不同综合疗法对老年性重度膝骨关节炎的临床观察

目的比较关节腔注射玻璃酸钠和复方倍他米松复合口服草乌甲素片或双氯芬酸钠治疗老年性重度膝骨关节炎(KOA)的疗效。方法从580例KOA患者中选择程度为重度关节炎的患者60例，分为草乌甲素组和双氯芬酸钠组，每组各30例。两组均采用膝关节内注射玻璃酸钠和复方倍他米松，每周1次，5次为1个疗程。另外，草乌甲素组还口服草乌甲素片；双氯芬酸钠组还口服双氯芬酸钠片。根据Tegner的膝关节功能评价标准进行综合评价疗效，并比较两组副作用。结果两组患者膝关节功能综合评分较治疗前显著提高，治疗后显效率达80％以上，疼痛明显缓解(P<0.01)；两组间疗效无显著性差异；但是草乌甲素组患者胃肠道反应的发生率明显低于双氯芬酸钠组(P＜0.01)。结论关节腔注射玻璃酸钠和复方倍他米松复合口服草乌甲素片的综合治疗方法对老年性重度关节炎的疗效确切，副作用少、安全性高。

Effect of Multimodal Therapeutic Measures on Severe Knee Osteoarthritis in the Old

ObjectiveTo observe clinical efficacy of intra-articular injection of sodium hyaluronate(SH) and betamethasone accompanied with Bulleyaconitin A or diclofenac sodium administration for severe knee osteoarthritis(KOA).Methods60 patients with severe KOA from 580 subjects with KOA were selected as observational subjects in the experiment. All patients were treated by intra-articular injection of sodium hyaluronate 2.5 ml and betamethasone administration once a week for five consecutive weeks as a therapeutic course, betamethasone only once. Bulleyaconitin A group was accompanied with Bulleyaconitin A 0.4 mg, t.i.d, p.o.; diclofenac sodium group was accompanied with diclofenac sodium 75 mg, b.i.d, p.o. According to knee joint comprehensive score table (Tegner rating systems), the function comprehensive scores for all the patients pre-treatment and post-treatment knee joints were assessed.ResultsThe function comprehensive scores improved significantly after treatment in two groups(P＜0.001). The side effects in Bulleyaconitin A group decreased significantly than in diclofenac sodium group(P＜0.01).ConclusionThe intra-articular injection of SH and betamethasone accompanied with Bulleyaconitin A administration was an effective and less side-effect therapeutic measure for the treatment of knee osteoarthritis, especially for the old patients with severe knee osteoarthritis.