摘要
目的:探索一种治疗膝骨性关节炎较为有效的药物疗法。方法:选择2002-05/2005-03在暨南大学附属第一医院骨科就诊的膝关节骨性关节炎患者127例,均同意接受分组治疗。按应用的不同药物疗法分为3组,双氯芬酸钠组43例,透明质酸钠组45例,混合用药组39例。①双氯芬酸钠组单独服用非甾体类消炎止痛药双氯芬酸钠75mg,1次/d,共4周。②透明质酸钠组在患者关节腔内注入透明质酸钠2mL,1次/周,4次为1个疗程,前3天加服双氯芬酸钠75mg,1次/d,共4周。③混合用药组在患者关节腔内注入透明质酸钠2mL,1次/周,4次为1个疗程,前3天服用双氯芬酸钠75mg,1次/d,同时加服硫酸氨基葡萄糖2粒,3次/d,共4周。各组患者分别于治疗前及治疗后2,4,8和12周进行膝关节综合评分(36～0),包括静息痛、运动痛、关节压痛、肿胀、活动度、行走能力6项,分数越高症状越轻。结果:纳入患者127例,分为3组,全部进入结果分析,无脱落。①各组患者治疗前及治疗后2,4,8和12周的膝关节综合评分比较:双氯芬酸钠组患者用药后2周膝关节综合评分最高为23.14±2.33,随后4,8,12周评分有所下降,至12周膝关节综合评分降至9.90±2.62。透明质酸钠组患者用药后2周膝关节综合评分达到24.16±2.76,用药后4周最高为30.10±2.49,12周降至22.90±3.10。混合用药组患者用药后2周膝关节综合评分已达到25.13±3.47,4周达31.03±2.25,8周和12周膝关节综合评分一直保持在高水平30.84±2.33和30.04±2.18。混合用药组患者用药后4,8,12周的评分均显著高于同期双氯芬酸钠组和透明质酸钠组(P<0.05～0.01)。②各组患者的不良反应:双氯芬酸钠组治疗过程中8例患者出现明显胃肠反应,透明质酸钠组和混合用药组无明显胃肠反应。结论:双氯芬酸钠、透明质酸钠和硫酸氨基葡萄糖联合应用,可以减少由于长期服用非甾体类消炎止痛药所引起的不良反应,获得近期及远期的满意疗效,是较为理想的药物疗法。
AIM： To explore .an effective method to treat knee osteoarthritis using drugs, METHODS： Totally 127 patients with knee osteoarthritis, who were diagnosed at the Department of Orthopaedics, First Affiliated Hospital of Jinan University from May 2002 to March 2005, were enrolled and they agreed to accept grouping therapy, They were divided into 3 groups according to the different drugs： 43 cases in diclofenac sodium group, 45 cases in the sodium hyalurate group and 39 cases in the mixed drug group. ① The patients in the diclofenac sodium group were given 75 mg diclofenac sodium, non-steroidalanti-inflammatory antalgica drugs, once a day for 4 weeks.②Sodium hyalurate 2 mL was injected into articular cavity in the patients of the sodium hyalurate group weekly for 4 weeks. In the first 3 days 75 mg diclofenac sodium was taken daily for 4 weeks. ③2 mL sodium hyalurate was injected into articular space of patients of the mixed drug group weekly for 4 weeks, and in the first 3 days 75 mg diclofenac sodium was given daily, in the same time 2 tablets of glucosamine sulfate capsules was added, 3 times a day for 4 weeks. Knee joint synthetical score （36-0） was performed before treatment and the 2nd, 4th, 8th and 12th weeks after treatment, respectively in patients of every group, including rest pain, exercise pain, joint tenderness, swelling, activity and walking ability, the higher the score, the lighter the synthesis was. RESULTS： A total of 127 patients from 3 groups were involved in the result analysis, without drop out.①Comparison of knee joint synthetical score before treatment and the 2^nd, 4^th, 8^th and 12^th weeks after treatment in patients of every group： Two weeks after taking medicine the highest score in the patients of the diclofenac sodium group was （23.14±2.33）, and score decreased at the 4^th, 8^th and 12^th weeks, it was （9.90±2.62） at the 12^th week. Two weeks after taking drug in the sodium hyalurate group the score was （24.16±2.76）, and at the 4^th week it was the highest （30.10±2.49）, and （22.90±3.10） at the 12^th week. In the mixed drug group the score was （25.13±3.47） at the 2^nd week, and reached （31.03±2.25） at the 4^th week, it peaked at the 8^th and 12^th weeks （30.84±2.33） and （30.04±2.18） all the time, respectively. The scores in the patients of the mixed drug group was higher significantly than those in the diclofenac sodium group and the sodium hyalurate group at the 4^th, 8^th and 12^th weeks after taking medicine （P 〈 0.05-0.01）.②Side effect in patients of each group： In the treatment there was obvious stomach-bowel reaction in the 8 patients of the dielofenac sodium group, and there was no this reaction in the sodium hyalurate group and the mixed drug group. CONCLUSION： Combining diclofenac sodium, sodium hyalurate and glucosamine sulfate can decrease the side effect induced by the non-steroidalanti-inflammatory antalgica drugs for a long time, obtain satisfactory effect in the near future and for a long term, which is an ideal pharmacotherapy.
出处
《中国临床康复》
CAS
CSCD
北大核心
2006年第12期21-23,共3页
Chinese Journal of Clinical Rehabilitation
基金
暨南大学医学院科研项目(2003019)~~
