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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第24卷

期数:

2012年12期

页码:

23-26

栏目:

临床研究

出版日期:

2012-12-20

文章信息/Info

Title:

Curative effect of the method of articular cavity tidal irrigation combined with intra-articular injection of sodium hyaluronate and exercise therapy in the treatment of type fluidify knee osteoarthritis

作者:

何本祥

成都体育学院附属体育医院,四川 成都 610041

Author(s):

HE Ben-xiang^*

^*Sport Hospital Attached to Chengdu Sport University,Chengdu 610041,Sichuan,China

关键词:

骨关节炎; 膝 关节积水 灌洗 注射; 关节内 运动疗法 治疗; 临床研究性

Keywords:

Osteoarthritis; knee;  Hydrarthrosis;  Irrigation;  Injections; intra-articular;  Exercise therapy;  Therapies; investigational

摘要:

目的:探讨潮式关节腔冲洗、玻璃酸钠关节内注射联合运动疗法治疗积液型膝骨性关节炎的临床疗效。方法:103例积液型膝骨性关节炎患者,男32例,女71例; 年龄41～82岁,中位数65岁; 病程2个月至30年,中位数4年; 左侧37例,右侧49例,双侧17例。依据Lequesne-Mery膝骨性关节炎严重度评价指数评价临床严重程度:轻度18例19膝,中度37例46膝,重度48例55膝。按就诊顺序随机分为2组。治疗组53例60膝,男15例,女38例; 左侧21例,右侧25例,双侧7例; 采用潮式关节腔冲洗、玻璃酸钠关节内注射联合运动疗法治疗。对照组50例60膝,男17例,女33例; 左侧16例,右侧24例,双侧10例; 采用关节积液抽吸加玻璃酸钠关节内注射治疗。观察2组患者患膝疼痛、功能及积液改善情况,并对综合疗效进行比较。结果:治疗前2组患者患膝疼痛评分(30.41±8.70,30.83±8.64)、功能评分(25.92±4.83,26.17±4.82)、积液评分(3.42±2.35,3.33±2.38)比较,差异无统计学意义(t=-0.263,P=0.793; Z=-0.367,P=0.714; Z=-0.194,P=0.846); 治疗3个月后,2组患者患膝疼痛评分(45.67±8.31,40.58±8.88)、关节功能评分(32.33±4.06,30.08±4.46)、积液评分(9.50±1.51,7.83±2.50)比较,差异有统计学意义(Z=-3.450,P=0.001; Z=-3.052,P=0.002; Z=-4.111,P=0.000); 且治疗组患膝疼痛、功能、积液改善(15.25±3.95,6.42±2.78,6.08±2.08)优于对照组(9.75±3.11,3.92±2.62,4.50±1.51),差异有统计学意义(Z=-6.851,P=0.000; Z=-4.623,P=0.000; Z=-4.394,P=0.000)。治疗组治愈15例15膝,显效28例32膝,有效7例9膝,无效3例4膝; 对照组治愈5例5膝,显效12例14膝,有效16例20膝,无效17例21膝; 治疗组综合疗效优于对照组( 治疗组=0.373, 对照组=0.627; Z=-4.819,P=0.000)。103例患者均获随访,随访时间1～3年,中位数18个月; 治疗组复发5例6膝,对照组复发32例38膝,治疗组复发率低于对照组(χ2=36.746,P=0.000)。复发患者均再次采用潮式关节腔冲洗、玻璃酸钠关节内注射联合运动疗法治疗1～2次(每次间隔6个月),其中治疗组1例2膝、对照组2例3膝辅以糖皮质激素关节腔注射治疗,症状均缓解。结论:潮式关节腔冲洗、玻璃酸钠关节内注射联合运动疗法治疗积液型膝骨性关节炎可有效缓解症状、改善关节功能、促进关节积液的吸收,疗效满意。

Abstract:

Objective:To explore the clinical curative effect of the method of articular cavity tidal irrigation combined with intra-articular injection of sodium hyaluronate and exercise therapy in the treatment of type fluidify knee osteoarthritis(KOA).Methods:One hundred and three type fluidify KOA patients were analyzed,male 32 cases,while female 71 cases; ranging in age from 41 to 82 years with a median of 65 years; ranging in courses of disease from 2 months to 30 years with a median of 4 years; 37 cases on left side,49 cases on right side and 17 cases on both sides.Clinical severity was evaluated according to Lequesne-Mery severity evaluation index of KOA and the results showed mild in 19 knees of 18 cases,medium in 46 knees of 37 cases and severe in 55 knees of 48 cases.The patients were randomly divided into 2 groups according to examining sequence.Fifty-three patients(60 knees)were divided into the treatment group,male 15 cases,while female 38 cases; 21 cases on left side,25 cases on right side and 7 cases on both sides; and they were administrated with the method of articular cavity tidal irrigation combined with intra-articular injection of sodium hyaluronate and exercise therapy.Fifty cases(60 knees)were divided into the control group,male 17 cases,while female 33 cases; 16 cases on left side,24 cases on right side and 10 cases on both sides; and they were administrated with the joint effusion suction combined with intra-articular injection of sodium hyaluronate.The extent of relief of pain,improvement of function and decrease of effusion in the sick knees and the comprehensive curative effects were compared between the 2 groups.Results:There were no statistical differences in pain scores(30.41±8.70,30.83±8.64),function scores(25.92±4.83,26.17±4.82)and effusion scores(3.42±2.35,3.33±2.38)of the sick knees between the 2 groups respectively before the treatment(t=-0.263,P=0.793; Z=-0.367,P=0.714; Z=-0.194,P=0.846).There were statistical differences in pain scores(45.67±8.31,40.58±8.88),function scores(32.33±4.06,30.08±4.46)and effusion scores(9.50±1.51,7.83±2.50)of the sick knees between the 2 groups respectively after treatment of 3 months(Z=-3.450,P=0.001; Z=-3.052,P=0.002; Z=-4.111,P=0.000); and the patients in the treatment group got better outcomes in relief of pain,improvements of function and decrease of effusion in sick knees(15.25±3.95,6.42±2.78,6.08±2.08),compared with those in the control group(9.75±3.11,3.92±2.62,4.50±1.51),and there was statistical difference between them(Z=-6.851,P=0.000; Z=-4.623,P=0.000; Z=-4.394,P=0.000).Fifteen knees of 15 patients got excellent results,32 knees of 28 cases good,9 knees of 7 cases fair and 4 knees of 3 cases invalid in treatment group; while 5 knees of 5 patients got excellent results,14 knees of 12 cases good,20 knees of 16 cases fair and 21 knees of 17 cases invalid in control group; and the comprehensive curative effect of treatment group was better than that of the control group(treatment group=0.373,control group=0.627; Z=-4.819,P=0.000).One hundred and three patients were all followed up of 1-3 years with a median of 18 months.Six knees of 5 cases with relapse were found in the treatment group,while 38 knees of 32 cases with relapse were found in the control group,and the relapse rate of the treatment group was lower than that of the control group(χ2=36.746,P=0.000).All of the patients with relapse obtained further articular cavity tidal irrigation combined with intra-articular injection of sodium hyaluronate and exercise therapy for one or two times(interval of 6 months),and 2 knees of 1 patient in the treatment group and 3 knees of 2 patients in the control group were assistantly administrated with intra-articular injection of glucocorticosteroids,and their symptoms were all released.Conclusion:The method of articular cavity tidal irrigation combined with intra-articular injection of sodium hyaluronate and exercise therapy can effectively release the symptoms,improve the joint functions and promote the suction of joint effusion in the treatment of type fluidify KOA,and it has satisfied curative effect.

备注/Memo

备注/Memo:

基金项目:四川省科学技术厅课题(2008SZ0239)

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更新日期/Last Update: 2012-12-20