多模式非手术疗法治疗膝骨关节炎的多中心研究
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摘要
背景:非手术疗法是膝骨关节炎阶梯治疗中非常重要的一部分,目前关于非手术疗法治疗膝骨关节炎的多中心研究较少。目的:评价多模式非手术疗法治疗不同严重程度的膝骨关节炎的效果。方法:选择2017年1月至2018年2月在我院门诊及本市4所社区卫生服务中心接受非手术治疗的患者227人(333膝),根据个体情况并依据西安大略和麦克马斯特大学骨关节炎指数(WOMAC)和凯尔格伦-劳伦斯(K-L)影像学分级标准分别给予4种不同模式的非手术疗法,对治疗前后的WOMAC评分进行回顾性分析。结果:227例(333膝)患者随访时间为3~10周,平均(6.6±1.7)周。基础治疗组对于WOMAC<21且K-L分级Ⅰ、Ⅱ级或21≤WOMAC≤48且K-L分级Ⅰ级患者有显著疗效;局部镇痛药物+改善病情药物组对于WOMAC≤48且K-L分级Ⅰ、Ⅱ、Ⅲ级或WOMAC>48且K-L分级Ⅱ级患者有显著疗效;全身镇痛药物组对于21≤WOMAC≤48且K-L分级Ⅰ、Ⅱ、Ⅲ级或WOMAC>48且K-L分级Ⅱ级患者有显著疗效;全身镇痛药物+关节腔注射组对于21≤WOMAC≤48且K-L分级Ⅱ、Ⅲ、Ⅳ级患者有显著疗效。结论:通过综合评估膝骨关节炎的严重程度,采用合理的治疗模式,轻、中度及一部分重度的膝骨关节炎可以获得良好的治疗效果。
Background: Non-surgical management is a very important part of the ladder treatment of knee osteoarthritis but there are few multicenter studies on it. Objective: To evaluate the effects of multi-mode non-surgical managements in the treatment of knee osteoarthritis of various severities. Methods: A total of 227 patients(333 knees) receiving non-surgical therapy in our hospital and four community health services from January 2017 to February 2018 were recruited and given four modes of non-surgical therapy based on individual condition according to the index of WOMAC and Kellgren-Lawrence(K-L) grades of imaging diagnosis. The scores of WOMAC before and after treatment were retrospectively analyzed. Results: 227 patients(333 knees) were followed up for 3-10 weeks,(6.6±1.7) months in average. The patients with WOMAC<21 and K-L grade Ⅰ and Ⅱ or 21≤WOMAC≤48 and K-L grade Ⅰ in basic treatment group were improved significantly. Local analgesic drugs in combination with drugs for disease modifying had significant effects on patients with WOMAC ≤ 48 and K-L grade Ⅰ, Ⅱ and Ⅲ or WOMAC > 48 and K-L grade Ⅱ. Systemic analgesic drugs had significant effect on patients with 21≤ WOMAC≤ 48 and K-L grade Ⅰ, Ⅱ and III or WOMAC>48 and K-L grade Ⅱ. Systemic analgesic drugs in combination with intra-articular drug injection had significant effect on patients with 21≤ WOMAC≤48 and K-L grade Ⅱ, Ⅲ and Ⅳ. Conclusions: By comprehensively assessing the severity of knee osteoarthritis and adopting a reasonable treatment mode, patients with mild, moderate and partially severe knee osteoarthritis can achieve good therapeutic effects.
Background: Non-surgical management is a very important part of the ladder treatment of knee osteoarthritis but there are few multicenter studies on it. Objective: To evaluate the effects of multi-mode non-surgical managements in the treatment of knee osteoarthritis of various severities. Methods: A total of 227 patients(333 knees) receiving non-surgical therapy in our hospital and four community health services from January 2017 to February 2018 were recruited and given four modes of non-surgical therapy based on individual condition according to the index of WOMAC and Kellgren-Lawrence(K-L) grades of imaging diagnosis. The scores of WOMAC before and after treatment were retrospectively analyzed. Results: 227 patients(333 knees) were followed up for 3-10 weeks,(6.6±1.7) months in average. The patients with WOMAC<21 and K-L grade Ⅰ and Ⅱ or 21≤WOMAC≤48 and K-L grade Ⅰ in basic treatment group were improved significantly. Local analgesic drugs in combination with drugs for disease modifying had significant effects on patients with WOMAC ≤ 48 and K-L grade Ⅰ, Ⅱ and Ⅲ or WOMAC > 48 and K-L grade Ⅱ. Systemic analgesic drugs had significant effect on patients with 21≤ WOMAC≤ 48 and K-L grade Ⅰ, Ⅱ and III or WOMAC>48 and K-L grade Ⅱ. Systemic analgesic drugs in combination with intra-articular drug injection had significant effect on patients with 21≤ WOMAC≤48 and K-L grade Ⅱ, Ⅲ and Ⅳ. Conclusions: By comprehensively assessing the severity of knee osteoarthritis and adopting a reasonable treatment mode, patients with mild, moderate and partially severe knee osteoarthritis can achieve good therapeutic effects.
引文
[1]中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版).中华骨科杂志,2018, 38(12):705-715.
[2]关于推进分级诊疗制度建设的指导意见.国办发(2015)70号.
[3]中华医学会骨科学分会.骨关节炎诊治指南(2007年版).中华关节外科杂志(电子版),2007, 27(4):28-30.
[4] Mcconnell S. Kolopack P, Davis AM. The western ontario and mcMaster universities osteoarthritis index(WOMAC):a review of its utility and measurement properties. ArthritisRheum, 2001, 45(5):453-461.
[5] Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988,15(12):1833-1840.
[6]张国宁,王友.膝关节评分标准的评估.中华外科杂志,2006,44(16):1141-1143.
[7] Symonds T, Hughes B, Liao S, et al. Validation of the Chinese western Ontario and mcMaster universities osteoarthritis index in patients from mainland china with osteoarthritis of the knee. Arthritis Care Res, 2015, 67(11):1553-1560.
[8] Beckw6e D, Vaes P, Cnudde M, et al. Osteoarthritis of the knee:why does exercise work? A qualitative study of the literature. Ageing Res Rev, 2013, 12(1):226-236.
[9] Fernandes L, Hagen KB, Bijlsma JW, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheuma Dis, 2013, 72(7):1125-1135.
[10] Bennell K, Hinman R. Exercise as a treatment for osteoarthritis. Curr Opin Rheumatol, 2005, 17(5):634-640.
[11] van Baar ME, Dekker J, Oostendorp RA, et al. Effectivenessof exercise in patients with osteoarthritis of hip or knee:nine months'follow up. Ann Rheum Dis,2001,60(12):1123-1130.
[12] Tanaka R, Ozawa J, Kito N, et al. Efficacy of strengthening or aerobic exercise on pain relief in people with knee osteoarthritis:a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil, 2013, 27(12):1059-1071.
[13] Larmer PJ, Reay ND, Aubert ER, et al. Systematic review of guidelines for the physical management of osteoarthritis.Arch Phys Med Rehabil, 2014, 95(2):375-389.
[14] Mcalindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage, 2014, 22(3):363-388.
[15] Jordan KM, Arden NK, Doherty M, et al. EULAR recommendations 2003:an evidence based approach to the management of knee osteoarthritis:Report of a task force of the standing committee for international clinical studies including therapeutic trials(ESCISIT). Ann Rheum Dis, 2003, 62(12):1145-1155.
[16]林俊宏,姜耘宙,方立,等.骨关节炎患者行关节腔注射疗法关节感染调査.中华医院感染学杂志,2018, 28(12):1864-1866.
[2]关于推进分级诊疗制度建设的指导意见.国办发(2015)70号.
[3]中华医学会骨科学分会.骨关节炎诊治指南(2007年版).中华关节外科杂志(电子版),2007, 27(4):28-30.
[4] Mcconnell S. Kolopack P, Davis AM. The western ontario and mcMaster universities osteoarthritis index(WOMAC):a review of its utility and measurement properties. ArthritisRheum, 2001, 45(5):453-461.
[5] Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988,15(12):1833-1840.
[6]张国宁,王友.膝关节评分标准的评估.中华外科杂志,2006,44(16):1141-1143.
[7] Symonds T, Hughes B, Liao S, et al. Validation of the Chinese western Ontario and mcMaster universities osteoarthritis index in patients from mainland china with osteoarthritis of the knee. Arthritis Care Res, 2015, 67(11):1553-1560.
[8] Beckw6e D, Vaes P, Cnudde M, et al. Osteoarthritis of the knee:why does exercise work? A qualitative study of the literature. Ageing Res Rev, 2013, 12(1):226-236.
[9] Fernandes L, Hagen KB, Bijlsma JW, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheuma Dis, 2013, 72(7):1125-1135.
[10] Bennell K, Hinman R. Exercise as a treatment for osteoarthritis. Curr Opin Rheumatol, 2005, 17(5):634-640.
[11] van Baar ME, Dekker J, Oostendorp RA, et al. Effectivenessof exercise in patients with osteoarthritis of hip or knee:nine months'follow up. Ann Rheum Dis,2001,60(12):1123-1130.
[12] Tanaka R, Ozawa J, Kito N, et al. Efficacy of strengthening or aerobic exercise on pain relief in people with knee osteoarthritis:a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil, 2013, 27(12):1059-1071.
[13] Larmer PJ, Reay ND, Aubert ER, et al. Systematic review of guidelines for the physical management of osteoarthritis.Arch Phys Med Rehabil, 2014, 95(2):375-389.
[14] Mcalindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage, 2014, 22(3):363-388.
[15] Jordan KM, Arden NK, Doherty M, et al. EULAR recommendations 2003:an evidence based approach to the management of knee osteoarthritis:Report of a task force of the standing committee for international clinical studies including therapeutic trials(ESCISIT). Ann Rheum Dis, 2003, 62(12):1145-1155.
[16]林俊宏,姜耘宙,方立,等.骨关节炎患者行关节腔注射疗法关节感染调査.中华医院感染学杂志,2018, 28(12):1864-1866.