低强度脉冲超声联合药物治疗创伤性膝关节骨性关节炎的临床研究

Clinical effectiveness of low intensity pulsed ultrasound combined with drugs therapy for the treatment of traumatic knee osteoarthritis

目的:观察低强度脉冲超声(low intensity pulsed ultrasound,LIPUS)联合药物治疗对创伤性膝关节骨性关节炎(traumatic knee osteoarthritis,TKOA)的临床治疗效果。方法:将60例TKOA患者随机分为联合组、对照1组和对照2组,20例/组。联合组:予LIPUS联合口服非甾体类抗炎药(NSAIDs)治疗;对照1组:予单纯LIPUS治疗;对照2组:予单纯口服NSAIDs治疗。分别在治疗前后,进行3组间的VAS评分、(Western Ontario and Mc Master universities osteoarthritis index,WOMAC)评分、(Lysholm knee score,LKSS)评分;并经MRI检查行ICRS标准分级,测量膝关节内外侧髁、髌软骨外侧、内侧软骨T2值。结果:经6周治疗后,三组VAS评分、WOMAC评分、LKSS评分均较治疗前有不同程度的改善,联合组疗效明显优于对照1组(P<0.05)和对照2组(P<0.05),对照1组优于对照2组,但无显著性意义(P>0.05);三组MRI检查T2值结果无论与检查前比较,还是三组间比较均未见明显治疗效果(P>0.05)。结论:LIPUS联合药物治疗可改善TKOA患者的临床症状和/或体征,可一定程度的提高患者的膝关节功能,但对依据MRI检查的TKOA患者膝关节软骨的损害或退变程度无明显关联性。

Objective： To comparatively study the efficiency of low steroid anti-inflammatory drugs（NSAIDs） vs NSAIDs or treatment of traumatic knee osteoarthritis. intensity pulsed ultrasotmd therapy combined with non- low intensity pulsed ultrasound therapy alone for the Method： Patients with traumatic knee osteoarthritis were randomized to 3 groups （n=20 in each group） subject to low intensity pulsed ultrasound therapy combined with NSAIDs Celebrex （experimental group）, low intensity pulsed ultrasound alone （control group 1） and Celebrex alone （control group 2） respectively. All patients were treated for 6 weeks. Result： At the end of trial, the effective rate in the experimental group was significantly higher than that in the two control groups. For the VAS score, WOMAC score or LkSS osteoarthritis severity index, the experi- mental group was superior to the two control groups with statistical significance （P〈0.05）. In addition, al- though the score in the groups 1 is higher than that in the group 2, there was no statistical significance be- tween the two groups （P〉0.05）. Indicators of magnetic resonance imaging （MRI） showed no statistical signifi-cance between three groups or before and after the treatment （P〉0.05）. Conclusion： Low intensity pulsed ultrasound therapy combined with NSAIDs Celebrex was more effective to alleviate the clinical symptom and sign of traumatic knee osteoarthritis. However, the results showed no signifi- cant relationship between articular cartilage of traumatic knee osteoarthritis and MRI findings. Author＇s address Dept. of Rehabilitation, Nanjing First Hospital, Nanjing Medical University, 210006