超声影像引导髌上囊注射复方倍他米松联合玻璃酸钠治疗膝关节骨性关节炎的回顾性研究
|
摘要
目的:探讨超声影像引导髌上囊注射复方倍他米松联合玻璃酸钠治疗膝关节骨性关节炎的临床疗效及注射准确率。方法:对2017年1月—7月我科门诊就诊的膝关节骨性关节炎患者予超声影像引导下髌上囊注射复方倍他米松(1mg,单次注射)联合玻璃酸钠(2.5ml,每周1次、连续注射5周)治疗,分别在患者注射前和注射后采用疼痛视觉模拟量表(VAS)、西部安大略省和加拿大麦克马斯特大学骨关节炎指数(WOMAC)和Lysholm评分对膝痛程度和运动功能进行比较,并对超声影像引导髌上囊注射的准确率及可能的不良反应进行观察。结果:超声影像引导下髌上囊注射治疗患膝41例,注射准确率为100%。与注射前相比,注射后1周患者VAS评分即显著下降(P<0.0083),1个月后VAS评分继续下降(P<0.0083),注射后3个月VAS评分仍低于注射前(P<0.0083);注射后1个月患者WOMAC评分(P<0.0167)显著下降,Lysholm评分(P<0.0167)显著上升;随访至注射后3个月,WOMAC评分和Lysholm评分与注射前相比仍有显著性差异(P<0.0167);无1例患者发生不良反应。结论:对于膝关节骨性关节炎的注射治疗,复方倍他米松联合玻璃酸钠治疗能有效缓解膝痛并改善膝关节运动功能;采用超声影像引导髌上囊注射方式有助于精准定位,减少徒手注射带来的不必要损伤,无明显不良反应。
Objective: To explore the effect of ultrasound-guided suprapatellar bursal injection of compound betamethasone with sodium hyaluronate in treatment for knee osteoarthritis and accuracy rate of injection.Method: From January 2017 to July 2017,outpatients with knee osteoarthritis in our department were treated with ultrasound-guided suprapatellar bursal injection of compound betamethasone(1 mg, single injection) with sodium hyaluronate(2.5 ml, weekly injection, for 5 consecutive weeks). Visual analogue scale(VAS), The Western Ontario and McMaster University composite index(WOMCA) and Lysholm score were used to compare knee pain and motor function of patients before and after injection. Accuracy rate of ultrasound-guided suprapatellar bursal injection was analyzed and any possible adverse reactions were recorded.Result: Forty-one affected knees were treated with ultrasound-guided suprapatellar bursal injection and accuracy rate of injection was 100%. Compared with VAS score before injection, it deceased significantly 1 week after injection(P<0.0083), and continued to fall at 1 month after injection(P<0.0083); 3 months after injection,VAS score was still lower than that before injection(P<0.0083). In addition, WOMAC score decreased signifi-cantly and Lysholm score increased significantly at 1 month after injection(P<0.0167); follow up to 3 months after injection, the differences were still statistically significant compared with that before injection(P<0.0167). No adverse reaction was observed in any patient.Conclusion: Compound betamethasone with sodium hyaluronate in treatment for knee osteoarthritis can alleviate knee pain and improve motor function remarkably. Ultrasound-guided suprapatellar bursal injection help to locate accurately, reduce possible damages caused by blind injection and has no adverse reaction.
Objective: To explore the effect of ultrasound-guided suprapatellar bursal injection of compound betamethasone with sodium hyaluronate in treatment for knee osteoarthritis and accuracy rate of injection.Method: From January 2017 to July 2017,outpatients with knee osteoarthritis in our department were treated with ultrasound-guided suprapatellar bursal injection of compound betamethasone(1 mg, single injection) with sodium hyaluronate(2.5 ml, weekly injection, for 5 consecutive weeks). Visual analogue scale(VAS), The Western Ontario and McMaster University composite index(WOMCA) and Lysholm score were used to compare knee pain and motor function of patients before and after injection. Accuracy rate of ultrasound-guided suprapatellar bursal injection was analyzed and any possible adverse reactions were recorded.Result: Forty-one affected knees were treated with ultrasound-guided suprapatellar bursal injection and accuracy rate of injection was 100%. Compared with VAS score before injection, it deceased significantly 1 week after injection(P<0.0083), and continued to fall at 1 month after injection(P<0.0083); 3 months after injection,VAS score was still lower than that before injection(P<0.0083). In addition, WOMAC score decreased signifi-cantly and Lysholm score increased significantly at 1 month after injection(P<0.0167); follow up to 3 months after injection, the differences were still statistically significant compared with that before injection(P<0.0167). No adverse reaction was observed in any patient.Conclusion: Compound betamethasone with sodium hyaluronate in treatment for knee osteoarthritis can alleviate knee pain and improve motor function remarkably. Ultrasound-guided suprapatellar bursal injection help to locate accurately, reduce possible damages caused by blind injection and has no adverse reaction.
引文
[1]李宁华,薛庆云,张毅,等.中国六城市中老年人群X线膝关节骨性关节炎流行病学分析[J].实用医学杂志,2008,24(16):2887-2888.
[2]Zhang W,Moskowitz RW,Nuki G,et al.OARSI recommendations for the management of hip and knee osteoarthritis Part II:OARSI evidence-based,expert consensus guidelines[J].Osteoarthritis Cartilage,2008,16(2):137-162.
[3]Jordan KM,Arden NK,Doherty M,et al.EULAR Recommendations 2003:an evidence based approach to the management of knee osteoarthritis:Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials(ESCISIT)[J].Ann Rheum Dis2003,62(12):1145-1155.
[4]Bookman JS,Pereira DS.Ultrasound guidance for intra-articular knee and shoulder injections:a review[J].Bull Hosp JDis(2013),2014,72(4):266-270.
[5]Altman R,Asch E,Bloch D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis Rheum,1986,29(8):1039-1049.
[6]Bum Park Y,Ah Choi W,Kim YK,et al.Accuracy of blind versus ultrasound-guided suprapatellar bursal injection[J].J Clin Ultrasound,2012,40(1):20-25.
[7]van Middelkoop M,Arden NK,Atchia I,et al.The OA Trial Bank:meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids[J].Osteoarthritis Cartilage,2016,24(7):1143-1152.
[8]Saffie F,Gordillo H,Gordillo E,et al.Intra-articular treatment of osteoarthrosis of the knee with betamethasone dipropionate and disodium phosphate.Non-controlled,open 5years'experience[J].Rev Med Chil,1989,117(11):1261-1266.
[9]周乙雄,丁悦,黄东生,等.关节腔注射复方倍他米松注射液治疗膝关节骨性关节炎疗效和安全性评价[J].中华创伤骨科杂志,2008,10(1):37-40.
[10]Godwin M,Dawes M.Intra-articular steroid injections for painful knees.Systematic review with meta-analysis[J].Can Fam Physician,2004,50(2):241-248.
[11]Aggarwal A,Sempowski IP.Hyaluronic acid injections for knee osteoarthritis.Systematic review of the literature[J].Can Fam Physician,2004,50(2):249-256.
[12]Ertürk C,Altay MA,Altay N,et al.Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?[J].Knee Surg Sports Traumatol Arthrosc,2016,24(11):3653-3660.
[13]陈付强,刘慧松,胡丹,等.玻璃酸钠联合臭氧或复方倍他米松注射治疗膝关节骨性关节炎临床观察[J].中国疼痛医学杂志,2012,18(6):325-327.
[14]李晓勤,顾楠,吕琳,等.超声引导下外侧膝眼进针膝关节腔注射与盲法膝关节腔注射的对照研究[J].中国疼痛医学杂志,2016,22(11):838-841.
[15]Maricar N,Parkes MJ,Callaghan MJ,et al.Where and how to inject the knee--a systematic review[J].Semin Arthritis Rheum,2013,43(2):195-203.
[16]Kianmehr N,Hasanzadeh A,Naderi F,et al.A randomized blinded comparative study of clinical response to surface anatomy guided injection versus sonography guided injection of hyaloronic acid in patients with primary knee osteoarthritis[J].Int J Rheum Dis,2018,21(1):134-139.
[17]Sibbitt WL Jr,Kettwich LG,Band PA,et al.Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee?[J].Scand J Rheumatol,2012,41(1):66-72.
[18]高永艳,秦静,张雪梅,等.超声引导下局部注射皮质类固醇混合制剂治疗老年性膝关节骨性关节炎的止痛疗效[J].中华老年多器官疾病杂志,2016,15(8):597-600.
[2]Zhang W,Moskowitz RW,Nuki G,et al.OARSI recommendations for the management of hip and knee osteoarthritis Part II:OARSI evidence-based,expert consensus guidelines[J].Osteoarthritis Cartilage,2008,16(2):137-162.
[3]Jordan KM,Arden NK,Doherty M,et al.EULAR Recommendations 2003:an evidence based approach to the management of knee osteoarthritis:Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials(ESCISIT)[J].Ann Rheum Dis2003,62(12):1145-1155.
[4]Bookman JS,Pereira DS.Ultrasound guidance for intra-articular knee and shoulder injections:a review[J].Bull Hosp JDis(2013),2014,72(4):266-270.
[5]Altman R,Asch E,Bloch D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis Rheum,1986,29(8):1039-1049.
[6]Bum Park Y,Ah Choi W,Kim YK,et al.Accuracy of blind versus ultrasound-guided suprapatellar bursal injection[J].J Clin Ultrasound,2012,40(1):20-25.
[7]van Middelkoop M,Arden NK,Atchia I,et al.The OA Trial Bank:meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids[J].Osteoarthritis Cartilage,2016,24(7):1143-1152.
[8]Saffie F,Gordillo H,Gordillo E,et al.Intra-articular treatment of osteoarthrosis of the knee with betamethasone dipropionate and disodium phosphate.Non-controlled,open 5years'experience[J].Rev Med Chil,1989,117(11):1261-1266.
[9]周乙雄,丁悦,黄东生,等.关节腔注射复方倍他米松注射液治疗膝关节骨性关节炎疗效和安全性评价[J].中华创伤骨科杂志,2008,10(1):37-40.
[10]Godwin M,Dawes M.Intra-articular steroid injections for painful knees.Systematic review with meta-analysis[J].Can Fam Physician,2004,50(2):241-248.
[11]Aggarwal A,Sempowski IP.Hyaluronic acid injections for knee osteoarthritis.Systematic review of the literature[J].Can Fam Physician,2004,50(2):249-256.
[12]Ertürk C,Altay MA,Altay N,et al.Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?[J].Knee Surg Sports Traumatol Arthrosc,2016,24(11):3653-3660.
[13]陈付强,刘慧松,胡丹,等.玻璃酸钠联合臭氧或复方倍他米松注射治疗膝关节骨性关节炎临床观察[J].中国疼痛医学杂志,2012,18(6):325-327.
[14]李晓勤,顾楠,吕琳,等.超声引导下外侧膝眼进针膝关节腔注射与盲法膝关节腔注射的对照研究[J].中国疼痛医学杂志,2016,22(11):838-841.
[15]Maricar N,Parkes MJ,Callaghan MJ,et al.Where and how to inject the knee--a systematic review[J].Semin Arthritis Rheum,2013,43(2):195-203.
[16]Kianmehr N,Hasanzadeh A,Naderi F,et al.A randomized blinded comparative study of clinical response to surface anatomy guided injection versus sonography guided injection of hyaloronic acid in patients with primary knee osteoarthritis[J].Int J Rheum Dis,2018,21(1):134-139.
[17]Sibbitt WL Jr,Kettwich LG,Band PA,et al.Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee?[J].Scand J Rheumatol,2012,41(1):66-72.
[18]高永艳,秦静,张雪梅,等.超声引导下局部注射皮质类固醇混合制剂治疗老年性膝关节骨性关节炎的止痛疗效[J].中华老年多器官疾病杂志,2016,15(8):597-600.