不同剂量体外冲击波治疗膝骨性关节炎近期疗效比较

目的]比较不同能流密度的体外冲击波治疗(ESWT)早中期膝关节骨性关节炎(KOA)的近期临床疗效,探索最佳ESWT治疗剂量。方法]将150个患有骨性关节炎的膝关节分为A、B、C、D、E五组,均使用ESWT治疗4周,各组的能流密度分别为0.06、0.10、0.14、0.18、0.22 mJ/mm^2。分别在治疗前、治疗后1个月及治疗后12个月,进行肢体活动疼痛视觉模拟评分(VAS评分)、Lysholm评分和WOMAC骨关节炎指数评分评价临床疗效。结果]按时间点比较,各组VAS和WOMAC评分治疗前最高,治疗后1个月降至最低,而在治疗后12个月再次升高(P<0.05),然而,各组Lysholm评分治疗前最低,治疗后1个月最高,治疗后12个月再次降低(P<0.05)。按组间比较观察,治疗前各组患膝的VAS、Lysholm和WOMAC评分差异无统计学意义(P>0.05)。治疗1个月后和治疗12个月后,VAS与WOMAC评分由低到高依次为:D组C组>B组>E组>A组,组间差异有统计学意义(P<0.05)。结论]中低能量的ESWT能有效地缓解早中期KOA患者的疼痛症状并改善关节功能,采用能流密度为0.18 mJ/mm^2,近期临床疗效最佳。

Comparison of early clinical outcomes of extracorporeal shock wave therapy in different energy flux densities for moderate knee osteoarthritis

Objective]To explore the best dosage of extracorporeal shock wave therapy(ESWT)for moderate knee osteoarthritis by comparison of the short-term clinical outcomes with different energy flux density of ESWT.Methods]A total of 150 knees with moderate osteoarthritis were included into this study,and divided equally into five groups,the A,B,C,D and E groups,which received ESWT for 4 weeks with the energy flux density of 0.06 mJ/mm^2,0.10 mJ/mm^2,0.14 mJ/mm^2,0.18 mJ/mm^2 and 0.22 mJ/mm^2 respectively.The visual analogue scale(VAS)for knee pain,Lysholm score and WOMAC osteoarthritis index score were used to evaluate the clinical conditions before treatment,1 month and 12 months after treatment.Results]In term of comparison among time points,the VAS and WOMAC score were at the highest before treatment,significantly declined to the lowest at 1 month after treatment,and then rose again to the middle at 12 months,conversely,the Lysholm scores were at the lowest before treatment,significantly increased to the highest at 1 month after treatment,and decreased again to the middle at 12 months after treatment in all the 5 groups,which were of statistical significance(P<0.05).Although no statistically significant differences were noticed regarding the VAS,Lysholm and WOMAC scores among the 5 groups before treatment(P>0.05),the VAS and WOMAC scores ranked down-up as D groupC group>B group>E group>A group,with statistical differences among the 5 groups at 1 month and 12 months after treatment(P<0.05).Conclusion]The ESWT in medium and low energy flux density do effectively relieve pain and improve joint function for moderate knee osteoarthritis.By comparison,the energy flux density of 0.18 mJ/mm^2 is the best dosage of ESWT for moderate knee osteoarthritis.