| 李明真,张元鸣飞,李 涛,周谋望.体外冲击波治疗膝关节骨性关节炎的疗效观察[J].中国康复医学杂志,2020,(12):1444~1449 |
| 体外冲击波治疗膝关节骨性关节炎的疗效观察 点此下载全文 |
| 李明真 张元鸣飞 李 涛 周谋望 |
| 北京大学第三医院，北京市，100191 |
| 基金项目： |
| DOI：10.3969/j.issn.1001-1242.2020.12.007 |
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| 摘要： |
| 摘要
目的：本研究将通过临床随机对照研究观察体外冲击波治疗（ESWT）对膝关节骨性关节炎（KOA）患者的疼痛和功能状态的影响，并探讨体外冲击波治疗后T2 mapping的变化及其意义。
方法：选取36例早中期膝关节骨性关节炎患者为受试者。将符合纳入标准的受试者随机分为对照组和试验组，试验组接受以肌力训练为主的康复训练，包括膝关节活动度训练、下肢肌力训练等，并进行超声引导下ESWT治疗；对照组行以肌力训练为主的康复训练，并进行冲击波能流密度为0的超声引导下ESWT治疗。对所有受试者，分别在治疗前、治疗后即刻及治疗后12周（±7天）行膝关节活动度、VAS评分、WOMAC评分、6MWT等评定，治疗前及治疗后12周（±7天）行膝关节核磁T2 mapping评估软骨损伤和退变程度。
结果：试验组和对照组相比较，治疗后即刻及治疗后12周VAS评分和WOMAC评分均存在显著性差异（P＜0.05），在WOMAC评分中的疼痛和僵硬评分存在显著性差异（P＜0.05），关节功能评分无显著性差异（P＞0.05）；两组治疗后即刻与治疗前6MWT差值及治疗后12周与治疗前差值存在显著性差异（P＜0.05）。治疗后12周（±7天）试验组和对照组T2 mapping值无显著性差异（P＞0.05）；T2 mapping值与VAS评分、WOMAC评分均无显著相关性（R＜0.4）。
结论：体外冲击波治疗可减轻膝关节骨性关节炎患者的疼痛，改善膝关节功能，有效提高患者的步行能力。本研究条件下体外冲击波治疗不能改善膝关节骨性关节炎患者关节软骨的T2 mapping值，T2 mapping值与膝关节骨性关节炎患者的膝关节疼痛和功能无直接关系。 |
| 关键词：膝关节骨性关节炎 体外冲击波治疗 软骨损伤 T2 mapping |
| Peking University Third Hospital， 100191 Download Fulltext |
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| Peking University Third Hospital， 100191 |
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| Abstract: |
| Abstract
Objective： To investigate the efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of knee osteoarthritis， and to investigate if shock wave can delay the progression of knee osteoarthritis in the early and middle stage by improving the cartilage condition.
Method： 36 patients with early-to-mid stage knee osteoarthritis were selected and randomly divided into control group and experimental group， Patients in the experimental group received rehabilitation training focusing on muscle strength training， including knee range of motion training and lower limb muscle strength training， ESWT guided by ultrasound was performed at the same time， and in the control group patients received rehabilitation training focusing on muscle strength training，however the ESWT energy flow density was 0.For all subjects， knee joint range of motion，VAS score， WOMAC score and 6MWT were assessed before treatment， immediately after treatment and 12 weeks(±7 days) after treatment， and knee joint magnetic resonance imaging was performed before treatment and 12 weeks(±7 days) after treatment to assess the extent of cartilage lesions.
Result： There were significant differences in VAS score and WOMAC score immediately after treatment and 12 weeks(±7 days) after treatment compared with the controls (P<0.05)， and there were significant differences in WOMAC pain and stiffness score (P<0.05)， nevertheless，there were no significant differences in joint function score (P>0.05) in WOMAC .The difference value of 6MWT immediately after treatment and before treatment and the difference value of 12 weeks (±7 days) after treatment and before treatment were significantly different (P<0.05). There was no significant difference in T2 mapping between the experimental group and the control group at 12 weeks (±7 days) after treatment(P>0.05)， There was no significant correlation between T2 mapping and WOMAC score (R<0.4).
Conclusion： Extracorporeal shock wave therapy could alleviate the pain of patients with knee osteoarthritis， and it could improve knee joint function， and effectively improved the walking ability of patients.Extracorporeal shock wave therapy could not improve the T2 mapping value of cartilage in patients with knee osteoarthritis in this study， and T2 mapping value of articular cartilage has no direct relationship with pain and function of knee joint in patients with knee osteoarthritis. |
| Keywords:knee osteoarthritis extracorporeal shock wave therapy cartilage injury T2 mapping |
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