林华　郑锦辉

[摘要] 目的 探讨系统性康复锻炼提高透明质酸关節腔内注射治疗膝关节骨性关节炎（OA）的疗效。 方法 选取膝关节OA患者84例，随机将其分为干预组和对照组各42例。两组患者予以透明质酸注射液20 mg关节腔内注射，每周1次，连用4周。对照组予以常规干预，干预组在对照组基础上予以综合康复干预治疗。观察两组干预治疗前后疼痛程度、膝关节功能的变化情况，并比较其近期及远期临床疗效。 结果 干预4周后，两组患者VAS评分较干预前明显下降（P<0.05或P<0.01），且干预组下降幅度较对照组更明显（P<0.05）；干预组患者膝关节Lysholm评分优良率较对照组更高（P<0.05）；干预组近期临床总有效率较对照组更高（χ2=4.09，P<0.05）。随访6个月，干预组远期临床总有效率较对照组更高（χ2=3.98，P<0.05）。 结论 系统性康复锻炼提高透明质酸关节腔内注射治疗膝关节OA的近期及远期疗效均较确切，能明显改善患者临床症状及体征，降低疼痛程度，提高膝关节的活动度。

[关键词] 骨性关节炎；膝关节；系统性康复锻炼；透明质酸

[中图分类号] R684 [文献标识码] B [文章编号] 1673-9701（2017）28-0065-04

[Abstract] Objective To investigate the effect of systemic rehabilitation exercises on improving the efficacy of intra-articular injection of hyaluronic acid in the treatment of knee osteoarthritis （OA）. Methods A total of 84 patients with OA were selected and randomly divided into intervention group and control group， with 42 patients in each group. Two groups of patients were given intra-articular injection of 20 mg hyaluronic acid， once a week for 4 weeks consecutively. The control group was given routine intervention， and the intervention group was given comprehensive rehabilitation intervention on the basis of the control group. The changes of pain degree and the function of knee joint before and after the intervention were observed in both groups， and their short-term and long-term clinical efficacy were compared. Results After 4 weeks of intervention， the VAS scores in the two groups were significantly lower than those before intervention（P<0.05 or P<0.01）， and the decline in the intervention group was more obvious than that in the control group （P<0.05）； the excellent and good rate of Lysholm score of the knee joint in the intervention group was higher than that in the control group（P<0.05）； the short-term clinical effective rate in the intervention group was higher than that in the control group（χ2=4.09， P<0.05）. After 6-month follow-up， the long-term clinical effective rate in the intervention group was higher than that in the control group（χ2=3.98， P<0.05）. Conclusion The short-term and long-term effect of systemic rehabilitation exercises on improving the efficacy of intra-articular injection of hyaluronic acid in the treatment of knee osteoarthritis are exact， which is able to significantly improve patients' clinical symptoms and physical signs， reduce the degree of pain and improve the activity of knee joint.

[Key words] Osteoarthritis； Knee joint； Systemic rehabilitation exercises； Hyaluronic acidendprint

骨性关节炎（OA）是骨科门诊常见的关节软骨退行性疾病，好发于膝关节，临床表现为反复发作的关节肿痛及活动障碍[1]。膝关节OA的发病机制至今尚不完全明确，临床上尚无特效的治疗药物[2]。透明质酸是目前治疗膝关节OA常用的药物，但部分患者疗效欠理想[3，4]，近年来研究发现对透明质酸关节腔内注射治疗膝关节OA的患者予以康复锻炼治疗可提高其临床效果[5，6]。本研究观察了系统性康复锻炼提高透明质酸关节腔内注射治疗膝关节OA的疗效，现报道如下。

1 资料与方法

1.1 一般资料

选取2015年1月～2016年6月骨科门诊治疗的膝关节OA患者84例。纳入标准：符合2007年制定《膝关节骨性关节病》中相关的诊断标准[7]，且经X线、CT或磁共振检查确诊。排除标准：①伴有风湿免疫、结缔组织病等者；②有膝关节结核、肿瘤、类风湿关节炎、创伤性骨关节炎或手术史者。……