透明质酸钠黏弹性补充治疗膝骨性关节炎的远期疗效观察  

Observation of long term efficacy of visco-supplementation with sodium hyaluronate in treating knee osteoarthritis

作　　者：闫立[1] 梁朝[1] 温建民[1] 李丁[2] 荀淑英[1] 李智尧[1] 

机构地区：[1]中国中医科学院望京医院关节二科,北京100102 [2]中国中医科学院西苑医院

出　　处：《中国骨伤》2010年第7期547-550,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:通过回顾性分析关节腔注射透明质酸钠对膝骨性关节炎的远期效果,为黏弹性补充疗法提供临床依据。方法:2006年1月至2007年8月治疗膝骨性关节炎181膝(120例),其中轻度61膝,中度72膝,重度48膝。采用透明质酸钠关节腔内注射治疗,每次2ml,每周1次,连续5周为1个疗程。应用VAS视觉模拟标尺法、日本骨科协会(JOA)的膝关节骨性关节炎评分系统,分别于治疗前及治疗后1个月、1、2年进行疗效评估。结果:①VAS疼痛分值:治疗前平均(7.26±1.83)分,治疗后1个月平均(1.85±1.21)分,随访1年时平均(2.54±1.40)分,随访2年时平均(3.07±1.51)分,均比治疗前降低。②JOA膝关节功能评分:治疗前平均(18.7±6.6)分,治疗后1个月平均(84.3±15.5)分,1年平均(75.4±22.4)分,2年平均(64.8±25.6)分,均较治疗前提高。③远期疗效评估:采用JOA评分方法,181膝治疗后1个月优91膝,良49膝,可27膝,差14膝;1年后优70膝,良51膝,可31膝,差29膝;2年后优40膝,良50膝,可46膝,差45膝。随着时间推移,疗效逐渐下降。治疗2年时轻度患者优16膝,良22膝,可15膝,差8膝;中度患者优16膝,良20膝,可21膝,差15膝;重度患者优8膝,良8膝,可10膝,差22膝。结论:关节腔注射透明质酸钠对膝骨性关节炎具有良好的远期疗效,尤其对轻、中度骨性关节炎更为满意,对重度骨性关节炎近期疗效尚可,远期疗效较差。Objective：To retrospectively analyze the long term efficacy of intra articular injection with sodium hyaluronate for the treatment of knee osteoarthritis.Methods：From January 2006 to August 2007,120 patients（181 knees） with knee osteoarthritis,（mild 61 knees,moderate 72 knees,severe 48 knees）,were treated by intra articular injection with sodium hyaluronate,2 ml every week for 5 weeks.The clinical effects were analyzed according to VAS,JOA scoring before treatment,at the 1 month,1,2 years after treatment.Results：①VAS scores were respectively（7.26±1.83）,（1.85±1.21）,（2.54±1.40）,（3.07±1.51） scores before treatment,at the 1 month,1 and 2 years after treatment.There was significant difference between every post treatment and pre treatment.②JOA scoring of knee function was respectively（18.7±6.6）,（84.3±15.5）,（75.4± 22.4）,（64.8±25.6） scores before treatment,at the 1 month,1 and 2 years after treatment.There was significant difference between every post treatment and pre treatment.③Assessment of long term efficacy among 181 knees who were followed up 1 year,70 cases got excellent results,54 good,34 fair and 23 poor.Those who were followed up 2 years,40 cases got excellent results,54 good,53 fair and 34 poor.Knee function became poor along with time lapse.The efficiency was respectively 86.89%（53 /61）,79.17%（57 /72）,54.17%（26 /48） in mild knees,moderate knees,severe knees at the 2 years after treatment.Conclusion：The long term efficacy of intra articular injection with sodium hyaluronate is satisfactory in treating knee osteoarthritis.The efficacy is better for mild and moderate osteoarthritis than for the severe osteoarthritis.The short term efficacy is acceptable and the long term one is worse for the severe knees.

关 键 词：骨关节炎 膝 透明质酸 注射 关节内 

分 类 号：R684.305[医药卫生—骨科学]