摘要
目的观察体外冲击波联合玻璃酸钠治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效及对关节液中白介素-32(interleukin-32,IL-32)、Dickopff相关蛋白1(Dickopff-1,DKK-1)水平的影响。方法将50例KOA患者随机分为治疗组和对照组,各25例。治疗组男16例,女9例;平均年龄(57.4±10.1)岁,病程(3.1±2.3)年。对照组男18例,女7例;平均年龄(58.3±10.2)岁,病程(3.3±1.7)年。对照组给予关节腔内注射玻璃酸钠,每周1次,共治疗5周。治疗组在对照组基础上加用体外冲击波治疗,每周1次,共治疗5周。在干预前和干预第5周采用活动时疼痛视觉模拟评分(visual analogue scale,VAS)、骨关节炎严重程度评分法(lequesne指数)和美国西部Ontario与McMaster大学骨关节炎指数(western Ontario and McMaster University osteoarthritis index,WOMAC)评分评价两组患者疗效,检测并比较两组患者关节液中IL-32、DKK-1水平的变化。结果两组患者治疗后VAS评分、Lequesne指数评分、WOMAC评分均明显降低(P<0.05或0.01),治疗后治疗组各评分明显低于对照组(P<0.05或0.01)。治疗后两组患者关节液中IL-32水平比治疗前显著下降(P<0.01),治疗组DKK-1水平较治疗前增高(P<0.01);治疗后治疗组关节液中IL-32水平显著低于对照组(P<0.05),而治疗后治疗组DKK-1水平则显著高于对照组(P<0.05)。结论体外冲击波联合玻璃酸钠治疗KOA疗效显著,可明显减轻关节疼痛,改善膝关节活动功能,其作用机制可能与降低关节液中IL-32水平、提高DKK-1水平有关。
Objective To observe the clinical efficacy of extracorporeal shock wave therapy combined with intra-articular injectioin of hyaluronate on knee osteoarthritis（KOA）and its effect on interleukin-32（IL-32）,Dickkopf-1（DKK-1）in synovial fluid.Methods A total of 50 patients with knee osteoarthritis were randomly divided into two groups：treatment group（n=25）and control group（n=25）.The control group was treated with intra-articular injection of sodium hyluronate alone,once per week for 5weeks.The treatment group was treated with extracorporeal shock wave therapy on the basis of the control group,once per week for 5weeks.Before intervention and 5th week after the intervention,the clinical efficacy in both groups were evaluated by Visual Analog Scale（VAS）on movement,Lequesne index and Western Ontario and McMaster Universities（WOMAC）Osteoarthritis index.The levels of IL-32,DKK-1in synovial fluid were determined and compared.Results The socres of VAS,Lequesne index and WOMAC Osteoarthritis index after treatment in both groups were significantly lower than those before treatment（P〈0.05）.The socres of VAS,Lequesne index and WOMAC Osteoarthritis index after treatment in treatment group were significantly lower than those in the control group（P〈0.05）.Compared with before treatment,the levels of IL-32 in synovial fluid after treatment in both groups were significantly lower than those（all P〈0.01）.The levels of DKK-1after treatment in the treatment group were significantly higher than that before treatment（P〈0.01）.The levels of IL-32 in synovial fluid after treatment in treatment group were significantly lower than that in the control group（P〈0.05）.The levels of DKK-1were significantly higher than that in the control group（P〈0.05）.Conclusion The extracorporeal shock wave therapy combined with intra-articular injectioin of hyaluronate has significant curative effect.It can relieve the pain and improve the function of knee joint in the patients with KOA,which is correlated with decreased the levels of IL-32 and increased the levels of DKK-1in synovial fluid.
出处
《实用骨科杂志》
2017年第9期807-810,共4页
Journal of Practical Orthopaedics
