胡永召 徐通 阮志华 赵腾飞 韩柄秋 张健 时红

【摘 要】目的：观察骨髓水肿区减压联合臭氧治疗膝骨关节炎的临床疗效。方法：将62例膝骨关节炎患者随机分为治疗组和对照组，每组31例。治疗组采用骨髓水肿区减压联合臭氧治疗，对照组采用单纯臭氧治疗。观察2组临床疗效，以及治疗前后疼痛视觉模拟评分法（VAS）评分、纽约特种外科医院（HSS）膝关节功能评分。结果：治疗组显效24例，有效5例，无效2例，总有效率为93.55%;对照组显效13例，有效10例，无效8例，总有效率为74.19%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组患者疼痛VAS评分较治疗前降低，HSS评分较治疗前升高，差异有统计学意义（P < 0.05）;且治疗组VAS评分、HSS评分优于对照组（P < 0.05）。结论：骨髓水肿区减压联合臭氧治疗膝骨关节炎，通过骨髓水肿区减压减缓了骨质的退变，联合臭氧减轻关节周围软组织的炎症反应，体现了筋骨并重的理念，值得临床进一步推广应用。

【关键词】 骨关节炎，膝;骨髓水肿区;钻孔减压;臭氧;临床疗效

【ABSTRACT】Objective：To observe the clinical effect of bone marrow edema area decompression combined with ozone in the treatment of knee osteoarthritis.Methods：Sixty-two patients with knee osteoarthritis were randomly divided into a treatment group and a control group，31 cases in each group.The treatment group was treated with bone marrow edema area decompression combined with ozone，while the control group was treated with ozone alone.The clinical effect of the two groups，as well as the VAS score of HSS before and after treatment was observed.Results：In the treatment group，24 cases were markedly effective，5 cases were effective，2 cases were ineffective，and the total effective rate was 93.55%，while in the control group，13 cases were markedly effective，10 cases were effective，8 cases were ineffective，and the total effective rate was 74.19%.The difference between the two groups was statistically significant（P < 0.05）.After treatment，the VAS score in both groups was lower than that before treatment，and the HSS score was higher than that before treatment，the difference being statistically significant（P < 0.05）.The VAS score and HSS score in the treatment group were better than those in the control group（P < 0.05）.Conclusion：Bone marrow edema area decompression combined with ozone slows down the degeneration of bone and reduces the inflammatory response of the soft tissue around the joint，embodying the concept of emphasis on both sinews and bones，worthy of further clinical application.

【Keywords】 osteoarthritis，knee;bone marrow edema area;drilling decompression;ozone;clinical efficacy

膝骨關节炎（knee osteoarthritis，KOA）是中老年常见疾病，严重影响生活质量。其病理改变多以软骨磨损和软骨下骨的病变为主，继而影响关节囊、滑膜以及周围肌腱韧带等组织。臭氧疗法是治疗KOA的一种新兴方法，近来应用于膝关节腔注射，收到很好的疗效[1]。钻孔减压术长期以来被用于缓解KOA疼痛[2]，两者联合应用鲜有报道。笔者采用骨髓水肿区减压联合臭氧关节腔内注射治疗KOA，现总结报告如下。

1 临床资料

1.1 一般资料 选取2016年8月至2018年8月在开封市中医院骨伤一科就诊的KOA患者62例，采用随机数字表法分为治疗组和对照组，每组31例。治疗组男10例，女21例;年龄43～80岁，平均（56.21±6.39）岁;病程最短2个月，最长16年，平均（4.79±6.43）年;发病关节双膝6例，单膝25例;骨关节炎放射学分级（Kellgren-Lawrence分级）Ⅰ级6例，Ⅱ级15例，Ⅲ级10例。对照组男8例，女23例;年龄44～81岁，平均（54.94±6.26）岁;病程最短3个月，最长15年，平均（4.82±6.71）年;发病关节双膝8例，单膝23例;Kellgren-Lawrence分级Ⅰ级5例，Ⅱ级17例，Ⅲ级9例。……