退化性膝關節炎病人注射玻尿酸的生理功能療效評估：初步報告

The Therapeutic Effects of Intra-articular Hyaluronic Acid on the Physical Functioning of Patients with Knee Osteoarthritis: A Preliminary Report

周正亮(Chen-Liang Chou) ； 羅元廷(Yuan-Ting Lo) ； 柳復威(Fu-Wei Liu) ； 黃麗龍(Li-Lung Haung) ； 陳俊忠(Jin-Jong Chen)

《台灣復健醫學雜誌》 40卷2期 (2012/06) Pp. 77-83

https://doi.org/10.6315/2012.40(2)03

摘要

退化性膝關節炎是造成老人失能的主要疾病之一，也是造成日常生活活動受限最主要的關節病變，同時也造成龐大的社會負擔。依據中央健保局2000年全民健保總醫療費用分析指出，退化性關節炎所致之人工關節置換術中，全膝關節置換術醫療費用支出達26.3億元，為住院醫療費用支出之第二名。退化性膝關節炎的病程是不斷的緩慢退化，治療的目標是以減輕病患的疼痛、改善關節活動度與功能、及提升生活品質為主。本研究選取雙側退化性膝關節炎的個案，每週膝關節內注射玻尿酸一次，共注射五次，注射前後以西安大略及麥可麥司特大學關節炎量表（Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC）、簡易36生活品質量表（Short Form-36, SF-36）及功能表現測試(包括關節活動度、肌肉量測量、下肢肌力測量及起站測試)評估其對退化性膝關節炎生理功能的療效，統計分析採用paired-T test分析。共有21人完成雙側玻尿酸注射療程，結果發現，在施打玻尿酸後，WOMAC在疼痛子分數（p=0.002）、僵硬子分數（p=0.017）、及整體分數（p=0.013)ｍ）有顯著下降，身體功能子分數則是有下降的趨勢（p=0.091），但未達顯著差異；在功能表現測試中，膝關節屈曲活動度有明顯改善，而起站測試(sit to stand)的穩定期與總時間在施打玻尿酸後未有顯著下降。由本研究結果顯示，膝關節玻尿酸的注射確實有其生理功能的療效，可為正規退化性膝關節炎的標準治療方式之一。（台灣復健醫誌2012；40(2)：77 - 83）

關鍵字

生理功能（physical function） ； 退化性膝關節炎（knee osteoarthritis） ； 玻尿酸（hyaluronic acid）

並列摘要

Osteoarthritis of the knee joints is one of the most disabling diseases among the elderly because it causes limitations affecting many daily activities, and this results a large economic burden on public health. According to the date from the Bureau of National Health Insurance in 2000, the total expenditure of money on total knee replacements due to osteoarthritis reached 2.63 billion dollars, which was the second place in all inpatient medical expenses.The natural course of osteoarthritis of the knee joints is a gradual degeneration. As a result, treatments are aimed at pain alleviation, improving the joint's range of motion and functioning, and improving the patient's quality of life. This study enrolled patients with osteoarthritis of the bilateral knee joints. Five hyaluronic acid (Unihylon Dispo) injections at weekly intervals into the bilateral knees were carried out. Outcome measures, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and tests for assessing physical functioning (knee range of motion, lower limb strength and the sit to stand test), were evaluated before and after the intervention on physical functioning.A total of 21 patients completed the study. There were statistically significant improvement in the WOMAC pain subscore, stiffness subscore and total score. There was also a trend towards improvement in the WOMAC physical function subscore. Among the various tests assessing physical functioning, there was a significant improvement in the knee flexion range of motion. However, stabilization phase duration and the total time for the sit to stand test were not significantly decreased.Overall, in patients with osteoarthritis of the knee joints, the intraarticular injection of hyaluronic acid resulted in an improvement in physical functioning and this support the use of hyaluronic acid when treating knee osteoarthritis. (Tw J Phys Med Rehabil 2012; 40(2): 77 - 83)

並列關鍵字

physical function ； knee osteoarthritis ； hyaluronic acid