击波治疗,C组采用体外冲击波联合玻璃酸钠注射治疗。对三组患者治疗前和治疗后第1、3、5周,采用视觉模拟评分(VAS)、Lequesne指数评分和西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分进行疗效评定,并进行组间比较。结果 治疗后第1、3、5周各组的VAS、Lequesne指数评分、WOMAC关节炎指数评分均依次降低,经配对分析显示,均低于治疗前,差异均有统计学意义(P值均＜0.05)。三组患者相同时间点的VAS、 Lequesne指数评分和WOMAC骨关节炎指数评分比较,差异均有统计学意义(P值均＜0.05);C组治疗前VAS为(8.59±0.98)分、Lequesne指数评分为(10.55±2.15)分、WOMAC骨关节炎指数评分为(35.58±10.13)分,治疗后第1、3、5周VAS分别为(5.51±0.63)分、(3.39±0.51)分、(1.57±0.12)分,Lequesne指数评分分别是(8.13±2.15)分、(7.01±2.03)分、(5.05±2.11)分,WOMAC骨关节炎指数评分分别为(28.45±9.48)分、(20.38±8.64)分、(14.85±5.45)分,疗效均优于A组及B组,差异均有统计学意义(P值均＜0.05)。结论 体外冲击波联合玻璃酸钠注射治疗KOA具有协同作用,能进一步缓解疼痛,建议临床推广和应用。

Therapeutic efficacy of extracorporeal shock wave therapy combined with sodium hyaluronate injection on knee osteoarthritis

Objective To investigate the therapeutic efficacy of extracorporeal shock wave therapy combined with sodium hyaluronate injection on knee osteoarthritis(KOA).Methods Prospective study of 240 patients with knee osteoarthritis from June 2015 to June 2017 in Department of Orthopedics, Shandong Provincial Third Hospital. The 240 patients were randomly assigned to group A (n=80), group B (n=80), group C (n=80). Group A was treated with sodium hyaluronate injection, group B was treated with extracorporeal shock wave therapy, while the group C was given extracorporeal shock wave therapy combined with sodium hyaluronate injection on knee osteoarthritis. They were evaluated with visual analog scale (VAS), the Lequesne index score and Western Ontario and McMaster College(WOMAC) osteoarthritis index before the intervention and at the 1st, 3rd, 5th week after the intervention.Results All patient’s VAS, Lequesne Index score and WOMAC Osteoarthritis Index were decrease in turn at the 1st, 3rd and 5th week after treatment, and were all lower than that before treatment by paired t test (all P values <0.05). All observed indexes were compared with the three groups at the same time point, and the differences were statistically significant (all P values <0.05). In group C, the VAS score before treatment was (8.59±0.98)points, the Lequesne index score was (10.55±2.15)points, and the WOMAC osteoarthritis index score was (35.58±10.13)points. The score of VAS was (5.51±0.63)points, (3.39±0.51)points, (1.57±0.12)points at the 1st, 3rd and 5th weeks after the treatment respectively. The score of Lequesne index was (8.13±2.15)points, (7.01±2.03)points, (5.05±2.11)points, while the WOMAC index score of bone and osteoarthritis was (28.45±9.48)points, (20.38±8.64)points, (14.85±5.45)points respectively. Statistically, group C was significantly better than group A and group B (all P values＜0.05).Conclusionse Synergistic action exits between the extracorporeal shock wave therapy and the sodium hyaluronate injection on KOA. It can further relieve the pain furthermore. This combined therapy is worth popularizing and applying in clinic.