关节镜清理术联合不同方法治疗膝关节骨性关节炎的临床研究

Clinical study on arthroscopic debridement combined with different approaches in treatment of knee osteoarthritis

目的比较关节镜清理术联合玻璃酸钠灌注、臭氧灌注、中药熏洗治疗膝关节骨性关节炎(KOA)的临床疗效。方法选择KOA患者120例,随机分为玻璃酸钠组40例(48膝)、臭氧组40例(52膝)及中药熏洗组40例(50膝)。3组患者均采用关节镜下清理术,玻璃酸钠组、臭氧组、中药熏洗组术后分别行玻璃酸钠灌注、臭氧灌注、中药熏洗。于治疗前及治疗后第1、3、6个月对3组患者进行Lysholm膝关节功能评分及疼痛视觉模拟评分(VAS),治疗后6个月进行中医临床疗效评价。结果中药熏洗组的中医临床疗效优于玻璃酸钠组、臭氧组,差异有统计学意义(P<0.05)。3组的VAS评分均随观察时间的延长而降低(P<0.05);治疗后中药熏洗组各时间点VAS评分均低于其他两组(P<0.05);治疗后1个月及3个月臭氧组VAS评分低于玻璃酸钠组(P<0.05),而在治疗后6个月两组VAS评分比较,差异无统计学意义(P>0.05)。中药熏洗组及玻璃酸钠组Lysholm评分均随观察时间延长升高。治疗后1个月臭氧组的Lysholm评分最高,随后评分降低(P<0.05);治疗后各个时间点中药熏洗组Lysholm评分均高于其他两组(P<0.05),治疗后1个月臭氧组评分高于玻璃酸钠组(P<0.05),而在治疗后3个月及6个月臭氧组评分低于玻璃酸钠组(P<0.05)。结论关节镜联合玻璃酸钠灌注、臭氧灌注及中药熏洗都能减轻KOA患者疼痛、改善膝关节功能,而关节镜清理术联合中药熏洗治疗KAO微创且近远期效果确切。

ObjectiveTo compare the clinical efficacy among arthroscopic debridement combined with infusion of sodium hyaluronate, infusion of ozone and herbal fumigation in the treatment of knee osteoarthritis（KOA）. MethodsA total of 120 patients with KOA were randomly divided into sodium hyaluronate group（n=40, 48 knees）, ozone group （n=40, 52 knees） and herbal fumigation group（n=40, 50 knees）. All patients underwent arthroscopic debridement. After surgery, infusion of sodium hyaluronate, infusion of ozone and herbal fumigation were conducted in the sodium hyaluronate group, ozone group and herbal fumigation group respectively.Before treatment, at 1 month, 3 months and 6 months after treatment, Lysholm knee function score and Visual Analogue Scale （VAS） were assessed in the three groups. After 6 months of treatment, the clinical efficacy of traditional Chinese medicine was compared among the three groups. ResultsThe clinical efficacy of traditional Chinese medicine in the herbal fumigation group was superior to that in the sodium hyaluronate group or ozone group（P＜0.05）. VAS scores in the three groups decreased over the time（P＜0.05）. At each time point after treatment, VAS score in the herbal fumigation was lower than those of the other groups（P＜0.05）. At 1 and 3 months after treatment, VAS scores in the ozone group were lower than those in the sodium hyaluronate group（P＜0.05）, but there was no significant difference in the score at 6 months after treatment between the two groups（P＞0.05）. Lysholm scores in the sodium hyaluronate group and herbal fumigation group increased over the time（P＜0.05）. Lysholm scores in the ozone group was the highest at 1 month after treatment and then decreased（P＜0.05）. At each time point after treatment, Lysholm score in the herbal fumigation was higher than those in the other groups（P＜0.05）. Lysholm score in the ozone group was higher than that in the sodium hyaluronate group at 1 month after treatment（P＜0.05）, but the scores in the ozone group were lower than those of the sodium hyaluronate group at 3 and 6 months after treatment（P＜0.05）. ConclusionArthroscopic debridement combined with infusion of sodium hyaluronate, infusion of ozone and herbal fumigation can alleviate the pain and improve the function of knee joint in the patients with KOA. Arthroscopic debridement combined with herbal fumigation is minimally invasive，and can obtain definite short-term and long-term efficacy.