透明质酸联合糖皮质激素关节腔注射治疗膝关节骨关节炎的短期疗效

Short-term effects of hyaluronic acid combined with glucocorticoid injection in treating knee osteoarthritis

目的探讨膝关节骨关节炎患者关节腔注射透明质酸联合糖皮质激素的短期疗效。方法2017年10月至2018年6月诊断为膝关节骨关节炎并行关节腔注射的患者188例,根据WOMAC膝关节功能评分分为轻度60例、中度72例、重度56例,根据膝关节X线Kellgren-Lawrence分级分为Ⅰ级48例、Ⅱ级49例、Ⅲ级45例、Ⅳ级46例。统一治疗方案为:首次以透明质酸钠(Sodium Hyaluronate,SHA)注射液2.5 ml关节腔注射,第2周SHA 2.5ml+复方倍他米松注射液(compound betamethason injection,CBI)1 ml关节腔注射,第3周SHA 2.5 ml关节腔注射。在首次注射前、SHA及SHA+CBI注射后采用WOMAC评分和Lequesne指数评估膝关节功能,Lequesne指数改善率≥30%为有效、WOMAC评分改善率≥25%为有效。结果轻度、中度和重度组在连续3周注射后Lequesne指数和WOMAC评分均逐渐降低。其中轻度组SHA注射后及SHA+CBI注射后Lequesne指数改善率分别为36.44%±8.46%和49.26%±13.75%,中度组为23.09%±12.61%和30.66%±14.95%,重度组为10.50%±8.78%和11.07%±6.52%。轻度组SHA注射后及SHA+CBI注射后的WOMAC评分改善率均大于25%;中度组SHA注射后为13.06%±10.21%,SHA+CBI注射后为27.49%±13.61%;重度组均小于25%。Kendall's taub相关性分析结果显示WOMAC功能评分与X线Kellgren-Lawrence分级存在较强的正相关关系(r=0.744,P<0.001)。不同X线Kellgren-Lawrence分级组在连续3周注射后Lequesne指数和WOMAC评分均逐渐降低。其中Ⅰ级组注射SHA及SHA+CBI后Lequesne指数改善率分别为36.64%±10.05%和52.00%±8.19%,Ⅱ级组为32.05%±8.09%和41.95%±10.53%,Ⅲ级组为16.93%±10.34%和27.77%±10.25%,Ⅳ级组为7.52%±5.53%和7.60%±6.66%。Ⅰ级组SHA注射后及SHA+CBI注射后WOMAC评分改善率分别为29.48%±11.77%和42.59%±13.55%,Ⅱ级组为26.72%±10.21%和30.49%±16.90%,Ⅲ级组为13.78%±5.96%和23.05%±9.52%,Ⅳ级组为4.77%±3.80%和4.27%±4.23%。结论对轻度或X线退变Ⅰ级、Ⅱ级膝关节骨关节炎患者关节腔注射SHA或SHA+CBI均有效,注射SHA+CBI效果优于单独注射SHA;对中度患者单独注射SHA无效,SHA+CBI注射有效;对重度或X线退变Ⅲ级、Ⅳ级患者,单独注射SHA或SHA+CBI注射均无效。

Objective To investigate the short-term effects of articular injection of hyaluronic acid combined with glucocorticoid in patients with knee osteoarthritis.Methods From October 2017 to June 2018,a total of 188 patients diagnosed with knee osteoarthritis received parallel articular injection.There were 60 cases with mild knee osteoarthritis,72 with moderate and 56 with severe according to the WOMAC knee functional score.There patients were divided into group rankⅠ48 cases,Ⅱ49 cases,Ⅲ45 cases,Ⅳ46 cases according to the knee joint X-ray Kellgren-Lawrence classification.The unified treatment regimen was 2.5 ml Sodium Hyaluronate(SHA)injection for the first time,SHA 2.5 ml and compound betamethasone injection(CBI)1 ml for the second week,and 2.5 ml of SHA for the third week.WOMAC score and Lequesne index were used to evaluate joint function before the first injection and after SHA and SHA+CBI injection.The improvement rate of Lequesne index≥30%or improvement rate of WOMAC score≥25%was regarded as effective treatment.Results Lequesne index and WOMAC score decreased gradually in the mild,moderate and severe groups after 3 weeks of injection.Among these patients,the improvement rates of Lequesne index after SHA injection and SHA+CBI injection were 36.44%±8.46%and 49.26%±13.75%in the mild group,23.09%±12.61%and 30.66%±14.95%in the moderate group,and 10.50%±8.78%and 11.07%±6.52%in the severe group.The improvement rate of WOMAC score in the mild group after SHA injection and after SHA+CBI injection was greater than 25%.After SHA injection,the improvement rate of WOMAC score was 13.06%±10.21%in the moderate group,and 27.49%±13.61%after SHA+CBI injection.Those in severe group were all less than 25%.Kendall's staub correlation analysis results showed that there was a strong positive correlation between WOMAC function score and X-ray Kellgren-Lawrence classification(r=0.744,P<0.001).The Lequesne index and WOMAC scores of the Kellgren-Lawrence X-ray classification decreased gradually after 3 weeks of injection.The improvement rate of Lequesne index period in group rankⅠafter SHA and SHA+CBI injection was 36.64%±10.05%and 52.00%±8.19%,respectively.That for group rankⅡwas 32.05%±8.09%and 41.95%±10.53%,group rankⅢ16.93%±10.34%and 27.77%±10.25%,group rankⅣ7.52%±5.53%and 7.60%±6.66%.The improvement rate of WOMAC score period in group rankⅠafter SHA and SHA+CBI injection was 29.48%±11.77%and 42.59%±13.55%,respectively.That for group rankⅡwas 26.72%±10.21%and 30.49%±16.90%,group rankⅢ13.78%±5.96%and 23.05%±9.52%,group rankⅣ4.77%±3.80%and 4.27%±4.23%.Conclusion For mild or X-ray classificationⅠ,Ⅱknee osteoarthritis patients,articular injection SHA or SHA+CBI are effective.Further,SHA+CBI is better than single injection of SHA.SHA+CBI injection was effective for moderate knee osteoarthritis patients.For severe or X-ray classificationⅢ,Ⅳpatients,SHA or SHA+CBI injection at interval are invalid.