摘要目的:探讨体外冲击波联合透明质酸钠治疗膝骨关节炎（KOA）的效果，及对膝关节功能、炎症水平和骨代谢活性的影响。方法:选取2022年1月至2023年12月陕西省康复医院收治的92例KOA患者作为研究对象。采用信封法，将患者随机分为对照组（46例）和观察组（46例）。对照组男29例，女17例；年龄（61.03±5.37）岁；体重指数（22.43±2.44）kg/m 2；病程（5.72±0.75）年。观察组男28例，女18例；年龄（60.98±5.35）岁；体重指数（22.41±2.42）kg/m 2；病程（5.69±0.73）年。对照组采用透明质酸钠治疗，观察组在对照组基础上联合体外冲击波治疗。两组均连续治疗4周。比较两组治疗前后膝关节功能［西安大略和麦克马斯特大学骨关节炎指数（WOMAC）］、炎症水平［白细胞介素（IL）-17、IL-8、环氧合酶-2（COX-2）、肿瘤坏死因子-α（TNF-α）、基质金属蛋白酶-9（MMP-9）］、骨代谢活性［骨钙素（BGP）、骨保护素（OPG）、总Ⅰ型胶原氨基端延长肽（TPINP）］，治疗期间不良反应发生情况（感染、发热、静脉炎、出血及关节肿痛）。采用独立样本 t检验、配对 t检验和 χ2检验进行统计学分析。 结果:治疗后，观察组WOMAC量表中的疼痛、僵硬及功能障碍评分均低于对照组［（3.53±0.47）分比（6.61±0.85）分、（0.67±0.13）分比（1.12±0.18）分、（8.51±0.89）分比（14.29±1.52）分］（均 P<0.05）；观察组IL-8、IL-17、TNF-α、COX-2及MMP-9水平均低于对照组［（59.78±5.73）ng/L比（109.68±14.31）ng/L、（15.63±2.59）ng/L比（23.32±3.97）ng/L、（60.21±6.81）μg/L比（89.57±10.25）μg/L、（12.14±1.52）ng/L比（18.58±2.69）ng/L、（41.17±5.79）μg/L比（69.59±7.84）μg/L］（均 P<0.05）；观察组BGP、OPG及TPINP水平均高于对照组［（7.67±0.71）U/L比（5.74±0.67）U/L、（6.46±0.59）ng/L比（4.86±0.53）ng/L、（34.69±5.63）μg/L比（32.12±4.96）μg/L］（均 P<0.05）。治疗期间，两组不良反应总发生率比较，差异无统计学意义（ P>0.05）。 结论:体外冲击波联合透明质酸钠可提高KOA患者膝关节功能，降低炎症水平，改善骨代谢活性，且安全性较高。

abstractsObjective:To explore the application effect of extracorporeal shock wave combined with sodium hyaluronate in patients with knee osteoarthritis (KOA) and its impacts on knee joint function, inflammation level, and bone metabolic activity.Methods:A total of 92 KOA patients admitted to Shaanxi Rehabilitation Hospital from January 2022 to December 2023 were selected as the study objects. The patients were randomly divided into a control group (46 cases) and an observation group (46 cases) by the envelope method. There were 29 males and 17 females in the control group, aged (61.03±5.37) years; the body mass index was (22.43±2.44) kg/m 2; the course of disease was (5.72±0.75) years. There were 28 males and 18 females in the observation group, aged (60.98±5.35) years; the body mass index was (22.41±2.42) kg/m 2; the course of disease was (5.69±0.73) years. The control group was treated with sodium hyaluronate, and the observation group was combined with extracorporeal shock wave therapy based on the control group. Both groups were treated continuously for 4 weeks. Knee function [Western Ontario and McMaster University Osteoarthritis Index (WOMAC)], inflammation level [interleukin (IL) -17, IL-8, cyclooxygenase-2 (COX-2), tumor necrosis factor-α (TNF-α), and matrix metalloproteinase-9 (MMP-9)], bone metabolic activity [osteocalcin (BGP), osteoprotegerin (OPG), and total type I collagen amino terminal prolongating peptide (TPINP)] before and after treatment, and occurrence of adverse reactions (infection, fever, phlebitis, bleeding, and joint swelling and pain) during treatment were compared between the two groups. Independent sample t test, paired t test, and χ2 test were used for statistical analysis. Results:After treatment, the pain, stiffness, and dysfunction scores of the WOMAC in the observation group were lower than those in the control group [(3.53±0.47) points vs. (6.61±0.85) points, (0.67±0.13) points vs. (1.12±0.18) points, (8.51±0.89) points vs. (14.29±1.52) points] (all P<0.05). The levels of IL-8, IL-17, TNF-α, COX-2, and MMP-9 in the observation group were lower than those in the control group [(59.78±5.73) ng/L vs. (109.68±14.31) ng/L, (15.63±2.59) ng/L vs. (23.32±3.97) ng/L, (60.21±6.81) μg/L vs. (89.57±10.25) μg/L, (12.14±1.52) ng/L vs. (18.58±2.69) ng/L, (41.17±5.79) μg/L vs. (69.59±7.84) μg/L] (all P<0.05). The BGP, OPG, and TPINP levels in the observation group were higher than those in the control group [(7.67±0.71) U/L vs. (5.74±0.67) U/L, (6.46±0.59) ng/L vs. (4.86±0.53) ng/L, (34.69±5.63) μg/L vs. (32.12±4.96) μg/L] (all P<0.05). During treatment, there was no statistically significant difference in the total incidence of adverse reactions between the two groups ( P>0.05). Conclusions:The combination of extracorporeal shock wave and sodium hyaluronate can improve knee joint function, reduce inflammatory factor levels, and improve bone metabolism activity in KOA patients. The treatment is safe and worthy of promotion and application.