季红辉　蒋聿瑛　补灿灿

[摘要] 目的 探讨系统性康复干预在关节腔内药物注射治疗膝关节骨性关节炎（OA）中的应用。 方法 选取2015年7月～2016年10月膝关节OA患者86例，将其分为康复组44例和对照组42例。两组均予以膝关节腔内注射25 mg玻璃酸钠，1次/周，连用6周。对照组予以常规康复干预，康复组加以系统性康复干预，两组均干预6周。观察两组干预治疗前后疼痛评分和膝关节功能变化，并比较近期及远期临床效果。 结果 干预6周后，两组VAS评分下降，HSS评分上升（P<0.05或P<0.01），且治疗后康复组VAS评分低于对照组，HSS评分高于对照组（P<0.05）；同时康复组近期临床总有效率优于对照组（χ2=5.49，P<0.05）。随访半年，康复组远期临床总有效率优于对照组（χ2=4.67，P<0.05）。 结论 系统性康复干预在关节腔内药物注射治疗膝关节OA中的应用效果较肯定，能更有效缓解其临床症状，降低疼痛程度，提高膝关节功能，且远期效果亦较佳。

[关键词] 骨性关节炎；膝关节；系统性康复干预；腔内药物注射

[中图分类号] R684.3 [文献标识码] B [文章编号] 1673-9701（2018）04-0108-03

[Abstract] Objective To investigate the application of systemic rehabilitation intervention in the treatment of knee osteoarthritis（OA） by intra-articular injection of drugs. Methods Totally 86 patients with knee OA from July 2015 to October 2016 were divided into rehabilitation group （n=44） and control group （n=42）. Both groups were given intra-articular injection of 25 mg sodium hyaluronate， 1 time/week， for 6 weeks. The control group was given routine rehabilitation intervention， and the rehabilitation group was treated with systemic rehabilitation intervention. Two groups were intervened for 6 weeks. The changes of pain scores and knee joint function before and after intervention were observed in both groups， and the clinical effects of short-term and long-term were compared. Results After 6 weeks of intervention， the VAS score in two groups decreased and the HSS score increased（P<0.05 or P<0.01）. After treatment， the VAS score of the rehabilitation group was lower than that of the control group and the HSS score of the rehabilitation group was higher than that of the control group （P<0.05）. The short-term total clinical effective rate of the rehabilitation group was better than that of the control group（χ2=5.49， P<0.05）. The patients were followed up for 6 months， and the long-term total clinical effective rate of the rehabilitation group was better than that of the control group （χ2=4.67， P<0.05）. Conclusion The systemic rehabilitation intervention has positive application effect on the intra-articular drug injection in the treatment of knee osteoarthritis， which can be more effective in relieving their clinical symptoms， reduce pain and improve knee function， and the long-term effect is also great.

[Key words] Osteoarthritis； Knee joint； Systemic rehabilitation intervention； Intra-cavity drug injection

膝關节骨性关节炎（Osteoarthritis，OA）是常用的慢性退行性关节疾病，好发于中老年人，主要表现为膝关节肿痛、僵硬及活动障碍，病理特点为关节软骨退行性改变引起软骨破坏、丢失，常伴有关节周围骨质增生，其病情常反复发作，严重影响日常生活和工作质量[1-3]。膝关节OA目前在临床上还没有理想的治疗方法，口服药物保守治疗虽可缓解临床症状，但难以抑制其病情进展[4-6]。关节腔内注射药物是目前治疗膝关节OA最有效的方法，而膝关节功能恢复的好坏与腔内注射后能否坚持严格康复干预有很大关系。近年来研究发现关节腔内药物注射治疗膝关节OA患者予以康复干预可提高其关节功能[7，8]。本研究观察了系统性康复干预在关节腔内药物注射治疗膝关节OA中的应用，现报道如下。

1 资料与方法

1.1 一般资料

选取86例膝关节OA病例，均为2015年7月～2016年10月骨科门诊就诊患者。……