摘要
目的探讨关节内注射透明质酸钠（HA）治疗膝骨关节炎（OA）的疗效及其影响因素。方法将2014年3月至2015年3月在上海中医药大学附属曙光医院骨关节科门诊就诊的膝OA患者作为研究队列,纳入标准：按美国风湿病学会OA诊断标准诊断的原发性膝OA患者;年龄在40~75岁;按疗程完成关节内注射HA治疗;随访时间3个月以上。排除标准：继发性膝OA和无法联系到的患者。回顾性分析该队列的临床资料,包括一般人口学特征、膝关节的肿胀分级、X线的Kellgren＆Lawrence分级（K-L分级）、胫股角,采用患者自身主观综合评价有效、无效作为评价指标,衡量治疗后3个月的疗效。分析患者的性别、年龄、身体质量指数（BMI）、居住状况、关节肿胀分级、累及关节间隙、K-L分级及胫股角对治疗疗效的影响。年龄、BMI、胫股角等计量资料采用两独立样本t检验;性别、居住状况、累及关节间隙、肿胀分级、K-L分级等计数资料采用2检验。分析影响疗效的可能因素,并计算影响因素的相对危险度。结果共303例（348膝）纳入研究,有效240膝,总有效率69.0%。X线K-L分级≥3级、累及胫股关节间隙、存在关节积液≥Ⅱ级的患者关节内注射HA后的有效率分别为58.7%、62.1%、52.5%,与对应的其他患者的有效率相比存在统计学差异（P〈0.05）;相对危险度分别为1.552、1.795、1.644。结论关节内注射HA治疗膝OA时,对于累及胫股关节的中重度膝OA、存在Ⅱ度以上关节积液、骨挫伤患者,应慎重选择。
Objective To study the outcomes and influence factors of intraarticular hyaluronate injection in knee osteoarthritis. Methods The patients aged from 40 to 75 with knee osteoarthritis who were treated with full course of intraarticular injection of hyaluronate from March,2014 to March,2015 at the clinic of joint department in Shuguang Hospital Affiliated to Shanghai University of Tradition Chinese Medicine were recruited as study cohort. The diagnosis standard of American College of Rheumatoid was used. The cohort were followed up for at least three months. The patients with secondary osteoarthritis were excluded. The demography,swelling degree,Kellgren Lawrence degree（ K-L degree） of X-ray,and femoral tibial angles were studied as influence factors. Self-praise of the outcome at the 3rdmonth after the treatment was obtained. The measurement data such as age,body mass index（ BMI） and femoral tibial angle（ FTA）,were analyzed by T test. Chi-square test was used to analyze the enumeration data,such as swelling degree,K-L degree of X-ray. The possible risk factors were analyzed and the relative risk was calculated. Results A total of 303 patients（ 348 knees） were included. The outcomes of 240 knees were effective. The total effective rate was 69. 0%. The effective rates of the patients with K-L scale over three degrees,or with femoral tibial joint involved,or with intraarticular effusion scale over two degree were58. 7%,62. 1%,and 52. 5% respectively（ P〈0. 05）. The relative risks were 1. 552,1. 795,1. 644 respectively. Conclusion Hyaluronate should be used cautiously in knee osteoarthritis with effusion,bone contusion or in mild to severe degree of osteoarthritis.
出处
《中华关节外科杂志（电子版）》
CAS
2016年第3期15-18,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
透明质酸
骨关节炎
膝
队列研究
Hyaluronic acid
Osteoarthritis
knee
Cohort studies
