药物联合治疗对大骨节病膝关节损伤疗效观察

Therapeutic effect of combined drug therapy on knee joint of Kaschin-Beck disease

目的探讨膝关节腔注射玻璃酸钠的基础上,联合口服双醋瑞因和/或硫酸氨基葡萄糖对大骨节病膝关节损伤的治疗效果.方法采用前瞻性设计,以2015年1月至2017年12月广安市人民医院普内科收治的80例大骨节病患者为研究对象,按照用药方法不同分成4组,每组20例.A组采用关节腔内注射玻璃酸钠,B组采用关节腔内注射玻璃酸钠+口服双醋瑞因,C组采用关节腔内注射玻璃酸钠+口服硫酸氨基葡萄糖,D组采用关节腔内注射玻璃酸钠+口服双醋瑞因及硫酸氨基葡萄糖,对比分析4组患者的整体治疗效果.结果D组用药后7、14、90、180d膝关节功能评分分别为(6.25±2.01)、(4.22±1.15)、(2.21±1.01)、(1.15±0.15)分,与A组[(12.11±3.02)、(11.91±2.98)、(11.85±2.85)、(11.05±2.52)分]、B组[(9.11±2.85)、(8.32±2.45)、(7.55±2.32)、(6.15±2.01)分]、C组[(9.12±2.84)、(8.23±2.32)、(7.43±2.29)、(6.11±2.00)分]比较明显降低(P均<0.05).4组治疗总有效率分别为60%(12/20)、65%(13/20)、70%(14/20)、90%(18/20),D组明显高于其他3组(x2=18.250、18.250、16.000,P均<0.05).D组用药后、随访期20m步行疼痛及关节触痛评分低于其他3组(P均<0.05).结论关节腔内注射玻璃酸钠与口服双醋瑞因及硫酸氨基葡萄糖联合治疗对改善大骨节病患者膝关节功能、减轻疼痛、提升整体治疗效果有着促进作用,有很好的临床推广价值.

Objective To investigate the effect of knee joint injection of sodium hyaluronate combined with oral administration of diacerein and/or glucosamine sulfate on knee joint of Kaschin-Beck disease. Methods The method of prospective study was used, 80 patients with Kaschin-Beck disease admitted to the General Internal Medicine, Guang'an People's Hospital from January 2015 to December 2017 were selected as subjects. They were divided into 4 groups according to the difference of their medication methods, 20 cases per group. Group A was treated with intra-articular injection of sodium hyaluronate, Group B was treated with intra-articular injection of sodium hyaluronate + oral diacerein, Group C was treated with intra-articular injection of sodium hyaluronate + oral glucosamine sulfate, Group D was treated with intra-articular injection of sodium hyaluronate + oral diacerein and glucosamine sulfate, and the overall therapeutic effects of the 4 groups were compared. Results The knee joint scores of Group D at 7, 14, 90, and 180 days after treatment were (6.25 ± 2.01),(4.22 ± 1.15),(2.21 ± 1.01), and (1.15 ± 0.15) scores, respectively, they were significantly lower than those of Group A [(12.11 ± 3.02),(11.91 ± 2.98),(11.85 ± 2.85),(11.05 ± 2.52) scores], Group B [(9.11 ± 2.85),(8.32 ± 2.45),(7.55 ± 2.32),(6.15 ± 2.01) scores] and Group C [(9.12 ± 2.84),(8.23 ± 2.32),(7.43 ± 2.29),(6.11 ± 2.00) scores], the differences were statistically significant (P < 0.05). The total effective rates of the 4 groups were 60%(12/20), 65%(13/20), 70%(14/20), and 90%(18/20), respectively, Group D was significantly higher than those of other 3 groups (χ2 = 18.250, 18.250, 16.000, P < 0.05). The scores of 20 m walking pain and joint tenderness in Group D after treatment and follow-up period were lower than those of other 3 groups (P < 0.05). Conclusions In the clinical practice of Kaschin-Beck disease, intra-articular injection of sodium hyaluronate combined with oral diacerein and glucosamine sulfate can improve the knee joint function of patients, alleviate pain and enhance the overall therapeutic effect. The combined therapy has great clinical value.