美国布鲁克陆军医疗中心Gail D. Deyle研究组取得一项新突破。他们探讨了物理治疗和糖皮质激素注射对膝骨关节炎的疗效。相关论文于2020年4月9日发表在《新英格兰医学杂志》上。

物理治疗和关节内注射糖皮质激素均显示对膝骨关节炎有临床益处。但这两种疗法在缓解疼痛和改善身体机能方面的短期和长期效果是否存在差异尚不确定。

研究组在美国军事卫生系统初级保健机构进行了一项随机试验，招募了156例单侧或双侧膝骨关节炎的患者，按1：1随机分组，分别接受物理疗法和糖皮质激素注射治疗，每组78例。主要结局是西安大略和麦克马斯特大学骨关节炎指数（WOMAC）在1年时的总分，0-240分，分数越高越疼痛，病情越严重。

两组患者的基线特征相似，其中糖皮质激素注射组的基线WOMAC平均值为108.8±47.1分，物理治疗组为107.1±42.4分。治疗1年后，物理治疗组的WOMAC平均得分为37.0±30.7分，显著低于糖皮质激素注射组（55.8±53.8分）。次要结局也有利于物理疗法。一名患者在接受糖皮质激素注射时晕倒。

总之，与关节内糖皮质激素注射相比，物理疗法治疗膝骨关节炎患者在1年后可有效减轻疼痛和功能障碍。

附：英文原文

Title: Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee

Author: Gail D. Deyle, D.Sc.,, Chris S. Allen, D.Sc.,, Stephen C. Allison, Ph.D.,, Norman W. Gill, D.Sc.,, Benjamin R. Hando, D.Sc.,, Evan J. Petersen, D.Sc.,, Douglas I. Dusenberry, M.S.,, and Daniel I. Rhon, D.Sc.

Issue&Volume: 2020-04-08

Abstract: Abstract

Background

Both physical therapy and intraarticular injections of glucocorticoids have been shown to confer clinical benefit with respect to osteoarthritis of the knee. Whether the short-term and long-term effectiveness for relieving pain and improving physical function differ between these two therapies is uncertain.

Methods

We conducted a randomized trial to compare physical therapy with glucocorticoid injection in the primary care setting in the U.S. Military Health System. Patients with osteoarthritis in one or both knees were randomly assigned in a 1:1 ratio to receive a glucocorticoid injection or to undergo physical therapy. The primary outcome was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year (scores range from 0 to 240, with higher scores indicating worse pain, function, and stiffness). The secondary outcomes were the time needed to complete the Alternate Step Test, the time needed to complete the Timed Up and Go test, and the score on the Global Rating of Change scale, all assessed at 1 year.

Results

We enrolled 156 patients with a mean age of 56 years; 78 patients were assigned to each group. Baseline characteristics, including severity of pain and level of disability, were similar in the two groups. The mean (±SD) baseline WOMAC scores were 108.8±47.1 in the glucocorticoid injection group and 107.1±42.4 in the physical therapy group. At 1 year, the mean scores were 55.8±53.8 and 37.0±30.7, respectively (mean between-group difference, 18.8 points; 95% confidence interval, 5.0 to 32.6), a finding favoring physical therapy. Changes in secondary outcomes were in the same direction as those of the primary outcome. One patient fainted while receiving a glucocorticoid injection.

Conclusions

Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection.

DOI: 10.1056/NEJMoa1905877

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1905877