肥胖对体外冲击波治疗膝骨关节炎疗效的影响

Impact of obesity on the efficacy of extracorporeal shockwave therapy in knee osteoarthritis

目的探讨肥胖对体外冲击波治疗(extracorporeal shockwave therapy,ESWT)膝骨关节炎(knee osteoarthri-tis,KOA)疗效的影响。方法选取2021年1月至2022年12月于武警浙江省总队医院进行ESWT的123例KOA患者,其中男性38例,女性85例;年龄(59.36±5.69)岁;病程(14.92±6.9)个月。患者根据体质量指数(body mass in-dex,BMI)分为正常组(BMI<25 kg/m^(2))和肥胖组(BMI≥25 kg/m^(2))。所有患者接受ESWT,每周1次,连续治疗8周。比较两组治疗前,治疗第2周后及第8周后患者的视觉模拟评分法(Visual Analogue Scale,VAS)、膝骨性关节炎功能指数(Lequesne评分)及西大略和麦克马斯特大学骨关节炎指数(McMaster University Osteoarthritis Index,WOMAC)评分,以评价患者疼痛和功能改善情况。结果两组患者治疗前VAS评分差异无统计学意义,治疗第2周后肥胖组VAS疼痛评分疼痛缓解优于正常组[(2.40±0.79)分比(3.28±1.17)分,P<0.01];肥胖组Lequesne评分改善优于正常组[(4.40±2.54)分比(5.81±2.58)分,P<0.01];肥胖组WOMAC评分中的疼痛评分、功能评分改善优于正常组[(6.76±2.58)比(7.98±2.24),P<0.01;(21.14±8.59)比(25.91±8.09),P<0.01]。治疗第8周后,VAS疼痛评分显示与正常组相比,肥胖组疼痛改善明显[(1.63±0.85)分比(2.27±1.44)分,P<0.01];Lequesne评分显示治疗第8周后与正常组相比,肥胖组患者治疗后功能改善明显[(3.09±1.68)分比(4.47±2.76)分,P<0.01];WOM-AC评分中疼痛评分、僵硬评分、功能评分治疗第8周后正常组为(5.00±2.74)、(2.54±1.15)、(22.25±8.17)分,与肥胖组(3.27±1.78)、(2.17±0.75)、(18.45±5.84)分相比,肥胖组患者治疗第8周后疼痛及功能改善明显(P<0.05),在治疗第2周后、第8周后,WOMAC评分中疼痛评分结果与VAS评分结果一致,疼痛明显减轻,WOMAC评分中的功能评分与Lequesne功能评分相一致,功能明显改善。结论ESWT可以早期缓解患者的疼痛及功能,早期治疗效果肥胖患者优于正常体重患者;在ESWT治疗过程中,对于肥胖的患者,ESWT对于膝骨关节炎的治疗效果优于正常体重患者;肥胖可以影响KOA发生发展,但是不影响ESWT对KOA的治疗,相较正常体重患者,肥胖患者更有利于ESWT对KOA的治疗。

Objective To investigate the effect of obesity on the efficacy of extracorporeal shockwave therapy(ESWT)in the treatment of knee osteoarthritis(KOA).Methods A total of 123 patients with KOA were selected including 38 males and 85 females,with the mean age of(59.36±5.69)years old;and disease duration of(14.92±6.9)months.Patients were divided into normal BMI group(BMI<25 kg/m^(2))and obese group(BMI≥25 kg/m^(2)).All patients received ESWT once a week for 8 weeks.The visual analog scale(VAS),Lequesne score,and Western Ontario and McMaster University Osteoarthritis Index(WOMAC)were compared between the two groups before treatment,after the 2nd week of treatment and after the 8th week of treatment,in order to evaluate the patients'pain and functional improvement.Results There was no significant difference in VAS score between the two groups before treatment.After 2 weeks of treatment,VAS pain score(2.40±0.79)in the obese group was better than that in the normal group(3.28±1.17)(P<0.01).Lequesne score of obesity group(4.40±2.54)was better than that of normal group(5.81±2.58)(P<0.01).The pain index and function index of WOMAC score in the obese group(6.76±2.58,21.14±8.59)were better than those in the normal group(7.98±2.24,25.91±8.09).After 8 weeks of treatment,VAS pain score of the normal group(2.27±1.44)was significantly improved compared with that of the obese group(1.63±0.85)(P<0.01).Lequesne score of the normal group(4.47±2.76)was significantly improved compared with that of the obese group(3.09±1.68)(P<0.01).The pain index,stiffness index and function index in WOMAC score after 8 weeks of treatment were(5.00±2.74,2.54±1.15,22.25±8.17)in normal group and(3.27±1.78,2.17±0.75,18.45±5.84)in obese groups,indicating the pain and function of the obese group were significantly improved(P<0.05).After 2 weeks and 8 weeks of treatment,the pain index of WOMAC score was consistent with the VAS score,with significant pain relief.The functional score of WOMAC score was consistent with the Lequesne functional score,and the function was significantly improved.Conclusions ESWT can relieve the pain and function of the patients in the early stage,and the early therapeutic effect of obese patients is better than that of normal weight patients.In the course of ESWT treatment,the treatment effect of ESWT for knee osteoarthritis in obese patients was better than that in patients with normal weight.Obesity can affect the occurrence and development of KOA,but does not affect the treatment of KOA by ESWT.Compared with normal weight patients,obese patients are more favourable to the treatment of KOA by ESWT.