臭氧、玻璃酸钠联合体外冲击波治疗膝关节骨性关节炎的疗效分析

Efficacy Analysis of Ozone,Sodium Hyaluronate Combined Extracorporeal Shock Wave Therapy in the Treatment of Knee Osteoarthritis

目的观察臭氧、玻璃酸钠(sodium hyaluronate,HA)联合体外冲击波(extracorporeal shock wave,ESW)治疗膝关节骨性关节炎(knee osteoarthritis,KOA)的临床疗效。方法回顾分析2020-10/2022-03月确诊为KOA的60例患者,根据患者所接受的治疗分为臭氧治疗组、臭氧+HA治疗组、臭氧+HA联合ESW治疗组,每组20例。其中臭氧治疗组予以膝关节腔内注射臭氧(30μg/ml),20 ml/次,每周1次,共2周;臭氧+HA治疗组膝关节腔内注射臭氧(30μg/ml,20 ml/次)和HA(2.5 ml,25 mg),每周1次,连续2周;臭氧+HA联合ESW治疗组膝关节腔内注射臭氧(30μg/ml,20 ml/次)和HA(2.5 ml,25 mg/次),并给予ESW治疗,每周1次,共2周。3组患者分别在治疗前、治疗结束后进行视觉模拟评分量表(visual analogue scale,VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)以及Lequene和Mery KOA严重度指数等作为评估临床治疗效果的评价指标。结果与治疗前比较,治疗后3组患者VAS评分、WOMAC评分以及Lequene和Mery KOA严重度指数总分明显降低(P均<0.01)。治疗后,3组VAS评分、WOMAC评分以及Lequene和Mery KOA严重度指数总分比较差异具有统计学意义(P<0.01)。臭氧+HA联合ESW治疗组、臭氧+HA治疗组VAS评分、WOMAC总分及WOMAC-疼痛评分、WOMAC-僵硬评分、WOMAC-日常生活难度评分、Lequene-Mery-日常活动能力评分低于臭氧治疗组,且臭氧+HA联合ESW治疗组较臭氧+HA治疗组更低(P均<0.05)。臭氧+HA联合ESW治疗组Lequene和Mery KOA严重度指数总分、Lequene-Mery-疼痛或不适状况评分均低于臭氧+HA治疗组与臭氧治疗组(P均<0.05)。臭氧+HA联合ESW治疗组Lequene-Mery-最大行走距离评分低于臭氧治疗组(P<0.05)。结论与单纯的臭氧膝关节腔内注射和臭氧+HA注射的方案相比较,臭氧+HA关节腔内注射联合ESW治疗的方案在改善KOA的临床效果上更为显著,在缓解患者膝关节疼痛、僵硬等体征、提升膝关节的活动能力以及患者日常生活能力方面,均有不错的疗效,在临床上值得进一步研究和推广。

Objective To observe the clinical efficacy of ozone and sodium hyaluronate(HA)combined extracorporeal shock wave(ESW)in the treatment of knee osteoarthritis(KOA).Methods A total of 60 patients diagnosed with KOA from October 2020 to March 2022 were retrospectively analyzed,and the patients were divided into ozone treatment group,ozone+HA treatment group and ozone+HA combined ESW treatment group according to the received treatment,with 20 in each.The patients in the group of ozone therapy received intra-articular injection of ozone(30μg/ml,20 ml once a week for 2 weeks);the patients in the group of ozone+HA therapy received intra-articular injection of ozone(30μg/ml,20 ml times)and HA(2.5 ml,25 mg)once a week for 2 weeks;the patients in the group of ozone+HA combined ESW therapy received intra-articular injection of ozone(30μg/ml,20 ml/times),HA(2.5 ml,25 mg/times)and ESW therapy once a week for 2 weeks.Visual analogue scale(VAS),the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),the Lequene and Mery KOA severity index were used to assess the clinical effectiveness of the treatment on the 3 groups of patients before and after treatments.Results Compared with those before treatment,VAS score,WOMAC score and total score of Lequene and Mery KOA severity index significantly decreased in 3 groups after treatments(all P<0.01).After treatment,there were significant differences in VAS score,WOMAC score and total score of Lequene,Mery KOA severity index among the 3 groups,and the difference was statistically significant(P<0.01).VAS score,WOMAC total score,WOMAC-pain score,WOMAC-stiffness score,WOMAC-difficulty of daily living score and Lequene-Mery-daily activity score of ozone+HA combined ESW treatment group and ozone+HA treatment group were lower than those of ozone treatment group,and the ozone+HA combined ESW treatment group was lower than that of ozone+HA treatment group(all P<0.05).The total score of Lequene and Mery KOA severity index and Lequene-Mery-pain or discomfort score of ozone+HA combined ESW treatment group were lower than those of ozone+HA treatment group and ozone treatment group(all P<0.05).Lequene-Mery-maximum walking distance score of ozone+HA combined ESW treatment group was lower than that of ozone group(P<0.05).Conclusion Compared with ozone-only intra-articular injection and ozone+HA injection,the combination of intra-articular ozone and HA with ESW therapy is more effective in the treatment of KOA,showing better therapeutic effects in relieving sympton like the pain,stiffness,and improving the patients'activities of daily living.The combined treatment is worthy of further study,research and promotion in clinic.