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

作　　者：刘彧 邬春虎[1] 吴坤 邢更彦 胡晓华[1] 张联合[1] 陈长松[1] 尹华东[1] 马玉海[1] Liu Yu;Wu Chunhu;Wu Kun;Xing Gengyan;Hu Xiaohua;Zhang Lianhe;Chen Changsong;Yin Huadong;Ma Yuhai(Department of Orthopedics,Zhejiang Armed Police Corps Hospital,Hangzhou 310051,Zhejiang,China;Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China;Department of Orthopedics,The Third Medical Center of the Peoples Liberation Army,Beijing 100080,China)

机构地区：[1]武警浙江省总队医院骨科,浙江杭州310051 [2]北京大学第三医院骨科,北京100191 [3]中国人民解放军总医院第三医学中心骨科,北京100080

出　　处：《中国医学前沿杂志（电子版）》2024年第6期38-43,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：浙江省医药卫生科研项目(2021432378);浙江省中医药科技项目(2021ZB236)。

摘　　要：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 functiona

关 键 词：肥胖 骨关节炎 膝关节 体外冲击波 

分 类 号：R684.3[医药卫生—骨科学]