[1]李腾辉,陈民.玻璃酸钠膝关节腔注射联合骨瓜提取物穴位注射治疗Kellgren- Lawrence Ⅲ、Ⅳ级膝骨关节炎的临床研究[J].中医正骨,2016,28(04):12-15.
　LI Tenghui,CHEN Min.Clinical study on intra-articular injection of sodium hyaluronate combined with acupoint injection of Gugua extracts for treatment of Kellgren-Lawrence gradeⅢandⅣknee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(04):12-15.
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玻璃酸钠膝关节腔注射联合骨瓜提取物穴位注射治疗Kellgren- Lawrence Ⅲ、Ⅳ级膝骨关节炎的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年04期
页码:
12-15
栏目:
临床研究
出版日期:
2016-04-20

文章信息/Info

Title:
Clinical study on intra-articular injection of sodium hyaluronate combined with acupoint injection of Gugua extracts for treatment of Kellgren-Lawrence gradeⅢandⅣknee osteoarthritis
作者:
李腾辉; 陈民
广东省人民医院,广东 广州 510080
Author(s):
LI Tenghui; CHEN Min
Guangdong Provincial People's Hospital,Guangzhou 510080,Guangdong,China
关键词:
骨关节炎; 膝;  注射; 关节内;  透明质酸;  骨瓜提取物;  水针;  临床试验
Keywords:
osteoarthritis; knee;  injections; intra-articular;  hyaluronic acid;  Gugua extracts;  hydro-acupuncture;  clinical trial
摘要:
目的:观察玻璃酸钠膝关节腔注射联合骨瓜提取物穴位注射治疗Kellgren-Lawrence Ⅲ、Ⅳ级膝骨关节炎(knee osteoarthritis,KOA)的临床疗效及安全性。方法:将80例Kellgren-Lawrence Ⅲ、Ⅳ级单侧KOA患者随机分为联合治疗组和玻璃酸钠组,每组40例。2组患者均行膝关节腔玻璃酸钠注射治疗,联合治疗组在此基础上行骨瓜提取物穴位注射治疗。玻璃酸钠膝关节腔注射和骨瓜提取物穴位注射治疗均每周1次,连续治疗5次。采用KOA治疗效果判定标准(JOA)从步行能力、上下楼梯能力、膝关节活动情况、膝关节肿胀情况4个方面评定临床疗效,并观察治疗期间2组患者不良反应的发生情况。结果:所有患者均顺利完成治疗,均未发生严重不良反应。治疗前2组患者的步行能力、上下楼梯能力、膝关节活动情况、膝关节肿胀情况评分比较,组间差异均无统计学意义[(19.000±5.570)分,(18.500±5.454)分,t=0.539,P=0.593;(11.000±5.089)分,(10.875±5.417)分,t=0.374,P=0.711;(21.375±6.404)分,(20.875±5.534)分,t=1.160,P=0.253;(5.250±2.762)分,(5.625±2.579)分,t=-1.356,P=0.183]。治疗结束后2组患者的步行能力评分和上下楼梯能力评分均提高(t=-9.844,P=0.000; t=-11.590,P=0.000; t=-14.811,P=0.000; t=-13.432,P=0.000),联合治疗组的评分均高于玻璃酸钠组[(24.625±4.986)分,(22.375±4.934)分,t=3.635,P=0.002;(18.500±4.696)分,(17.000±4.777)分,t=3.122,P=0.003]。治疗结束后2组患者的膝关节活动情况均无明显改善(t=-1.862,P=0.070; t=-0.710,P=0.482); 2组治疗结束后的膝关节活动评分比较,差异无统计学意义[(22.250±6.883)分,(21.500±5.905)分,t=0.813,P=0.421]。治疗结束后2组患者的膝关节肿胀评分均较治疗前提高(t=-3.122,P=0.003; t=-2.082,P=0.044); 2组治疗结束后的膝关节肿胀评分比较,差异无统计学意义[(6.250±2.193)分,(6.125±2.399)分,t=0.443,P=0.660]。结论:玻璃酸钠膝关节腔注射联合骨瓜提取物穴位注射可有效减轻Kellgren-Lawrence Ⅲ、Ⅳ级KOA患者的膝关节肿胀和日常活动时的疼痛程度,改善日常活动能力,具有较高的安全性,但对于患者的膝关节活动度改善无明显作用,在减轻患者日常活动时疼痛方面的疗效优于单纯玻璃酸钠膝关节腔注射治疗。
Abstract:
Objective:To observe the clinical curative effect and safety of intra-articular injection of sodium hyaluronate combined with acupoint injection of Gugua(骨瓜)extracts for treatment of Kellgren-Lawrence gradeⅢandⅣknee osteoarthritis(KOA).Methods:Eighty patients with Kellgren-Lawrence gradeⅢorⅣunilateral KOA were randomly divided into combination therapy group and sodium hyaluronate group,40 cases in each group.The sodium hyaluronate were injected into the knee joint cavity of patients in both of the 2 groups,meanwhile,the Gugua extracts were injected into acupuncture points of patients in combination therapy group.The intra-articular injection of sodium hyaluronate and acupoint injection of Gugua extracts were performed once a week for consecutive 5 times.Walking ability,stair ambulation ability,knee joint motion and knee swelling were evaluated and used as the measure of curative effects according to therapeutic effect criterion of KOA made by Japanese orthopaedic association,and the adverse reactions were observed during the treatment period.Results:The treatment were finished successfully in all the patients and no severe adverse reactions were found.There was no statistical difference in walking ability,stair ambulation ability,knee joint motion and knee swelling between the 2 groups before the treatment(19.000+/-5.570 vs 18.500+/-5.454 points,t=0.539,P=0.593; 11.000+/-5.089 vs 10.875+/-5.417 points,t=0.374,P=0.711; 21.375+/-6.404 vs 20.875+/-5.534 points,t=1.160,P=0.253; 5.250+/-2.762 vs 5.625+/-2.579 points,t=-1.356 P=0.183).The scores of walking ability and stair ambulation ability increased in both of the 2 groups after the end of the treatment(t=-9.844,P=0.000; t=-11.590,P=0.000; t=-14.811,P=0.000; t=-13.432,P=0.000),and the scores were higher in combination therapy group compared to sodium hyaluronate group(24.625+/-4.986 vs 22.375+/-4.934 points,t=3.635,P=0.002; 18.500+/-4.696 vs 17.000+/-4.777 points,t=3.122,P=0.003).No significant improvement were found in the knee joint motion in both of the 2 groups after the end of the treatment(t=-1.862,P=0.070; t=-0.710,P=0.482).There was no statistical difference in the scores of knee joint motion between the 2 groups after the end of the treatment(22.250+/-6.883 vs 21.500+/-5.905 points,t=0.813,P=0.421).The knee joint swelling scores increased in both of the 2 groups after the end of the treatment(t=-3.122,P=0.003; t=-2.082,P=0.044)and there was no statistical difference in the knee joint swelling scores between the 2 groups(6.250+/-2.193 vs 6.125+/-2.399 points,t=0.443,P=0.660).Conclusion:In treatment of Kellgren-Lawrence gradeⅢandⅣKOA,the therapy of intra-articular injection of sodium hyaluronate combined with acupoint injection of Gugua extracts can effectively reduce knee swelling and knee pain during daily activities,and improve daily locomotor activity with high safety,however,it has no significant effect on improvement of knee joint motion.It surpasses the monotherapy of knee intra-articular injection of sodium hyaluronate in relieving the knee pain during daily activities.

参考文献/References:

[1] Kellgren JH,Lawrence JS.Radiological assessment of osteo-arthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[2] Wilder E,Flanagan R,Strauss E,et al.BMI,age,radiographic severity and ultrasound guidance impact the response to hyaluronic acid injections in knee osteoarthritis[J].Osteoarthritis & Cartilage,2015,23:A405-A406.
[3] Altman R,Asch E,Bloch D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis Rheum,1986,29(8):1039-1049.
[4] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:203-204.
[5] 张董喆.玻璃酸钠结合功能锻炼对膝关节骨性关节炎的疗效[J].实用医学杂志,2013,29(18):2994-2995.
[6] 陈民,李腾辉,李嘉,等.鹿瓜多肽注射液穴位注射治疗老年膝关节骨关节炎临床疗效观察[J].实用医学杂志,2009,25(8):1291-1292.
[7] 李艺彬,吴昭克,朱勇.针灸治疗膝骨性关节炎临床研究现状[J].中医正骨,2013,25(2):74-75.
[8] 苏泉,鲁光钱.针刺配合关节腔注射和中药内服治疗膝骨关节炎53例[J].中医正骨,2014,26(5):35-36.
[9] 张蓉,李峰,李珩,等.膝关节骨性关节炎针灸治疗选穴特点及分析[J].中国康复医学杂志,2007,22(4):357-358.
[10] 薛玲.骨瓜提取物注射液临床疗效观察[J].西北药学杂志,2008,23(3):174.
[11] 陈晓波,李丽.骨瓜提取物注射液促进骨折愈合的疗效观察[J].中国药业,2011,20(3):73-74.
[12] 蔡志琴,周福永,陈晨.60例骨瓜提取物注射剂不良反应文献分析[J].中国药房,2014,25(15):1419-1421.

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通讯作者:李腾辉 E-mail:50403092@qq.com
更新日期/Last Update: 2016-08-30