不同部位注射玻璃酸钠治疗髌股关节炎临床疗效观察
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摘要
目的观察膝关节髌股关节间隙和膝眼两个部位注射玻璃酸钠对膝关节髌股关节炎的疗效及应用特点。方法选择2017年2月-2018年4月在武警特色医学中心骨科接受关节腔玻璃酸钠注射治疗的膝关节髌股关节炎患者64例,根据注射位点不同,依据就诊顺序按随机数字表法分为髌股关节间隙注射组(34例)和膝眼注射组(30例)。两组均接受剂量为2.5 ml/次,1次/周,连续5周的膝关节腔玻璃酸钠注射治疗。比较两组患者治疗前后的VAS评分、Lysholm评分及治疗后优良率。结果两组治疗后VAS评分均较治疗前降低,Lysholm评分均较治疗前升高(P <0.05)。首次注射后和注射3周后,髌股关节间隙注射组VAS评分显著低于膝眼注射组(P <0.05)。注射3周后及注射后3个月,髌股间隙注射组Lysholm评分高于膝眼注射组(P <0.05)。注射5周后及注射后3个月髌股间隙注射组优良率略高于膝眼注射组(85.29%vs76.67%;85.29%vs 80.00%,P> 0.05)。结论髌股关节间隙注射玻璃酸钠治疗膝关节髌股关节炎早期和长期临床效果优于膝眼注射法。
Objective To observe the therapeutic effects of sodium hyaluronate(SH) intra-articular injection via lateral midpatellar approach versus anteralateral approach in treatment of patellofemoral osteoarthritis. Methods Sixty-four patients with knee patellofemoral osteoarthritis in department of orthopedics of Specialized Medical Center of the Chinese People's Armed Police Force from February 2017 to April 2018 were randomly divided into lateral midpatellar approach group [n=34, 16 males and 18 females with average age of(53.7±6.5) years(ranging from 39 to 82 years)], and anteralateral approach group [n=30, 14 males and 16 females with average age of(51.6±5.7) years(ranging from 36 to 80 years)] using random table method. Patients in two groups were respectively treated with intra-articular injection of sodium hyaluronate(SH)(2.5 ml/time, once weekly, for 5 weeks)via lateral midpatellar approach or anteralateral approach. After treatment, the VAS scores, Lysholm scores and clinical effect were evaluated and compared between two groups. Results The VAS score decreased, and Lysholm score increased significantly over time after treatment in two groups(P < 0.05, respectively). After the first and the third injections, the VAS scores in lateral midpatellar approach group were significantly lower than those in anteralateral approach group [(5.50±1.14) vs 6.1±0.92, P=0.025;(4.85±0.96) vs(5.30±0.79), P=0.044]; the Lysholm scores in lateral midpatellar approach group were significantly higher than the scores in anteralateral approach group [(76.38±6.20) vs(73.33±5.37), P=0.041;(87.26±4.76) vs(84.43±4.95), P=0.023].After the fifth injection and at three months after injection, the clinical effect in lateral midpatellar approach group was slightly superior to anteralateral approach group(85.29% vs 76.67%; 85.29% vs 80.00%; P > 0.05), but the difference was not significant.Conclusion Injection of sodium hyaluronate through the lateral midpatellar approach for the treatment of patellofemoral osteoarthritis has a better clinical effect than injection through the anteralateral approach.
Objective To observe the therapeutic effects of sodium hyaluronate(SH) intra-articular injection via lateral midpatellar approach versus anteralateral approach in treatment of patellofemoral osteoarthritis. Methods Sixty-four patients with knee patellofemoral osteoarthritis in department of orthopedics of Specialized Medical Center of the Chinese People's Armed Police Force from February 2017 to April 2018 were randomly divided into lateral midpatellar approach group [n=34, 16 males and 18 females with average age of(53.7±6.5) years(ranging from 39 to 82 years)], and anteralateral approach group [n=30, 14 males and 16 females with average age of(51.6±5.7) years(ranging from 36 to 80 years)] using random table method. Patients in two groups were respectively treated with intra-articular injection of sodium hyaluronate(SH)(2.5 ml/time, once weekly, for 5 weeks)via lateral midpatellar approach or anteralateral approach. After treatment, the VAS scores, Lysholm scores and clinical effect were evaluated and compared between two groups. Results The VAS score decreased, and Lysholm score increased significantly over time after treatment in two groups(P < 0.05, respectively). After the first and the third injections, the VAS scores in lateral midpatellar approach group were significantly lower than those in anteralateral approach group [(5.50±1.14) vs 6.1±0.92, P=0.025;(4.85±0.96) vs(5.30±0.79), P=0.044]; the Lysholm scores in lateral midpatellar approach group were significantly higher than the scores in anteralateral approach group [(76.38±6.20) vs(73.33±5.37), P=0.041;(87.26±4.76) vs(84.43±4.95), P=0.023].After the fifth injection and at three months after injection, the clinical effect in lateral midpatellar approach group was slightly superior to anteralateral approach group(85.29% vs 76.67%; 85.29% vs 80.00%; P > 0.05), but the difference was not significant.Conclusion Injection of sodium hyaluronate through the lateral midpatellar approach for the treatment of patellofemoral osteoarthritis has a better clinical effect than injection through the anteralateral approach.
引文
1 Mills K,Hunter DJ.Patellofemoral joint osteoarthritis:an individualised pathomechanical approach to management[J].Best Pract Res Clin Rheumatol,2014,28(1):73-91.
2 Van Middelkoop M,Bennell KL,Callaghan MJ,et al.International patellofemoral osteoarthritis consortium:Consensus statement on the diagnosis,burden,outcome measures,prognosis,risk factors and treatment[J].Semin Arthritis Rheum,2018,47(5):666-675.
3 McAlindon TE,Bannuru RR,Sullivan MC,et al.OARSIguidelines for the non-surgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388.
4 Richette P,Chevalier X,Ea HK,et al.Hyaluronan for knee osteoarthritis:an updated meta-analysis of trials with low risk of bias[J].RMD Open,2015,1(1):e000071.
5中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796.
6 Crossley KM,Stefanik JJ,Selfe J,et al.2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat,Manchester.Part 1:Terminology,definitions,clinical examination,natural history,patellofemoral osteoarthritis and patient-reported outcome measures[J].Br J Sports Med,2016,50(14):839-843.
7 Kellgren JH,Lawrence JS.Radiological assessment of osteoarthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
8 Wewers ME,Lowe NK.A critical review of visual analogue scales in the measurement of clinical phenomena[J].Res Nurs Health,1990,13(4):227-236.
9 Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
10苏祥正,李众利,张浩,等.双醋瑞因与塞来昔布联合硫酸氨基葡萄糖对骨性膝关节炎疗效比较[J].解放军医学院学报,2017,38(9):856-859.
11 Hunter DJ.Viscosupplementation for osteoarthritis of the knee[J].N Engl J Med,2015,372(11):1040-1047.
12 Hochberg MC,Altman RD,April KT,et al.American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand,hip,and knee[J].Arthritis Care Res(Hoboken),2012,64(4):465-474.
13苏祥正,李众利,李冀,等.玻璃酸钠联合药物和功能锻炼治疗早中期膝骨关节炎的疗效分析[J].解放军医学院学报,2018,39(6):484-486.
14 Nguyen C,Lefevre-Colau MM,Poiraudeau S,et al.Evidence and recommendations for use of intra-articular injections for knee osteoarthritis[J].Ann Phys Rehabil Med,2016,59(3):184-189.
15 Altman RD,Schemitsch E,Bedi A.Assessment of clinical practice guideline methodology for the treatment of knee osteoarthritis with intra-articular hyaluronic acid[J].Semin Arthritis Rheum,2015,45(2):132-139.
16贾梦岩.髌骨软化症与髌股关节形态的相关性研究及玻璃酸钠对其治疗的临床研究[D].广州:南方医科大学,2016.
17 Campbell KA,Erickson BJ,Saltzman BM,et al.Is Local Viscosupplementation Injection Clinically Superior to Other Therapies in the Treatment of Osteoarthritis of the Knee:A Systematic Review of Overlapping Meta-analyses[J].Arthroscopy,2015,31(10):2036-2045.e2014.
18 Henrotin Y,Raman R,Richette P,et al.Consensus statement on viscosupplementation with hyaluronic acid for the management of osteoarthritis[J].Semin Arthritis Rheum,2015,45(2):140-149.
19 Conrozier T,Monfort J,Chevalier X,et al.EUROVISCORecommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis[J/OL].https://doi.org/10.1177/1947603518783455.
20朱由兵.关节镜联合透明质酸钠治疗髌股关节炎50例[J].中国中西医结合外科杂志,2018,24(5):564-568.
21罗裕强,史占军,唐元,等.给药位点差异对透明质酸在膝关节软骨表面覆盖范围的影响[J].中华骨科杂志,2015,35(11):1159-1167.
2 Van Middelkoop M,Bennell KL,Callaghan MJ,et al.International patellofemoral osteoarthritis consortium:Consensus statement on the diagnosis,burden,outcome measures,prognosis,risk factors and treatment[J].Semin Arthritis Rheum,2018,47(5):666-675.
3 McAlindon TE,Bannuru RR,Sullivan MC,et al.OARSIguidelines for the non-surgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388.
4 Richette P,Chevalier X,Ea HK,et al.Hyaluronan for knee osteoarthritis:an updated meta-analysis of trials with low risk of bias[J].RMD Open,2015,1(1):e000071.
5中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796.
6 Crossley KM,Stefanik JJ,Selfe J,et al.2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat,Manchester.Part 1:Terminology,definitions,clinical examination,natural history,patellofemoral osteoarthritis and patient-reported outcome measures[J].Br J Sports Med,2016,50(14):839-843.
7 Kellgren JH,Lawrence JS.Radiological assessment of osteoarthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
8 Wewers ME,Lowe NK.A critical review of visual analogue scales in the measurement of clinical phenomena[J].Res Nurs Health,1990,13(4):227-236.
9 Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
10苏祥正,李众利,张浩,等.双醋瑞因与塞来昔布联合硫酸氨基葡萄糖对骨性膝关节炎疗效比较[J].解放军医学院学报,2017,38(9):856-859.
11 Hunter DJ.Viscosupplementation for osteoarthritis of the knee[J].N Engl J Med,2015,372(11):1040-1047.
12 Hochberg MC,Altman RD,April KT,et al.American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand,hip,and knee[J].Arthritis Care Res(Hoboken),2012,64(4):465-474.
13苏祥正,李众利,李冀,等.玻璃酸钠联合药物和功能锻炼治疗早中期膝骨关节炎的疗效分析[J].解放军医学院学报,2018,39(6):484-486.
14 Nguyen C,Lefevre-Colau MM,Poiraudeau S,et al.Evidence and recommendations for use of intra-articular injections for knee osteoarthritis[J].Ann Phys Rehabil Med,2016,59(3):184-189.
15 Altman RD,Schemitsch E,Bedi A.Assessment of clinical practice guideline methodology for the treatment of knee osteoarthritis with intra-articular hyaluronic acid[J].Semin Arthritis Rheum,2015,45(2):132-139.
16贾梦岩.髌骨软化症与髌股关节形态的相关性研究及玻璃酸钠对其治疗的临床研究[D].广州:南方医科大学,2016.
17 Campbell KA,Erickson BJ,Saltzman BM,et al.Is Local Viscosupplementation Injection Clinically Superior to Other Therapies in the Treatment of Osteoarthritis of the Knee:A Systematic Review of Overlapping Meta-analyses[J].Arthroscopy,2015,31(10):2036-2045.e2014.
18 Henrotin Y,Raman R,Richette P,et al.Consensus statement on viscosupplementation with hyaluronic acid for the management of osteoarthritis[J].Semin Arthritis Rheum,2015,45(2):140-149.
19 Conrozier T,Monfort J,Chevalier X,et al.EUROVISCORecommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis[J/OL].https://doi.org/10.1177/1947603518783455.
20朱由兵.关节镜联合透明质酸钠治疗髌股关节炎50例[J].中国中西医结合外科杂志,2018,24(5):564-568.
21罗裕强,史占军,唐元,等.给药位点差异对透明质酸在膝关节软骨表面覆盖范围的影响[J].中华骨科杂志,2015,35(11):1159-1167.