復健介入對退化性膝關節炎接受玻尿酸注射患者之健康促進效益研究

The Effect of Health Promotion with Physical Therapy and Intra-Articular Hyaluronic Acid for Knee Osteoarthritis

周正亮(Chen-Liang Chou) ； 宋文旭(Wen-Hsu Sung) ； 柳復威(Fu-Wei Liu) ； 李雪楨(Hsuci-Chen Lee) ； 黃麗龍(Li-Lung Haung) ； 陳俊忠(Jin-Jong Chen)

《台灣復健醫學雜誌》 41卷1期 (2013/03) Pp. 39-49

https://doi.org/10.6315/2013.41(1)05

摘要

目的：退化性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，同時也造成社會的龐大負擔，目前已有許多研究分別證實關節內玻尿酸注射與復健物理治療對於退化性膝關節炎具有臨床效益，但鮮有研究對合併治療的健康效益進行探討。所以本研究即在探討：（1）同時合併關節內玻尿酸注射與復健物理治療；（2）接受關節內注射療程後再給予復健物理治療對療效的影響。方法：本研究選擇雙側退化性關節炎的病患，分成玻尿酸組（接受5週關節內玻尿酸注射），同時物理治療組（同時接受5週關節內玻尿酸注射與物理治療）與後物理治療組（接受5週關節內玻尿酸注射後再進行5週物理治療）。研究分為實驗一、比較玻尿酸組與同時物理治療組，實驗二、比較玻尿酸組與後物理治療組，評估內容包括（1）西安大略及麥肯麥司特大學退化性關節炎量表（Western Ontario and McMaster University Osteoarthritis Index）；（2）簡易36生活品質量表（short form-36）；（3）膝伸直肌與膝屈曲肌最大等長肌力；（4）身體組成-肌肉比例及總下肢肌肉量；（5）膝關節活動度。各組分別在介入前，介入後第5週及第10週進行評估。結果：共有88人完成測試，其中玻尿酸組30人，同時物理治療組30人，後物理治療組28人。實驗一結果在介入第5週後，兩組在WOMAC關節炎量表及簡易36生活品質量表皆顯著改善，而同時物理治療組在下肢肌力也有顯著改善；在10週介入後，下肢肌力同時物理治療組有顯著提升。實驗二結果，後物理治療組在第10週介入後，WOMAC關節炎量表，簡易36生活品質量表及下肢肌力皆顯著改善，且進步程度明顯優於玻尿酸組。結論：由本研究結果顯示退化性關節炎患者同時合併關節內玻尿酸注射與復健物理治療的結合介入方式可以有效改善病患病徵與生活品質，且效果優於單獨接受玻尿酸的患者；而在玻尿酸注射後再持續給予復健物理治療，可以持續有健康促進效益。

關鍵字

退化性膝關節炎（knee osteoarthritis） ； 玻尿酸（hyaluronic acid） ； 物理治療（physical therapy） ； 健康促進（health promotion）

並列摘要

Purpose: Knee osteoarthritis (knee OA) is a common chronic disease that affects elderly. Intra-articular injection of hyaluronic acid (IAHA) and physical therapy for knee OA have been shown to have clinical benefits in randomized, clinical trials separately. However, it is generally accepted that optimal management of knee OA requires a combination of pharmacologic and nonpharmacologic treatment. Currently, few studies have directly evaluated the benefits of combining the 2 treatments for knee OA. The purpose of this study explored the efficacy of interventions in patients with knee osteoarthritis through combined IAHA and physical therapy. This study investigated the potential benefit of two strategies of interventions: 1) receiving IAHA and physical therapy at the same period; 2) receiving physical therapy after IAHA. Methods: This is a prospective purposive control trial study. The subjects with knee OA were distributed to three groups purposively: group I - IAHA group, group II - receiving IAHA and physical therapy at the same period, and group III-after receiving 5 times IAHA, receiving physical therapy for 5 weeks. Experiment I executed to compare group I with group II and Experiment II executed to compare group I with group III. The measurements included: 1) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC index) ; 2) Short Form-36 (SF-36) ; 3) muscle rate of whole body and muscle mass of lower extremities; 4) maximal isometric muscle strength of knee extensors and knee flexors; 5) range of motion of knee. Results: Experiment I-After 5 weeks intervention, both groups improved in WOMAC index scores and SF-36 scores significantly. The subjects of group II also improved in the strength of knee extensors (P＜0.001), flexors (P＜0.001) significantly. Between group comparison, the group II had a greater significant improvement than group I in above mentioned variables, except WOMAC stiffness subindex (P＞0.050). After 10 weeks, the group II had a significant increase in maximal isometric muscle strength of knee flexors and knee extensors (P＜0.050). Experiment II - After 5 weeks, group I improved in WOMAC index and SF-36 score significantly. Group III had a greater significant improvement in WOMAC index (P＜0.001), SF36 score (P＜0.001), the strength of knee extensors (P＜0.001), flexors (P＜0.001). Between group comparison, the group III had a greater significant improvement than group I in above mentioned variables, except WOMAC pain and stiffness subindex (P＞0.050). Conclusion: Both interventions of IAHA and combining IAHA and physical therapy relieve symptoms in patients with knee OA. However, combining two treatments is superior to IAHA for patients with knee osteoarthritis in muscle strength, functional ability and quality of life.

並列關鍵字

knee osteoarthritis ； hyaluronic acid ； physical therapy ； health promotion