几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效分析  

Analysis of the clinical efficacy of intra-articular injection of chitosan combined with low-dose corticosteroids in the treatment of knee osteoarthritis in the early and middle stages

作　　者：刘久翔 吕天润[1] 曹亮[1] 黄晓文[1] 鲁璐 LIU Jiuxiang;LÜTianrun;CAO Liang;HUANG Xiaowen;LU Lu(Department of Orthopedics Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Rheumatology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,江苏南京210029 [2]南京中医药大学附属医院风湿免疫科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第8期1114-1119,1145,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省中医药管理局(QN202209)。

摘　　要：目的:探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法:回顾性分析2021年6月—2022年12月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共164例。按治疗方式分为3组:A组(对照组,口服给药)55例,B组(几丁糖关节腔注射+口服给药)53例,C组(几丁糖联合小剂量糖皮质激素关节腔注射给药)56例。比较3组治疗前后的疼痛视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、美国特种外科医院(Hospital for Special Surgery,HSS)评分和关节液炎性细胞因子白介素(interleukin,IL)-1、IL-6和肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的变化,并对临床疗效进行评价。结果:所有病例均获得随访,随访时间7~12个月,无失访病例。每组治疗后的VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平均优于治疗前,差异有统计学意义(P<0.05)。治疗前VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平在3组间的差异无统计学意义(P>0.05);但治疗后各项指标在3组间的差异有统计学意义(P<0.05);两两比较显示,C组优于A、B两组,B组优于A组,差异均有统计学意义(P<0.05)。3组临床疗效评价比较,差异有统计学意义(P<0.05)。结论:几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎临床疗效显著,具有创伤小,起效迅速,疗效持久的特点,同时避免了外用或口服非甾体类抗炎药的不良反应,作为一线治疗方案,建议在临床推广和使用。Objective:To investigate the clinical efficacy of intra-articular injection of chitosan combined with low-dose corticosteroids in the treatment of knee osteoarthritis(KOA)in the early and middle stages.Methods:A retrospective analysis was conducted on 164 patients with KOA who visited and were followed up at the outpatient department of orthopedics at the First Affiliated Hospital of Nanjing Medical University from June 2021 to December 2022.Based on the treatment methods,patients were divided into three groups:Group A(control group,oral administration)consisted of 55 patients,Group B(intra-articular injection of chitosan+oral administration)had 53 patients,Group C(intra-articular injection of chitosan combined with low-dose glucocorticoids)included 56 patients.Variations in pain visual analogue scale(VAS),Lysholm score,Hospital for Special Surgery(HSS)score,and the levels of inflammatory cytokines in the synovial fluid(interleukin-1,IL-1;interleukin-6,IL-6;tumor necrosis factor-alpha,TNF-α)were compared before and after treatment.Clinical efficacy was also evaluated.Results:All cases were followed up for 7-12 months and no cases were lost.Post-treatment VAS scores,Lysholm scores,HSS scores,and the levels of synovial fluid inflammatory cytokines(IL-1,IL-6,and TNF-α)were all significantly improved compared to pre-treatment levels in each group(P<0.05).There were no significant differences in pre-treatment VAS scores,Lysholm scores,HSS scores and the levels of IL-1,IL-6,and TNF-αamong the three groups(P>0.05);however,post-treatment comparisons showed significant differences(P<0.05).Compared with each other,Group C showed better outcomes than Groups A and B,and Group B was superior to Group A,with significant statistical differences(P<0.05).The comparison of clinical efficacy among the three groups also showed statistically significant differences(P<0.05).Conclusion:Intra-articular injection of chitosan combined with low-dose corticosteroids shows significant clinical efficacy in the treatment of KOA in early and

关 键 词：骨关节炎 几丁糖 小剂量糖皮质激素 关节腔注射 

分 类 号：R684.3[医药卫生—骨科学]