最佳能量流密度的体外冲击波疗法对膝骨关节炎治疗的影响

Effect of extracorporeal shock wave therapy with optimal energy flux density on the treatment of knee osteoarthritis

目的探索体外冲击波疗法(ESWT)治疗膝骨关节炎(KOA)的最佳能量流密度。方法选取2019年5月至2021年1月在厦门市长庚医院骨科住院的48例KOA患者作为研究对象。将患者随机分为三组,低能量流密度组(L组,n=16)、中能量流密度组(M组,n=16)、高能量流密度组(H组,n=16),每组向胫骨内侧平台区域发送1000个冲击波,每周1次,连续3周。主要观察指标为视觉模拟评分法(VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及Roles和Maudsley(RM)评分。每项评估均在体外冲击波疗法后第1、4和12周进行。结果三组VAS评分、WOMAC评分及RM评分随时间推移均有显著改善,差异有统计学意义(P<0.05),M组在治疗后第4周和第12周VAS评分、WOMAC评分优于L组、H组,在治疗后第1周和第4周RM评分优于L组、H组,差异有统计学意义(P<0.05)。结论M组在缓解疼痛和恢复功能预后方面较L组及H组有更大的改善,因此可以认为中能量冲击波对治疗KOA效果最佳。

Objective To explore the optimal energy flux density of extracorporeal shock wave therapy(ESWT)in the treatment of knee osteoarthritis(KOA).Methods A total of 48 KOA patients hospitalized in the Department of Orthopedics of Xiamen Chang Gung Hospital from May 2019 to January 2021 were selected as the study subjects.The patients were randomly divided into three groups:the low energy flux density group(group L,n=16),the medium energy flux density group(group M,n=16),and the high energy flux density group(group H,n=16).For each group,1000 shock waves were emitted to the medial tibial plateau area once a week for three consecutive weeks.The main observation measures were visual analogue scale(VAS)score,Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score and Roles and Maudsley(RM)score.Each assessment was performed at 1,4,and 12 weeks after ESWT.Results The VAS score,WOMAC score and RM score of the three groups were significantly improved over time,with statistically significant differences(P<0.05).The VAS score and WOMAC score of group M were better than those of group L and group H at 4 and 12 weeks after treatment,and the RM score of group M was better than that of group L and group H at 1 and 4 weeks after treatment,with statistically significant differences(P<0.05).Conclusion The prognoses of pain relief and functional recovery in group M are better than those in group L and group H,so it can be considered that the medium energy shock wave exerts the best effect on knee osteoarthritis.