背景：臨床上治療退化性膝關節炎的主要方式有(1)口服葡萄糖胺(2)關節腔內注射玻尿酸，
經由文獻的回顧•不論國內、外，對於關節腔內注射玻尿酸針對退化性關節炎的療效，大多
採正面的看法，但是對於葡萄糖胺治療退化性關節炎的療效，則支持者與反對者約各佔一半。
目前全民健保給付規定，僅對「口服葡萄糖胺」及「玻尿酸關節內注射」制定嚴格的個別使
用規範，卻未對兩者合併使用做相關療效評估及規範。因此，若患者在施打五週玻尿酸關節
內注射後，緊接著接受三個月的口服葡萄糖胺治療，如此治療方式是否比單獨使用「口服葡
萄糖胺」或「玻尿酸關節內注射」有效，目前並無相關資料可參考。
目的：本研究目的，在於詳細精確評估合併使用「口服葡萄糖胺」及「玻尿酸關節內注射」
〈在兩次玻尿酸關節內注射療程中，加入一次三個月的口服葡萄糖胺治療〉，對膝關節炎患者
之臨床疼痛症狀之改善，日常生活功能之增進效果是否優於單獨使用「玻尿酸關節內注射」？
方法：本研究以高雄市某區域教學醫院骨科門診及復健科門診病患群為研究對象。自民國97
年10 月起，於該醫院骨科門診或復健科門診因退化性膝關節炎伴隨疼痛而就醫治療的患者，
於醫師診察後，判定符合本次研究計劃納入條件者，在詳細告知研究過程中，徵得病患同意
後，隨即依隨機分配方式分配到第一組(合併使用「口服葡萄糖胺」及「玻尿酸關節內注射」)
或第二組(使用「玻尿酸關節內注射」及安慰劑)。本研究設計為隨機分配、雙盲、臨床實驗。
結果：第一組(合併使用「口服葡萄糖胺」及「玻尿酸關節內注射」)受試者與第二組(使用「玻
尿酸關節內注射」及安慰劑) 受試者，各組治療前與治療後在膝關節炎病人疼痛指數
(Lequesne’s Index)總分的減低、疼痛強度的視覺類似物標度(visual analogue scale)成
績的減低、柏格氏平衡量表(Berg Balance Test)總分的進步與身體站姿平衡測量總分的進
步，均有明顯統計學上的差異。但這些差異性，在兩個不同組別彼此間並無明顯統計學上的
差異。
結論：本研究結果得知，在已使用玻尿酸關節內注射，來治療退化性膝關節炎的患者身上，
輔以三個月的口服葡萄糖胺治療，如此治療方式並不比單獨使用玻尿酸關節內注射有效。

Background : The oral administration of Glucosamine and intra-articular (IA) injection of
Hyaluronic Acid were used to treat osteoarthritis. Several studies supported that clinical pain
symptoms could be alleviated, and activities of daily life improved after the completion of IA knee
hyaluronic acid injections. However, the efficacy of oral administration of Glucosamine was
inconclusive. In Taiwan, the Taiwan's National Health Insurance (NHI) made the strict formulations
for the both of “oral administration of Glucosamine “and “IA knee hyaluronic acid injections.” But,
there were no evidence to prove that whether the combined treatments from both oral
administration of Glucosamine and IA knee hyaluronic acid injections were more effective than the
treatment with the IA knee hyaluronic acid injections alone.
Objectives : The porpose of this study was to examine whether the effects of treatment combined
with both “oral administration of Glucosamine and IA knee hyaluronic acid injections” on clinical
pain symptoms and activities of daily living were better than “IA knee hyaluronic acid injections”
alone.
Methods : We randomly assigned 60 patients with symptomatic knee osteoarthritis, at the
department of Orthopedics, Kaohsiung Municipal Union Hospital, between 2008 and 2009, to
receive oral administration of Glucosamine and IA knee hyaluronic acid injections or oral
administration of Placebo and IA knee hyaluronic acid injections. In this study, clinical pain
symptoms, and activities of daily living were assessed by using Lequesne's Index, visual analogue
scale index, Berg Balance Test, and Biodex Balance Test before and after the treatment in 60
patients with the knee OA.
Result : The mean age was 66.6 years, and 70 percent were woman. There was a significant
efficacy before and after treatments both in the treatment group(p<0.001) and the placebo control
group(p<0.001). In the other hand, there was not the statistical significance in the efficacy between
the treatment group and the control group(p=0.869).
Conclusion : The combined treatment with both oral administration of Glucosamine and IA knee
hyaluronic acid injections was not significantly better than the IA knee hyaluronic acid injections
alone in reducing knee pain or promoting the function of daily life.

第一章 緒論
第一節 研究背景與動機 ----------------------------------------1
第二節 研究目的 ----------------------------------------------3
第二章 文獻探討
第一節 退化性關節炎 -------------------------------------------4
第二節 退化性關節炎的治療 -------------------------------------7
第三節 使用口服葡萄糖胺治療退化性關節炎的優點及缺點 -----------8
第四節 使用關節腔內注射玻尿酸退化性關節炎的優點及缺點 ---------9
第三章 研究方法與執行步驟
第一節 研究假設 ----------------------------------------------11
第二節 研究樣本與資料來源 ------------------------------------11
第三節 研究流程 ----------------------------------------------12
第四節 測量變項 ----------------------------------------------15
第五節 分析方法 ----------------------------------------------18
第四章 結果分析
第一節 描述性統計 --------------------------------------------20
第二節 推論性統計 --------------------------------------------21
第五章 討論 ----------------------------------------------------32
第六章 結論
第一節 研究結論 ----------------------------------------------38
第二節 研究限制 ----------------------------------------------39
第三節 研究建議 ----------------------------------------------40
參考文獻 --------------------------------------------------------41

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