切换至 "中华医学电子期刊资源库"
高级检索
中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (10) : 925 -929. doi: 10.3877/cma.j.issn.1674-0785.2022.10.002

骨科学·临床研究

体外冲击波治疗膝关节炎伴屈曲畸形的疗效分析
张绍龙1, 曾俊杰1, 苑博1,†()   
  1. 1. 100123　北京，北京大学民航临床医学院　民航总医院骨科
  • 收稿日期:2022-10-08 出版日期:2022-10-15
  • 通信作者: 苑博

Efficacy of extracorporeal shock wave therapy in treatment of osteoarthritis of the knee with flexion deformity

Shaolong Zhang1, Junjie Ceng1, Bo Yuan1,†()   

  1. 1. Department of Orthopedics, Civil Aviation General Hospital, Civil Aviation Clinical College, Peking University, Beijing 100123, China
  • Received:2022-10-08 Published:2022-10-15
  • Corresponding author: Bo Yuan
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

张绍龙, 曾俊杰, 苑博. 体外冲击波治疗膝关节炎伴屈曲畸形的疗效分析[J]. 中华临床医师杂志(电子版), 2022, 16(10): 925-929.

Shaolong Zhang, Junjie Ceng, Bo Yuan. Efficacy of extracorporeal shock wave therapy in treatment of osteoarthritis of the knee with flexion deformity[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(10): 925-929.

目的

探讨体外冲击波（ESWT）治疗合并屈曲畸形膝关节炎的临床疗效。

方法

回顾性收集2021年1月至2021年12月民航总医院骨科行保守治疗的57例合并屈曲畸形膝关节炎患者的临床资料，包括年龄、性别、病程、体重指数、膝关节炎（Kellgren-Lawrence，K-L）分级、治疗前、治疗后即刻、治疗第3个月美国膝关节协会评分（KSS）、美国西安大略和麦克马斯特大学（WOMAC）骨关节炎指数评分、视觉模拟评分（VAS）、屈曲畸形角度（FD）及最大屈曲度（ROM），根据是否接受冲击波治疗分为冲击波组与非冲击波组。通过两独立因素t检验与秩和检验比较两组基础资料差异，通过重复测量方差分析比较两组治疗前及治疗后即刻、第3个月KSS评分、VAS评分、FD及ROM差异。

结果

冲击波组治疗3个月KSS评分、VAS评分、WOMAC评分、FD及ROM分别为（121.63±9.25、3.74±0.26、37.50±1.44、10.79±4.74、124.05±1.38），均较治疗前（91.63±10.41、6.11±0.26、51.63±0.97、15.37±0.56、110.00±3.37）明显改善（P＜0.05），且VAS评分、FD及ROM较非冲击波组（4.79±0.28、13.34±4.65、119.21±2.24）更佳（P＜0.05）。

结论

体外冲击波可有效改善膝关节炎伴屈曲畸形患者的关节功能及疼痛，并且可改善患者关节活动度，疗效较传统物理治疗效果更佳。

关键词: 膝关节炎, 体外冲击波, 活动范围, 屈曲畸形
Objective

To evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of osteoarthritis of the knee with flexion deformity (FD).

Methods

A retrospective study was conducted in patients who were diagnosed with osteoarthritis of the knee with FD and treated with conservative therapyat the Civil Aviation General Hospital from January 2021 to December 2021. A total of 57 patients were enrolled in this study, and they were divided into either an ESWT group or a non-EWST group. Age, gender, disease course, body mass index, Kellgren-Lawrence (K-L) grade, and Knee Society Score (KSS), Western Ontario and McMaster University (WOMAC) osteoarthritis index, Visual Analogue Scale (VAS) score, FD, and range of motion (ROM) before operation, immediately after operation, and 3 months after operation were recorded. Two independent samples t-test or rank-sum test was used to compare age, gender, disease course, body mass index, K-L grade. Repeated measures ANOVA was used to compare KSS, WOMAC, VAS, FD, and ROM.

Results

KSS, VAS, WOMAC, FD and ROM at 3 months after operation in the EWST group were 121.63±9.25, 3.74±0.26, 37.50±1.44, 10.79±4.74, and 124.05±1.38, respectively, which were significantly better than corresponding preoperative values (91.63±10.41, 6.11±0.26, 51.63±0.97, 15.37±0.56, and 110.00±3.37, respectively, P＜0.05). VAS, FD, and ROM at 3 months after operation were statistically better in the ESWT group than in the non-ESWT group (4.79±0.28, 13.34±4.65, and 119.21±2.24, respectively, P＜0.05).

Conclusion

ESWT is an effective treatment to relieve pain and improve joint function, ROM, and FD in patients with osteoarthritis of the knee with FD, which is better than traditional physical treatment.

Key words: Arthritis of knee, Extracorporeal shock wave therapy, Range of motion, Flexion deformity
表1 2组基础临床资料比较
项目 冲击波组 非冲击波组 统计值 P值
年龄（岁，
x¯
±s）		 51.92±8.52 52.95±5.96 -0.470 0.640
性别［例（%）］ -0.788 0.431
男性 14（35.9%） 5（27.8%）
女性 25（64.1%） 13（72.2%）
K-L分级［例（%）］ 0.098 0.754
Ⅱ级 13（33.3%） 7（38.9%）
Ⅲ级 17（43.6%） 7（38.9%）
Ⅳ级 9（23.1%） 4（22.2%）
病程（m，
x¯
±s）		 15.66±4.73 13.79±3.21 1.549 0.127
体重指数（kg/m2，
x¯
±s）		 26.74±3.65 27.73±2.98 -1.018 0.313
表2 2组患者功能评分结果比较（
xˉ
±s）
项目 治疗前 治疗后即刻 治疗后第3个月
KSS WOMAC VAS KSS WOMAC VAS KSS WOMAC VAS
冲击波组 91.63±10.41 51.63±0.97 6.11±0.26 130.63±4.29 28.16±2.95 2.79±1.08 121.63±9.25 37.50±1.44 3.74±0.26
非冲击波组 94.47±10.89 47.95±2.56 5.79±0.38 118.90±2.68 30.53±1.71 3.63±1.21 114.11±8.84 36.84±1.19 4.79±0.28
F值 0.821 1.490 0.396 4.902 9.294 9.143 2.600 2.666 8.431
P值 0.377 0.238 0.537 0.040 0.007 0.007 0.124 0.120 0.009
表3 2组患者FD及ROM结果比较（
xˉ
±s）
项目 治疗前 治疗后即刻 治疗后第3个月
FD ROM FD ROM FD ROM
冲击波组 15.37±0.56 110.00±3.37 8.16±0.56 125.26±1.11 10.79±4.74 124.05±1.38
非冲击波组 15.11±0.51 115.21±3.27 13.42±0.55 120.26±2.04 13.34±4.65 119.21±2.24
F值 0.183 1.146 29.268 5.029 4.697 4.612
P值 0.674 0.299 ＜0.001 0.038 0.004 0.046
1
Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice [J]. Lancet, 2011, 377(9783): 2115-2126.
2
Varela-Eirin M, Loureiro J, Fonseca E, et al. Cartilage regeneration and ageing: Targeting cellular plasticity in osteoarthritis [J]. Ageing Res Rev, 2018, 42: 56-71.
3
王友, 朱振安, 史定伟, 等. 膝关节屈曲挛缩畸形全膝关节置换术的软组织平衡 [J]. 中华骨科杂志, 2004, 24(4): 220-223.
4
中华医学会骨科学分会关节外科学组. 骨关节炎诊疗指南(2018年版) [J]. 中华骨科杂志, 2018, 38(12): 705-715.
5
Ramon S, Gleitz M, Hernandez L, et al. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia [J]. Int J Surg, 2015, 24: 201-206.
6
Zhao J, Huang H, Liang G, et al. Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis [J]. BMC Musculoskelet Disord, 2020, 21(1): 224.
7
An S, Li J, Xie W, et al. Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism [J]. Biosci Rep, 2020, 40(11): BSR20200926.
8
中华医学会物理医学与康复学分会, 肌肉骨骼疾病体外冲击波治疗专家共识组. 肌肉骨骼疾病体外冲击波治疗专家共识 [J]. 中华物理医学与康复杂志, 2019, 41(7): 481-487.
9
Lee WC, Ng GY, Zhang ZJ, et al. Changes on tendon stiffness and clinical outcomes in athletes are associated with patellar tendinopathy after eccentric exercise [J]. Clin J Sport Med, 2020, 30(1): 25-32.
10
Hsu WH, Yu PA, Lai LJ, et al. Effect of extracorporeal shockwave therapy on passive ankle stiffness in patients with plantar fasciopathy [J]. J Foot Ankle Surg, 2018, 57(1): 15-18.
11
Zhang H, Li ZL, Yang F, et al. Radial shockwave treatment promotes human mesenchymal stem cell self-renewal and enhances cartilage healing [J]. Stem Cell Res Ther, 2018, 9(1): 54.
12
Hashimoto S, Ichinose T, Ohsawa T, et al. Extracorporeal shockwave therapy accelerates the healing of a meniscal tear in the avascular region in a rat model [J]. Am J Sports Med, 2019, 47(12): 2937-2944.
13
Wang CJ, Weng LH, Ko JY, et al. Extracorporeal shockwave therapy shows chondroprotective effects in osteoarthritic rat knee [J]. Arch Orthop Trauma Surg, 2011, 131(8): 1153-1158.
14
Wang CJ, Cheng JH, Chou WY, et al. Changes of articular cartilage and subchondral bone after extracorporeal shockwave therapy in osteoarthritis of the knee [J]. Int J Med Sci, 2017, 14(3): 213-223.
15
Vetrano M, Ranieri D, Nanni M, et al. Hyaluronic Acid (HA), platelet-rich plasm and Extracorporeal Shock Wave Therapy (ESWT) promote human chondrocyte regeneration in vitro and ESWT-mediated increase of CD44 expression enhances their susceptibility to HA treatment [J]. PLoS One, 2019, 14(6): e0218740.
16
Heimes D, Wiesmann N, Eckrich J, et al. In vivo modulation of angiogenesis and immune response on a collagen matrix via extracorporeal shock waves [J]. Int J Mol Sci, 2020, 21(20): 7574.
17
Chen TW, Lin CW, Lee CL, et al. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella [J]. Kaohsiung J Med Sci, 2014, 30(7): 362-370.
18
Lizis P, Kobza W, Manko G. Extracorporeal shockwave therapy vs. kinesiotherapy for osteoarthritis of the knee: a pilot randomized controlled trial [J]. J Back Musculoskelet Rehabil, 2017, 30(5): 1121-1128.
19
韦明照, 李宏宇, 尹东, 等. 体外冲击波联合关节镜术治疗膝关节骨性关节炎 [J]. 中国矫形外科杂志, 2020, 28(7): 607-612.
20
Uysal A, Yildizgoren MT, Guler H, et al. Effects of radial extracorporeal shock wave therapy on clinical variables and isokinetic performance in patients with knee osteoarthritis: a prospective, randomized, single-blind and controlled trial [J]. Int Orthop, 2020, 44(7): 1311-1319.
21
Taheri P, Vahdatpour B, Mellat M, et al. Effect of extracorporeal shock wave therapy on lower limb spasticity in stroke patients [J]. Arch Iran Med, 2017, 20(6): 338-343.
22
Anwar N, Li S, Long L, et al. Combined effectiveness of extracorporeal radial shockwave therapy and ultrasound-guided trigger point injection of lidocaine in upper trapezius myofascial pain syndrome [J]. Am J Transl Res, 2022, 14(1): 182-196.
23
Brunelli S, Bonanni C, Traballesi M, et al. Radial extracorporeal shock wave therapy: a novel approach for the treatment of Dupuytren's contractures: a case report [J]. Medicine (Baltimore), 2020, 99(24): e20587.
24
穆莹, 姚鹏. 放散式体外冲击波治疗膝骨关节炎伴膝关节周围韧带钙化的疗效观察 [J]. 中国现代医学杂志, 2021, 31(11): 43-48.
[1] 吴俊贤, 曾俊杰, 许有银, 苑博. 体外冲击波疗法辅助治疗肩袖修补术后关节僵硬[J]. 中华关节外科杂志(电子版), 2023, 17(04): 571-576.
[2] 邬春虎, 马玉海, 陈长松, 尹华东, 朱晓峰, 何剑星, 刘彧. 冲击波联合富血小板血浆对骨关节炎软骨损伤的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(03): 334-339.
[3] 薛清佩. 玻璃酸钠注射对半月板撕裂患者疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(02): 288-291.
[4] 江钰璇, 陈颖, 周钟明, 温宝泓, 陈文韬, 钟国庆, 张余, 李丽萍. 全身关节过度活动的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(01): 52-59.
[5] 王素凯, 邵季超, 仲亮, 李静, 李军勇, 宁翠利. 发散式与聚焦式冲击波治疗肩周炎合并糖尿病的疗效比较[J]. 中华关节外科杂志(电子版), 2022, 16(04): 406-411.
[6] 刘俊利, 曾一平, 崔京钦, 金正. 布洛芬联合体外冲击波治疗膝骨关节炎的随机对照研究[J]. 中华关节外科杂志(电子版), 2022, 16(03): 261-266.
[7] 李沅隆, 潘海, 袁霆, 张志杰, 周宏宇, 张纳, 屠宏亮, 李佳卉, 李培. 体外冲击波联合富血小板血浆治疗骨不连[J]. 中华关节外科杂志(电子版), 2022, 16(02): 246-249.
[8] 徐慧新, 刘波, 唐立钧. 体外冲击波治疗>1 cm输尿管上段结石失败的预测模型建立[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 506-511.
[9] 木彬, 邓志强, 刘一萍, 高云茂, 陈天祥, 罗永朴, 湛海伦. 高密度肾输尿管上段结石经皮肾镜与体外冲击波碎石的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(06): 516-519.
[10] 廖国龙, 刘颖, 唐嘉妮, 熊海云, 庞俊, 江东根. 中药田七治疗体外冲击波碎石术后早期肾损伤的前瞻性随机对照研究[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(05): 415-418.
[11] 章璟, 吕涛, 张鹤, 胡传义, 崔心刚, 姜宁. 腔镜时代体外冲击波碎石患者的选择[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 354-357.
[12] 张子砚, 曾红, 许苑晶, 郭璐琦, 王金武, 王少白, 任富超, 缪伟强, 戴尅戎, 王茹. 膝关节生物力学标志物预测膝关节炎研究进展[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 315-320.
[13] 徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.
[14] 廖家权, 吴波, 唐昌敏. 体外冲击波联合肌电生物反馈对脑卒中后足下垂的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 286-292.
[15] 杨冰, 潘东亮, 晋连超, 周哲, 高鹏飞, 周赜, 张志宏, 李宁忱. 体外冲击波碎石对高密度输尿管结石治疗效果的影响因素分析[J]. 中华临床医师杂志(电子版), 2022, 16(04): 308-311.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号