等速肌力训练联合关节腔内注射及关节松动术治疗膝骨性关节炎的疗效观察

The therapeutic effects of isokinetic strength training combined with intra-articular injection of hyaluronate and joint mobilization for patients with knee osteoarthritis

目的观察等速肌力训练联合玻璃酸钠关节腔内注射及关节松动术治疗膝骨性关节炎（KOA）的疗效。方法采用随机数字表法将81例KOA患者分为联合治疗组、常规治疗组及对照组。联合治疗组给予等速肌力训练、玻璃酸钠关节腔内注射及关节松动术治疗，常规治疗组给予玻璃酸钠关节腔内注射及关节松动术治疗，对照组仅遵医嘱进行家庭自我踝泵训练。于治疗前、治疗4周后分别对各组患者膝关节疼痛程度、膝关节活动度、生活质量（采用WOMAC简明健康调查量表评定）及等速肌力指标[包括膝关节屈、伸肌峰力矩值（PT），屈、伸肌峰力矩值对应角度（AOPT）]进行评定。结果各组患者分别经4周治疗后，发现对照组膝关节疼痛VAS评分、膝关节活动度、WOMAC量表评分（包括疼痛、僵硬、功能评分及总分）、等速肌力指标（包括膝关节屈肌及伸肌PT值、屈肌及伸肌AOPT值）均较治疗前无显著改善（P〉0．05）；而联合治疗组及常规治疗组患者上述指标均较治疗前明显改善（P〈0．05），并且联合治疗组患者疼痛VAS评分[（3．34±1．76）分]、膝关节活动度[屈膝（117．66±20．60）°、伸膝（5．69±2．12）°]、WOMAC指数评分[疼痛（110．34±49．53）分、僵硬（38．97±35．49）分、功能评分（430．52±270．43）分、总分（581．21±322．90）分]及等速肌力指标[膝关节屈肌PT值（21．83±3．63）N·m、伸肌PT值（28．90±6．76）N·m、屈肌AOPT值（99．86±18．94）°、伸肌AOPT值（49．93±6．78）°]亦显著优于常规治疗组及对照组水平（P〈0．05）。结论联合采用等速肌力训练、玻璃酸钠关节腔内注射及关节松动术治疗KOA患者具有协同疗效，能进一步提高患者膝关节稳定性、改善其日常生活活动能力，该联合疗法值得临床推广、应用。

Objective To observe any effects of using isokinetie strengthening exercises combined with intra-artieular injection of sodium hyaluronate and joint mobilization in treating patients with knee osteoarthritis （KOA）. Methods Eighty-one KOA patients were divided into a combined treatment group, a conventional treatment group and a control group. The combined treatment group received isokinetic strengthening training, intra-articular injections of sodium hyaluronate and joint mobilization therapy; the conventional treatment group received the injections and mobilization only; the control group was instructed to do ankle pumps at home on their own. Before the start of treatment and after 4 weeks, knee pain was self-assessed [ using a visual analogue scale （VAS） for painl along with knee range of motion （ROM） , quality of life （ using the WOMAC condensed health survey rating scale） and indexes of isokinetic strength [ including the knee flexors, extensor peak torque （PT） , and the flexion and extension angles corresponding peak torque （AOPT）] in both groups. Results After 4 weeks of treatment, statistically significant improvements compared to the baseline values were observed in both groups. The combined treatment group, however, improved to a significantly greater extent than the conventional treatment group in terms of all of the measures. Conclusion Isokinetie strength training combined with intra-artieular injections of sodium hyaluronate and joint mobilization has a synergistic effect in enhancing knee stability and improving the performance in activities of daily life of KOA patients.