透明质酸钠治疗髌骨软化症的疗效:52周前瞻性临床随访

目的观察采用髌骨下入路注射透明质酸钠（HA）治疗髌骨软化症（CP）的临床疗效。方法纳入诊断为CP的患者（n=88），根据影像学特点进行分组，表现为早期CP的纳入CP组（n=50），具备骨关节炎表现的纳入髌股关节炎组（n=38）。两组均采用髌骨下给药位点HA注射治疗，每周1次，连续用药5周。评估参数包括首要指标：记录给药前、给药后4、12、26、52周的WOMAC评分和Lequesne指数；次要指标：给药前、给药后1~4周的步行30 m用时、上下楼梯用时。结果两组的患者在给药后4、12、26、52周的WOMAC评分及Lequesne指数分别与各自的给药前相比均有显著改善（P<0.01）。两组之间比较，在给药前、给药后4、12 周的WOMAC评分及Lequesne 指数评分对比未见统计学差异（P>0.05）；但是，髌股关节炎组在给药后26 及52 周的WOMAC评分及Lequesne指数显著高于CP组（P<0.05）。两组的患者在给药后1、2、3、4周的步行30 m用时、上楼梯用时、下楼梯用时均显著改善（P<0.05）；而两组之间比较，未发现显著性差异（P>0.05）。结论采用髌骨下入路关节腔内注射HA治疗CP疗效显著。HA治疗早期CP的中远期疗效显著优于出现髌股关节炎的晚期CP。

Hyaluronate acid for treatment of chondromalacia patellae: a 52-week follow-up study

Objective To assess the therapeutic effect of hyaluronate acid (HA) injection through the subpatellar route fortreatment of chondromalacia patellae (CP). Methods Eighty-eight patients with the diagnosis of CP were enrolled in thisprospective study, including 38 with early CP (CP group) and 50 with advanced CP (patellofemoral arthritis group) diagnosedbased on image presentations. All the patients received intra-articular HA injections through a subpatellar route once a weekfor 5 consecutive weeks. The primary outcome measures included WOMAC index scores and Lequesne scores before and at 4,12, 26 and 52 weeks after the injections. The secondary outcome measures included the 30-m walking time and stair ascendingand descending time (one floor) before and at 1, 2, 3, and 4 weeks after the injections. Results In both groups the patientsshowed significantly decreased WOMAC scores and Lequesne scores at 4, 12, 26 and 52 weeks after HA injections as comparedwith the baseline scores (all P<0.01). No significant difference was found between the two groups in WOMAC scores andLequesne scores at 4 or 12 weeks after the injections (both P>0.05). The WOMAC scores and Lequesne scores at 26 and 52weeks after the injections were significantly higher in patellofemoral arthritis group than in CP group (both P<0.05). In bothgroups, the 30-m walking time and the stair ascending and descending time decreased significantly at 1, 2, 3, and 4 weeks afterHA injections (all P<0.05) without significant differences between the two groups (all P>0.05). Conclusion HA injectionthrough the subpatellar route is effective for treatment of CP. HA injection produces better long-term efficacy for treatment ofearly CP than for advanced CP where patellofemoral arthritis occurs.