体外发散式冲击波治疗膝关节骨性关节炎的临床疗效和安全性

Efficacy and safety of extracorporeal shock wave therapy for knee osteoarthritis

目的探讨体外发散式冲击波(ESWT)治疗膝关节骨性关节炎的早期疗效和安全性。方法将53例膝关节骨性关节炎患者随机分入ESWT组(27例)和药物组(26例)。ESWT组患者每周接受ESWT3 000次冲击治疗,连续4周;药物组患者予口服非甾体抗炎药(依托考昔)60mg/次、1次/d和硫酸氨基葡萄糖0.25g/次、3次/d,连续服用4周。分别在治疗前和治疗2、6周后,采用疼痛视觉模拟评分(VAS评分)、膝关节损伤和骨关节炎评分(KOOS)量表评估膝关节骨性关节炎的治疗疗效。同时记录患者在治疗过程中发生的不良事件。结果两组治疗6周后的疼痛VAS评分均显著低于同组治疗前(P值均<0.01),且ESWT组显著低于药物组(P<0.05)。药物组和ESWT组治疗后,KOOS量表各维度评分均有不同程度提高,治疗6周后均显著高于同组治疗前(P值均<0.05)。ESWT组治疗6周后与治疗前的KOOS量表疼痛、运动功能、生活质量的评分差值均显著高于药物组(P值分别<0.01、0.05),ESWT组与药物组间治疗6周后与治疗前的KOOS量表症状、日常生活活动功能的评分差值的差异均无统计学意义(P值均>0.05)。两组间不良事件发生率的差异无统计学意义(P=0.318)。结论药物治疗和ESWT均能缓解膝关节骨性关节炎患者的疼痛和改善膝关节功能。与药物治疗相比,ESWT治疗在改善疼痛、运动功能和生活质量方面的疗效更为突出,且无明显不良反应。

Objective To evaluate the short-term efficacy and safety of extracorporeal shock wave therapy （ESWT） for knee osteoarthritis. Methods A total of 53 patients with knee osteoarthritis were randomly divided into ESWT group （n = 27） and pharmacological intervention group （n = 26）. For ESWT, patients received 3 000 pulses of shockwave weekly for 4 weeks. In the pharmacological intervention group, patients received non- steroidal anti-inflammatory drug （NSAID, toricoxib） once and glucosamine sulfate 3 times per day for 4 weeks. Clinical outcome was assessed by visual analog scale （VAS）, knee injury and osteoarthritis outcome score （KOOS） before treatment and 2 and 6 weeks after treatment. All patients were questioned regarding any adverse events during treatment. Results Compared with those before treatment, VAS scores were significantly decreased and KOOS scores were significantly increased in all patients 6 weeks after treatment （P〈0. 01, 0.05）. The VAS scores in the ESWT group were significantly lower than that in the pharmacological intervention group （P〈0.05）. The mean differences of KOOS pain, KOOS sport and KOOS knee-related quality of life （QOL） scores at week 6 adjusted by the values at week 0 of ESWT were superior to those of pharmacological intervention group （P〈0.01, 0.05）. There was no significant difference in the mean differences of KOOS or QOL scores at week 6 adjusted by the values at week 0 between the two groups （all P〉0.05）; neither was the incidence of adverse events between two groups （P = 0. 318）. Conclusion Both ESWT and pharmacological intervention can relieve pain and improve knee joint function in patients with knee osteoarthritis. Compared with NSAIDs combined with glucosamine sulfate, ESWT can significantly improve pain, motor function and QOL. There is no difference in the incidence of adverse events between the two therapies. （Shanghai Med J, 2014, 37： 669-672）