膝关节功能练习对退变性骨关节炎的治疗意义

Clinical Significance of Physical Exercise for Degenerative Knee Joint Osteoarthritis

目的:探讨膝关节功能练习对老年骨关节炎的的治疗意义,分析其治疗效果。方法:随访分析251例膝关节骨关节炎的病人,所有病人均进行膝关节功能练习的指导,根据病人复查时是否进行了严格的功能练系情况进行分为系统训练的A组和不系统训练的B组,根据Kellegen-Lawrence关节炎的分期分为A0、A1、A2、A3和B0、B1、B2、B3组。各组内根据病人是否应用玻璃酸钠关节腔内注射再分为亚组,如A1.1,A1.2。一年治疗结束后根据HSS和VAS评分对比不同组别膝关节功能情况。结果:A组在不同时间段的随访评分均优于B组。应用关节腔内注射的A1.1组在各期的临床效果均优于A1.2组。应用关节腔内注射的B2.1组在一个月和三个月的临床效果优于B2.2组,但在6个月、12个月无明显差别。其他各亚组由于既能坚持严格功能练习,有能完成关节腔内玻璃酸钠注射病例均小于10例,没有进行统计学分析。但仅从直接数据来看,能配合系统的功能练习且进行足疗程玻璃酸钠注射的病例近期和远期的HSS和VAS评分效果更好。结论:系统的膝关节功能练习能明显提高膝关节功能,特别是对Kellegen-Lawrence分期1～2期患者疗效更好。如能同时进行足疗程的玻璃酸钠关节腔内注射,则效果更好。

Objective： To investigate the Clinical Significance of Physical Exercise to Degenerative Knee Joint Osteoarthritis, and analyse the clinical result. Methods： We visited and analysed 251 cases of osteoarthritic . All the patients were under guidance of knee joint physical exercise. The patients were classified as Group A（systematic practice） and Group B（non-systematic practice） according to their obayance of the instruction. The osteoarthritic cases patients were classified as Group A0,A1,A2,A3 and Group B0,B1,B2,B3 according to Kellegen-Lawrence osteoarthritis classification. Every group was classified as Group A1.1 and Group A1.2 according to sodium hyaluronate is prescribed or not. Compare the knee joint function according to HSS and VAS of different groups after 1year follow-up. Results： The follow-up result of Group A is better than group B in all phrases. Group A1.1 with sodium hyaluronate injection got a better result in all phrases than Group A1.2. Group B2.1 with sodium hyaluronate injection got a better result than Group B2.1 at the end of the 1st month and the end of the 3rd month. But there is no difference at the end of 6th month and 12th month between Group B2. 1 and Group B2.1. Statistical analysis was not performed for the other subgroups because of less than 10 cases of patients keep on practicing. But from the clinical data directly, the patients who could accomplish the knee joint practice and sodium hyaluronate injection got higher middle term and long term HSS and VAS. Conclusion： Systematic knee joint practice could improve the knee joint function, especially for the Kellegen-Lawrence classification 1 and 2 stage. Accompanied systematic sodium hyaluronate injection could improve the clinical result.