针刀松解联合臭氧关节腔注射治疗膝骨关节炎的疗效观察

Observation on the clinical curative effect of release with knife needle combined with intra-articular injection of ozone for treatment of knee osteoarthritis

目的:观察针刀松解联合臭氧关节腔注射治疗膝骨关节炎的临床疗效。方法:将60例符合要求的膝骨关节炎患者随机分为2组,每组30例,分别采用针刀松解联合臭氧关节腔注射治疗和单纯臭氧关节腔注射治疗。针刀松解和臭氧关节腔注射均每周1次,共治疗2次。采用明通A830L M-tone压痛测试仪测定膝关节疼痛最明显部位的压痛值,压痛值越大提示疼痛程度越轻。采用美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评价量表评定总体疗效。结果:治疗前2组患者的膝关节压痛值比较,差异无统计学意义[(2.19±0.25)kg,(2.21±0.34)kg,t=0.348,P=0.729];治疗结束后2组患者的膝关节压痛值均增加(t=23.342,P=0.000;t=8.025,P=0.000);针刀联合臭氧治疗组的压痛值大于臭氧治疗组[(3.44±0.18)kg,(2.82±0.86)kg,t=10.545,P=0.000]。治疗前后不同时间点HSS评分的差异有统计学意义,即存在时间效应(F=1 055.406,P=0.000);2组患者治疗前膝关节HSS评分均最低,治疗结束后即刻评分均最高,然后随时间延长评分均逐渐降低[(52.47±3.08)分,(79.83±2.39)分,(74.90±2.88)分,(70.67±2.20)分,F=895.384,P=0.000;(52.40±2.94)分,(73.33±3.65)分,(69.70±3.13)分,(66.27±3.08)分,F=784.345,P=0.000]。2组患者HSS评分总体比较,组间差异有统计学意义,即存在分组效应(F=8.968,P=0.000);除治疗前外(t=0.343,P=0.733),治疗结束后即刻、1个月、2个月时针刀联合臭氧治疗组的HSS评分均高于臭氧治疗组(t=8.154,P=0.000;t=6.694,P=0.000;t=6.359,P=0.000)。时间因素和分组因素存在交互效应(F=17.368,P=0.000)。结论:针刀松解联合臭氧关节腔注射治疗膝骨关节炎,可在短期内缓解关节疼痛症状、改善关节功能,但疗效会随时间延长逐渐减退,总体疗效优于单纯臭氧关节腔注射治疗。

Objective ： To observe the clinical curative effects of release with knife needle combined with intra - articular injection of o- zone for treatment of knee osteoarthritis （KOA）. Methods：Sixty patients with KOA were enrolled in the study and were randomly divided into 2 groups ,30 cases in each group. The patients were treated with combination therapy of release with knife needle and intra - articular injection of ozone （ group A ） and monotherapy of intra - articular injection of ozone （ group B ） respectively, once a week for consecutive 2 times. The tenderness values of knee were measured at the site where the knee pain was the most obvious by using A830L M - tone ten- derness - measuring apparatus, and greater tenderness values represented less pain. The total curative effects were evaluated and compared between the 2 groups by using knee rating scale established by American Hospital for Special Surgery（HSS）. Results：There was no statisti- cal difference in the tenderness values of knee between the 2 groups before the treatment（ 2.19 ＋/- 0.25 vs 2.21 ＋/- 0.34 kg, t = 0. 348, P = 0.729 ）. The knee tenderness values increased in both of the 2 groups after the end of the treatment （ t = 23. 342, P = 0. 000 ; t = 8. 025, P = 0. 000）. The knee tenderness values were greater in group A compared to group B （3.44 ＋/- 0.18 vs 2.82 ＋/- 0.86 kg, t = 10. 545, P = 0. 000）. There was statistical difference in HSS scores between different timepoints before and after the treatment,in other words, there was time effect （ F = 1 055. 406, P = 0. 000 ）. The lowest HSS scores were found before the treatment and the highest HSS scores were found immediately after the end of the treatment,and then the HSS scores decreased gradually with time（52.47 ＋/- 3.08,79.83 ＋/- 2.39,74.90 ＋/- 2.88,70.67 ＋/- 2.20 points, F = 895. 384, P = 0. 000 ; 52.40 ＋/- 2.94,73.33 ＋/- 3.65,69.70 ＋/- 3.13,66.27 ＋/- 3.08 points, F = 784. 345 ,P = 0. 000）. There was statistical difference in the HSS scores between the 2 groups in general, in other words, there was group effect（ F = 8. 968 ,P = 0.000）. The HSS scores were higher in group A compared to group B immediately after the end of the treatment, at 1 and 2 months after the end of the treatment（ t = 8. 154, P = 0. 000 ; t = 6. 694, P = 0.000 ; t = 6. 359, P = 0.000） except before treatment （t = 0. 343, P =0.733 ）. There was interaction between time factor and group factor （F = 17. 368, P = 0. 000）. Conclusion： The combination therapy of release with knife needle and intra - articular injection of ozone can effectively relieve the knee pain and im- prove the knee function in short term in the treatment of KOA and its total curative effect is better than that of monotherapy of intra - articu- lar injection of ozone, however,its curative effect will decrease gradually with time.