关节腔内注射透明质酸钠联合塞来昔布治疗早中期膝关节骨关节炎的疗效分析

Clinical efficacy of intra-articular hyaluronate injection combined with celecoxib in treatment of early and mid stage knee osteoarthritis

目的观察关节腔内注射透明质酸钠联合口服塞来昔布治疗早中期膝关节骨关节炎(OA)的临床疗效。方法将2013年1月至2015年6月在广州市天河区妇幼保健院外科治疗的膝关节OA患者作为研究队列。纳入标准:符合美国风湿病学会膝关节OA诊断标准;年龄>40岁;Kellgren-Lawrence X线分级Ⅰ、Ⅱ级。排除标准:(1)在观察期内失随访和不遵从医嘱的患者;(2)合并其他骨与关节疾病;(3)合并严重的内科疾病及精神病患者;(4)近期使用过激素治疗;(5)随访期间手术治疗;(6)对使用的药物过敏的。共选取120例纳入研究,采用随机表法分为三组,每组40例。塞来昔布组为单纯口服塞来昔布(200 mg/d,连续5周),透明质酸钠组为单纯关节腔内注射透明质酸钠(1次/周,连续5周),以及联合治疗组,记录患者在治疗前和治疗5周后、治疗结束3个月后的膝关节功能评分(Lysholm)和疼痛视觉模拟评分(VAS)。采用SPSS 19.0软件分析数据,年龄、三组间Lysholm和VAS评分等计量资料比较采用t检验;而性别、不同分级患者数等计数资料采用x2检验。结果所有患者治疗结束后随访3个月。三组患者治疗5周后的Lysholm评分和VAS评分较治疗前明显改善,组间差异有统计学意义。Lysholm评分t值分别为7.19,8.47,9.76,P值均<0.05;VAS评分t值分别为16.67,18.20,23.89,P值均<0.05。但联合治疗组的效果更为显著,Lysholm评分t值分别为4.10,3.19,P值均<0.05;VAS评分t值分别为5.35,6.65,P值均<0.05)。治疗后3个月,透明质酸钠组和联合治疗组的Lysholm评分与治疗5周后相比无统计学差异(t=1.74,0.89,P值均>0.05);而塞来昔布组的Lysholm评分与治疗5周后相比明显降低,组间差异有统计学意义(t=5.51,P<0.05);塞来昔布组和透明质酸钠组的VAS评分与治疗5周后相比明显升高,组间差异有统计学意义(t=16.43,5.84,P值均<0.05);而联合治疗组的VAS评分与治疗5周后相比无统计学差异(t=1.48,P>0.05)。所有患者均无明显不良反应。结论关节腔内注射透明质酸钠联合口服塞来昔布治疗早中期膝关节OA,副作用少、效果确切、疗效持久。

Objective To analyze the clinical effect of intra-articular hyaluronate injection combined with celecoxib in the treatment of early and mid stage knee osteoarthritis （OA）. Methods Inclusion criteria： diagnosis according with the American Society of Rheumatology Knee OA standard; age 〉 40 years; Kellgren-Lawrence X-ray grade [ and 11. Exclusion criteria： being lost follow-up or poor compliance; associating with other bone and joint diseases; associating with severe medical and mental diseases; recently using hormones; undergoing surgery during the follow-up; allergic to the drug. According to the standard, 120 patients who were treated for knee OA from January 2013 to June 2015 at surgical department in the Tianhe Maternal and Child Health Hospital were selected, and randomly dividedinto three groups, 40 patients in each group： the celecoxib group were given oral celecoxib treatment （200 mg/d, for five weeks ）, the hyaluronate group were given intra-articular hyaluronate injection treatment （once per week, for five weeks）, and the combined treatment group were given oral celecoxib combining with the intra-articular hyaluronate injection treatment. The clinical effects were evaluated before the treatment, five weeks and three months after the treatment by Lysholm knee score and the visual analogue scale （VAS）. The measurement data such as age, the Lysholm knee score and VAS were analyzed by t-test; Chi-square test was used to analyze the enumeration data. Results All the patients were followed-up for three months. After five weeks of treatment, the VAS score and Lysholm score of the three groups improved significantly （ Lysholm score： t = 7. 19, 8.47, 9.76, P 〈 0. 05 ; VAS score ： t = 16.67, 18. 20, 23.89, P 〈 0. 05 ） ,and the combined group was superior to the other two groups （Lysholm score： t=4.10, 3.19, P 〈0.05; VAS score： t =5.35, 6.65, P 〈0.05）. Three months after the treatment, the Lysholm score of the celecoxib group was significantly lower than that of five weeks after the treatment （ t = 5.51, P 〈 0.05） , while no significant difference was found in the other two groups （ P 〉 0. 05 ）. The VAS scores of the celecoxib group and the hyaluronate group were significantly higher than that of five weeks after the treatment （t = 16. 43, 5.84, P 〈0. 05） , and no significant difference was found in the combined treatment group （t = 1.48, P 〉 0. 05 ）. There was no obvious adverse reaction in the three groups. Conclusion Intra-articular hyaluronate injection combined with celecoxib is a safe and effective method for treatment of early and mid-stage knee osteoarthritis.