除塞来昔布外进行神经肌肉锻炼与单独使用塞来昔布治疗有症状的膝关节骨性关节炎和影像学膝关节骨性关节炎的比较：一项随机对照试验

Neuromuscular exercise in addition to celecoxib versus celecoxib alone for symptomatic and radiographic knee osteoarthritis: a randomized controlled trial.

作者信息

Yang Xiaotian, Song Haixin, Li Xuqing, Wu Tao, Li Jianhua, He Chengqi

机构信息

Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 East Qingchun Road, Hangzhou, 310016, China.

Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.

出版信息

BMC Sports Sci Med Rehabil. 2025 Jul 24;17(1):213. doi: 10.1186/s13102-025-01263-7.

DOI:10.1186/s13102-025-01263-7

PMID:40708052

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12288239/

Abstract

BACKGROUND

Neuromuscular exercise (NEXA) and celecoxib each are effective for treating knee osteoarthritis (OA), but the potential benefits of combination therapy remain unclear. The aim of this study was to investigate the effects of NEXA in addition to celecoxib compared to celecoxib alone on pain and physical function in patients with symptomatic and radiographic knee OA.

METHODS

A prospective, assessor-blinded, two-arm, superiority randomised controlled trial. Sixty participants with Kellgren and Lawrence (KL) grade 2-3 symptomatic knee OA were included and randomly assigned 1:1 to undergo 12 weeks NEXA and celecoxib or to receive celecoxib 200 mg once daily alone. The primary outcomes were visual analog scale (VAS) and total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 6 months. The secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), six-minute walk test, and Timed Up and Go (TUG) test at 3 months and 6 months.

RESULTS

At 6 months, the between-group differences in the VAS score (mean difference, -10.30; 95% CI, -19.38 to -1.23; P = 0.026) and total WOMAC score (mean difference, -10.40; 95% CI, -15.54 to -5.27; P < 0.001) were statistically in favour of the NEXA and celecoxib group. There was evidence that NEXA in addition to celecoxib were superior to celecoxib alone for KOOS symptoms score (P = 0.040), KOOS activities of daily living score (P < 0.001), KOOS sport and recreation score (P = 0.014), KOOS quality of life score (P = 0.036), six-min walk test (P = 0.006), and TUG test (P = 0.001) at 6 months. The NEXA and celecoxib group achieved significantly higher proportions of patients above the minimal clinically important difference in total WOMAC score (78.6% vs. 51.9% for absolute improvement; 75% vs. 37% for relative improvement) at 6 months.

CONCLUSIONS

Compared with celecoxib alone, there was a beneficial effect of NEXA in addition to celecoxib on pain and physical function in patients with symptomatic and radiographic knee OA at 6 months.

TRIAL REGISTRATION

ChiCTR-IOR-14,005,414, 31/10/2014.

摘要

背景

神经肌肉锻炼（NEXA）和塞来昔布各自对治疗膝关节骨关节炎（OA）有效，但联合治疗的潜在益处仍不明确。本研究的目的是调查与单独使用塞来昔布相比，NEXA联合塞来昔布对有症状且经影像学检查确诊的膝关节OA患者疼痛和身体功能的影响。

方法

一项前瞻性、评估者盲法、双臂、优效性随机对照试验。纳入60例Kellgren和Lawrence（KL）分级为2 - 3级的有症状膝关节OA患者，并按1:1随机分配，一组接受12周的NEXA和塞来昔布治疗，另一组仅接受每日一次200 mg塞来昔布治疗。主要结局指标为6个月时的视觉模拟量表（VAS）评分和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）总分。次要结局指标包括3个月和6个月时的膝关节损伤和骨关节炎结局评分（KOOS）、6分钟步行试验以及计时起立行走试验（TUG）。

结果

在6个月时，VAS评分的组间差异（平均差值，-10.30；95%可信区间，-19.38至-1.23；P = 0.026）和WOMAC总分的组间差异（平均差值，-10.40；95%可信区间，-15.54至-5.27；P < 0.001）在统计学上支持NEXA联合塞来昔布组。有证据表明，NEXA联合塞来昔布在6个月时对KOOS症状评分（P = 0.040）、KOOS日常生活活动评分（P < 0.001）、KOOS运动和娱乐评分（P = 0.014）、KOOS生活质量评分（P = 0.036）、6分钟步行试验（P = 0.006）以及TUG试验（P = 0.001）优于单独使用塞来昔布。在6个月时，NEXA联合塞来昔布组在WOMAC总分上达到最小临床重要差异以上的患者比例显著更高（绝对改善：78.6%对51.9%；相对改善：75%对37%）。