体外冲击波与膝关节腔内注射透明质酸钠治疗膝骨关节炎的比较
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摘要
背景:膝关节腔内注射透明质酸钠可以安全、有效地治疗膝关节骨性关节炎,明显改善膝关节的疼痛和膝关节的功能,目前对于体外冲击波治疗早中期膝关节骨性关节炎的确切疗效,还存在争议。目的:比较体外冲击波治疗与膝关节腔内注射透明质酸钠治疗早中期膝关节骨性关节炎的临床疗效。方法:根据纳入标准共选择77例膝关节骨性关节炎患者作为观察对象,随机分为体外冲击波组和透明质酸钠组。体外冲击波组给予体外冲击波治疗,治疗能流密度0.2mJ/mm~2,单侧膝关节冲击2000次,每周治疗1次,连续治疗5周;透明质酸钠组给予膝关节腔内注射透明质酸钠治疗,每次注射透明质酸钠2.5 mL,每周治疗1次,连续治疗5周。治疗前和治疗5周后,采用目测类比评分、Lequesne指数评分和骨关节炎指数评分评价2组患者的临床效果。结果与结论:①治疗5周后,2组患者的目测类比评分、骨关节炎指数、Lequesne指数均较治疗前明显降低(P <0.05);体外冲击波组患者的目测类比评分、骨关节炎指数、Lequesne指数较透明质酸钠组均显著降低(P <0.05);②结果说明,体外冲击波治疗与膝关节腔内注射透明质酸钠治疗早中期膝关节骨性关节炎均有效,体外冲击波的治疗效果更显著。
BACKGROUND: Intra-articular injection of sodium hyaluronate can safely and effectively treat knee osteoarthritis and obviously improves the pain and function of knee joint. The efficacy of extracorporeal shock wave therapy for early-and middle-term knee osteoarthritis still remains controversial. OBJECTIVE: To compare the effects of extracorporeal shock wave therapy and intra-articular injection of sodium hyaluronate for early-and middle-term knee osteoarthritis. METHODS: According to the inclusion criteria, a total of 77 patients with knee osteoarthritis were enrolled, and randomly divided into extracorporeal shock wave therapy group and sodium hyaluronate therapy group. The extracorporeal shock wave therapy group underwent 5 sessions of 2 000 shockwave pulses performed on the affected knee with the dosage adjusted to 0.2 mJ/mm~2 energy. The sodium hyaluronate group was administered intra-articularly sodium hyaluronate once per week for 5 weeks. The results were assessed with the Visual Analogue Scale, Lequesne index and Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS AND CONCLUSION:① After 5 weeks of treatment, the Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne index in the two groups were significantly decreased compared with the baseline(P < 0.05). All above indexes in the extracorporeal shock wave therapy group were significantly lower than those in the sodium hyaluronate therapy group(P < 0.05).② These results indicate that the extracorporeal shock wave therapy and sodium hyaluronate therapy are effective for early-and middle-term knee osteoarthritis, and the former is more significant.
BACKGROUND: Intra-articular injection of sodium hyaluronate can safely and effectively treat knee osteoarthritis and obviously improves the pain and function of knee joint. The efficacy of extracorporeal shock wave therapy for early-and middle-term knee osteoarthritis still remains controversial. OBJECTIVE: To compare the effects of extracorporeal shock wave therapy and intra-articular injection of sodium hyaluronate for early-and middle-term knee osteoarthritis. METHODS: According to the inclusion criteria, a total of 77 patients with knee osteoarthritis were enrolled, and randomly divided into extracorporeal shock wave therapy group and sodium hyaluronate therapy group. The extracorporeal shock wave therapy group underwent 5 sessions of 2 000 shockwave pulses performed on the affected knee with the dosage adjusted to 0.2 mJ/mm~2 energy. The sodium hyaluronate group was administered intra-articularly sodium hyaluronate once per week for 5 weeks. The results were assessed with the Visual Analogue Scale, Lequesne index and Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS AND CONCLUSION:① After 5 weeks of treatment, the Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne index in the two groups were significantly decreased compared with the baseline(P < 0.05). All above indexes in the extracorporeal shock wave therapy group were significantly lower than those in the sodium hyaluronate therapy group(P < 0.05).② These results indicate that the extracorporeal shock wave therapy and sodium hyaluronate therapy are effective for early-and middle-term knee osteoarthritis, and the former is more significant.
引文
[1]Litwic A,Edwards MH,Dennison EM,et al.Epidemiology and burden of osteoarthritis.Br MedBull.2013;105:185-199.
[2]Busija L,Bridgett L,Williams SR,et al.Osteoarthritis.Best Pract ResClin Rheumatol.2010;24(6):757-768.
[3]Mishra SK,Pramanik R,Das P,et al.Role of intra-articular ozone in osteo-arthritis of knee for functional and symptomatic improvement.Ind J Phys Med Rehabil.2011;22(2):65-69.
[4]Raeissadat SA,Rayegani SM,Forogh B,et al.Intra-articular ozone or hyaluronic acid injection:Which one is superior in patients with knee osteoarthritis?A 6-month randomized clinical trial.J Pain Res 2018;11:111-117.
[5]刘爱峰,裴开源,王平,等.玻璃酸钠注射液与生理盐水对照对于膝骨性关节炎临床疗效的Meta分析[J].中国矫形外科杂志,2016,24(17):1581-1586.
[6]Kang S,Gao F,Han J,et al.Extracorporeal shock wave treatment can normalize painful bone marrow edema in knee osteoarthritis:A comparative historical cohort study.Medicine(Baltimore)2018;97:e9796.
[7]Lizis P,Kobza W.Extracorporeal shockwave therapy vs.kinesiotherapy for osteoarthritis of the knee:A pilot randomized controlled trial.J Back Musculoskelet Rehabil2017;30:1121-1128.
[8]视觉模拟评分法(Visual analogue scale,VAS)[J].临床和实验医学杂志,2013,12(23):1925.
[9]陆斌,李建武,杨艳,等.臭氧联合玻璃酸钠对膝关节骨性关节炎患者膝关节功能及疼痛症状的改善效果观察[J].临床和实验医学杂志,2018,17(11):1186-1189.
[10]潘勇,祝健,卢华斌.白细胞介素-6、白细胞介素-17、白细胞介素-23与膝骨关节炎患者病情活动的相关性研究[J].中国卫生检验杂志,2018,28(11):1395-1396+1400.
[11]Jackson BD,Wluka AE,Teichtahl AJ,et al.Reviewing knee osteoarthritis-a biomechanical perspective.J Sci Med Sport.2004;7(3):347.
[12]Wu CW,Kalunian KC.New developments in osteoarthritis.Clin Geriatr Med.2005;21(3):589.
[13]Gracitelli GC,Moraes VY,Franciozi CE,et al.Surgical interventions(microfracture,drilling,mosaicplasty,and allograft transplantation)for treating isolated cartilage defects of the knee in adults.Cochrane Database SystRev.2016;3(9):CD010675.
[14]Raeissadat SA,Babaee M,Rayegani SM,et al.An overview of platelet products(PRP,PRGF,PRF,etc.)in the Iranian studies.Futur Sci OA.2017;3(4):FSO231.
[15]Kanchanatawan W,Arirachakaran A,Chaijenkij K,et al.Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee.Knee Surg Sports Traumatol Arthrosc.2016;24(5):1665-1677.
[16]Raeissadat SA,Rayegani SM,Hassanabadi H,et al.Knee osteoarthritis injection choices:platelet-rich plasma(PRP)versus hyaluronic acid(a one year randomized clinical trial).Clin Med Insights Arthritis Musculoskelet Disord.2015;8:1-8.
[17]Adams ME,Atkinson MH,Lussier AJ,et al.The role of viscosupplementation with hylan G-F 20 in the treatment of osteoarthritis of the knee:a Canadian multicenter trial comparing hylan G-F 20 alone,hylan G-F 20 with non-steroidal anti-inflammatory drugs(NSAIDs)and NSAIDs alone.Osteoarthr Cartil.1995;3(4):213-225
[18]Rodriguez-Merchan EC.Intra-articular injections of hyaluronic acid and other drugs in the knee joint.HSS J.2013;9(2):180-182
[19]Nguyen C,Lefevre-Colau MM,Poiraudeau S,et al.Evidence and recommendations for use of intraarticular injections for knee osteoarthritis.Ann Phys Rehabil Med 2016;59:184-9
[20]Richette P,Chevalier X,Ea HK,et al.Hyaluronan for knee osteoarthritis:an updated meta-analysis of trials with low risk of bias.RMD Open 2015;1:e000071
[21]Altman RD,Manjoo A,Fierlinger A,et al.The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee:a systematic review.BMC Musculoskelet Disord 2015;16:321.
[22]Muratovic D,Findlay DM,Cicuttini FM,et al.Bone matrix microdamage and vascular changes characterize bone marrow lesions in the subchondral bone of knee osteoarthritis.Bone 2018;108:193-201.
[23]Wang CJ,Hsu SL,Weng LH,et al.Extracorporeal shockwave therapy shows a number of treatment related chondroprotective effect in osteoarthritis of the knee in rats.BMC Musculoskelet Disord2013;14:44.
[24]Wang CJ,Sun YC,Wong T,et al.Extracorporeal shockwave therapy shows timedependent chondroprotective effects in osteoarthritis of the knee in rats.J Surg Res 2012;178:196-205.
[25]Zhao Z,Ji H,Jing R,et al.Extracorporeal shock-wave therapy reduces progression of knee osteoarthritis in rabbits by reducing nitric oxide level and chondrocyte apoptosis.Arch Orthop Trauma Surg 2012;132:1547-53
[26]Ochiai N,Ohtori S,Sasho T,et al.Ex tracorporeal shock wave therapy improves motor dysfunction and pain originating from knee osteoarthritis in rats.Osteoarthritis Cartilage 2007;15:1093-1096.
[27]Moretti B,Iannone F,Notarnicola A,et al.Extracorporeal shock waves down-regulate the expression of interleukin-10and tumor necrosis factor alpha in osteoarthritic chondrocytes.BMC Musculoskelet Disord 2008.31(9):16.
[28]刘洪柏,区丽明.体外冲击波对骨关节炎作用的研究进展[J].现代医院,2012,12(01):13-15.
[29]Lee JH,Lee S,Choi S,et al.The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis.J Phys Ther Sci 2017;29:536-538.
[30]赵喆,史展,闫君,等.体外冲击波治疗早中期膝骨关节炎的效果[J].中国康复理论与实践,2014,20(1):76-78.
[31]Lee JK,Lee BY,Shin WY,et al.Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis.Ann Rehabil Med 2017;41:828-835.
[32]Imamura M,Alamino S,Hsing WT,et al.Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis.J Rehabil Med 2017;49:54-62.
[33]Kim JH,Kim JY,Choi CM,et al.The Dose-Related Effects of Extracorporeal Shock Wave Therapy for Knee Osteoarthritis.Ann Rehabil Med.2015;39(4):616.
[2]Busija L,Bridgett L,Williams SR,et al.Osteoarthritis.Best Pract ResClin Rheumatol.2010;24(6):757-768.
[3]Mishra SK,Pramanik R,Das P,et al.Role of intra-articular ozone in osteo-arthritis of knee for functional and symptomatic improvement.Ind J Phys Med Rehabil.2011;22(2):65-69.
[4]Raeissadat SA,Rayegani SM,Forogh B,et al.Intra-articular ozone or hyaluronic acid injection:Which one is superior in patients with knee osteoarthritis?A 6-month randomized clinical trial.J Pain Res 2018;11:111-117.
[5]刘爱峰,裴开源,王平,等.玻璃酸钠注射液与生理盐水对照对于膝骨性关节炎临床疗效的Meta分析[J].中国矫形外科杂志,2016,24(17):1581-1586.
[6]Kang S,Gao F,Han J,et al.Extracorporeal shock wave treatment can normalize painful bone marrow edema in knee osteoarthritis:A comparative historical cohort study.Medicine(Baltimore)2018;97:e9796.
[7]Lizis P,Kobza W.Extracorporeal shockwave therapy vs.kinesiotherapy for osteoarthritis of the knee:A pilot randomized controlled trial.J Back Musculoskelet Rehabil2017;30:1121-1128.
[8]视觉模拟评分法(Visual analogue scale,VAS)[J].临床和实验医学杂志,2013,12(23):1925.
[9]陆斌,李建武,杨艳,等.臭氧联合玻璃酸钠对膝关节骨性关节炎患者膝关节功能及疼痛症状的改善效果观察[J].临床和实验医学杂志,2018,17(11):1186-1189.
[10]潘勇,祝健,卢华斌.白细胞介素-6、白细胞介素-17、白细胞介素-23与膝骨关节炎患者病情活动的相关性研究[J].中国卫生检验杂志,2018,28(11):1395-1396+1400.
[11]Jackson BD,Wluka AE,Teichtahl AJ,et al.Reviewing knee osteoarthritis-a biomechanical perspective.J Sci Med Sport.2004;7(3):347.
[12]Wu CW,Kalunian KC.New developments in osteoarthritis.Clin Geriatr Med.2005;21(3):589.
[13]Gracitelli GC,Moraes VY,Franciozi CE,et al.Surgical interventions(microfracture,drilling,mosaicplasty,and allograft transplantation)for treating isolated cartilage defects of the knee in adults.Cochrane Database SystRev.2016;3(9):CD010675.
[14]Raeissadat SA,Babaee M,Rayegani SM,et al.An overview of platelet products(PRP,PRGF,PRF,etc.)in the Iranian studies.Futur Sci OA.2017;3(4):FSO231.
[15]Kanchanatawan W,Arirachakaran A,Chaijenkij K,et al.Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee.Knee Surg Sports Traumatol Arthrosc.2016;24(5):1665-1677.
[16]Raeissadat SA,Rayegani SM,Hassanabadi H,et al.Knee osteoarthritis injection choices:platelet-rich plasma(PRP)versus hyaluronic acid(a one year randomized clinical trial).Clin Med Insights Arthritis Musculoskelet Disord.2015;8:1-8.
[17]Adams ME,Atkinson MH,Lussier AJ,et al.The role of viscosupplementation with hylan G-F 20 in the treatment of osteoarthritis of the knee:a Canadian multicenter trial comparing hylan G-F 20 alone,hylan G-F 20 with non-steroidal anti-inflammatory drugs(NSAIDs)and NSAIDs alone.Osteoarthr Cartil.1995;3(4):213-225
[18]Rodriguez-Merchan EC.Intra-articular injections of hyaluronic acid and other drugs in the knee joint.HSS J.2013;9(2):180-182
[19]Nguyen C,Lefevre-Colau MM,Poiraudeau S,et al.Evidence and recommendations for use of intraarticular injections for knee osteoarthritis.Ann Phys Rehabil Med 2016;59:184-9
[20]Richette P,Chevalier X,Ea HK,et al.Hyaluronan for knee osteoarthritis:an updated meta-analysis of trials with low risk of bias.RMD Open 2015;1:e000071
[21]Altman RD,Manjoo A,Fierlinger A,et al.The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee:a systematic review.BMC Musculoskelet Disord 2015;16:321.
[22]Muratovic D,Findlay DM,Cicuttini FM,et al.Bone matrix microdamage and vascular changes characterize bone marrow lesions in the subchondral bone of knee osteoarthritis.Bone 2018;108:193-201.
[23]Wang CJ,Hsu SL,Weng LH,et al.Extracorporeal shockwave therapy shows a number of treatment related chondroprotective effect in osteoarthritis of the knee in rats.BMC Musculoskelet Disord2013;14:44.
[24]Wang CJ,Sun YC,Wong T,et al.Extracorporeal shockwave therapy shows timedependent chondroprotective effects in osteoarthritis of the knee in rats.J Surg Res 2012;178:196-205.
[25]Zhao Z,Ji H,Jing R,et al.Extracorporeal shock-wave therapy reduces progression of knee osteoarthritis in rabbits by reducing nitric oxide level and chondrocyte apoptosis.Arch Orthop Trauma Surg 2012;132:1547-53
[26]Ochiai N,Ohtori S,Sasho T,et al.Ex tracorporeal shock wave therapy improves motor dysfunction and pain originating from knee osteoarthritis in rats.Osteoarthritis Cartilage 2007;15:1093-1096.
[27]Moretti B,Iannone F,Notarnicola A,et al.Extracorporeal shock waves down-regulate the expression of interleukin-10and tumor necrosis factor alpha in osteoarthritic chondrocytes.BMC Musculoskelet Disord 2008.31(9):16.
[28]刘洪柏,区丽明.体外冲击波对骨关节炎作用的研究进展[J].现代医院,2012,12(01):13-15.
[29]Lee JH,Lee S,Choi S,et al.The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis.J Phys Ther Sci 2017;29:536-538.
[30]赵喆,史展,闫君,等.体外冲击波治疗早中期膝骨关节炎的效果[J].中国康复理论与实践,2014,20(1):76-78.
[31]Lee JK,Lee BY,Shin WY,et al.Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis.Ann Rehabil Med 2017;41:828-835.
[32]Imamura M,Alamino S,Hsing WT,et al.Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis.J Rehabil Med 2017;49:54-62.
[33]Kim JH,Kim JY,Choi CM,et al.The Dose-Related Effects of Extracorporeal Shock Wave Therapy for Knee Osteoarthritis.Ann Rehabil Med.2015;39(4):616.