关节腔内注射联合康复训练治疗膝关节骨性关节炎临床观察

Clinical effect of intra-articular injection of sodium hyaluronate combined with rehabilitation training in treatment of knee osteoarthritis in the elderly

目的观察关节腔内注射透明质酸钠联合康复训练治疗膝关节骨性关节炎（KOA）的临床疗效及对血浆β-内啡肽和P物质含量的影响。方法将106例膝关节骨性关节炎患者分为治疗组及对照组，治疗组给予关节腔内注射透明质酸钠及康复训练治疗，对照组仅给予康复训练治疗。于治疗前、治疗6周后及随访3个月、6个月时采用Lysholm功能评分对2组患者膝关节功能进行评定，同时对2组患者血浆β-内啡肽及P物质含量进行检测。结果治疗6周后及随访3个月、6个月时，2组患者膝关节功能评分均较治疗前明显改善（P〈0．01），且均以治疗组的改善幅度较显著，与对照组比较，组间差异均有统计学意义（P〈0．01）。2组患者治疗后，其血浆0一内啡肽含量均明显增高，P物质含量均显著降低，并以治疗组的变化幅度较显著，与对照组间差异有统计学意义（P〈0．01）。结论关节腔内注射透明质酸钠联合康复训练治疗膝关节骨性关节炎，能有效改善膝关节功能，且疗效持久，同时能显著提高KOA患者血浆β-内啡肽活性，降低P物质含量，对缓解疼痛、提高膝关节活动功能具有重要意义。

Objective To observe the clinical effect of intra-articular injection of sodium hyaluronate combined with rehabilitation training in treatment of knee osteoarthritis, and their effects on i3 endorphin and substance P levels in plasma. Methods All 106 cases with knee osteearthritis were divided into treatment group and control group. Treatment group were treated by intra-articular injection of sodium hyaluronate combined with rehabilitation training, and control group underwent rehabilitation training only. Knee joint function was evaluated using Lysholm scores before and six weeks after treatment, and at 3-month and 6 month follow-up. Meanwhile, the concentrations of β endorphin and substance P in plasma were tested in the two groups. Results Compared with pretreatment, the Lysholm scores were obviously increased after 6 week treatment, at 3-month and 6- month follow-up in both groups, with more obvious increase in treatment versus control group （P〈0.01）. The Lysholm scores were higher in treatment group than in control group （P〈0.01）. The concentration of β endorphin in plasma was significantly increased, and the substance P concentration in plasma was decreased after treatment in both groups. There were also significant differences in concentrations of β endorphin and substance P in plasma between treatment group and control group （P〈0. 01 ）. Conclusions Intra-articular injection of sodium hyaluronate combined with rehabilitation training is effective in improving knee joint function in elderly patients, in relieving pain and in enhancing joint movement.