超声引导下髋关节腔内药物注射对盂唇源性髋部疼痛的诊断价值
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摘要
目的:探讨超声引导下髋关节腔内药物注射治疗对盂唇源性髋部疼痛的治疗及诊断价值。方法:选取2015年6月至2017年7月因髋部疼痛及功能障碍来我院运动医学科就诊的30名患者共31例髋关节(1名为双侧),入组患者影像学检查提示髋关节盂唇撕裂,但临床表现与之不完全相符。我科在超声引导下行患侧髋关节腔内药物注射治疗,对比治疗前后髋部疼痛程度及髋关节活动度,评估治疗效果,并判断髋部疼痛等不适是否来源于盂唇撕裂。随访后续临床治疗及疗效,评定该方法的准确性。结果:超声引导下髋关节腔内药物注射治疗后,25例髋部疼痛缓解、关节功能好转,推断髋部疼痛来源于盂唇撕裂;6例效果不佳,考虑髋部疼痛为其他非关节腔内病变引起。25例注射治疗有效的患者中,22例髋关节后期接受关节镜盂唇修复术,术后疗效满意,证实了通过髋关节药物注射筛选盂唇源性髋部疼痛患者的可行性。6例效果不佳者于康复科接受保守治疗。结论:对于症状及体征不典型的盂唇撕裂患者,超声引导下髋关节药物注射治疗不仅可有效治疗因盂唇撕裂引起的髋部疼痛,还可根据其疗效较准确地判断髋部疼痛是否来源于盂唇撕裂,从而辅助临床医生选择后期治疗方案。
Objective To explore the value of the ultrasound guided hip joint injection in the diagnosis and treatment of the acetabular labral pain.Methods A total of 30 patients,including 31 hips,who came to our hospital for hip pain between June 2015 and July 2017 were selected. The imaging examination of these patients showed the acetabular labrum tear,but the clinical manifestations were not typical. All patients underwent the ultrasound guided hip joint injection. The pain degree and range of the motion of the hip were compared before and after the injection. Moreover,it was determined whether the pain was caused by the hip labral tear. The clinical curative effect was focused on during the follow-up to evaluate the accuracy of this method. Results After the injection,25 patients showed relief of pain and improvement of function,and their hip pain may result from the acetabular labrum tear. For another 6 cases,no changes were found and they may suffer from other non-intra-articular lesions. Among the former 25 patients, 22 received arthroscopic repair of acetabular labral tears with good effects.Conclusion The ultrasound-guided hip joint injection can not only effectively relieve the hip pain caused by the acetabular labral tear,but also can help clinicians to choose later treatment for patients with the acetabular labral tear without clear signs and symptoms.
Objective To explore the value of the ultrasound guided hip joint injection in the diagnosis and treatment of the acetabular labral pain.Methods A total of 30 patients,including 31 hips,who came to our hospital for hip pain between June 2015 and July 2017 were selected. The imaging examination of these patients showed the acetabular labrum tear,but the clinical manifestations were not typical. All patients underwent the ultrasound guided hip joint injection. The pain degree and range of the motion of the hip were compared before and after the injection. Moreover,it was determined whether the pain was caused by the hip labral tear. The clinical curative effect was focused on during the follow-up to evaluate the accuracy of this method. Results After the injection,25 patients showed relief of pain and improvement of function,and their hip pain may result from the acetabular labrum tear. For another 6 cases,no changes were found and they may suffer from other non-intra-articular lesions. Among the former 25 patients, 22 received arthroscopic repair of acetabular labral tears with good effects.Conclusion The ultrasound-guided hip joint injection can not only effectively relieve the hip pain caused by the acetabular labral tear,but also can help clinicians to choose later treatment for patients with the acetabular labral tear without clear signs and symptoms.
引文
[1]李敏,孙钢,彭兆辉,等.髋部疼痛常见病的磁共振表现[J].医学影像学杂志,2011,21(6):901.
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[3]Leunig M,Ganz R.Femoroacetabular impingement.Acommon cause of hip complaints leading to arthrosis[J].Unfallchirurg,2005,108(1):9-10.
[4]Lynch TS,Terry MA,Bedi A,et al.Hip arthroscopic surgery:patient evaluation,current indications,and outcomes.Am J Sports Med,2013,41(5):1174-89.
[5]陈孝平.八年制外科学[M].第2版.北京:人民卫生出版社,2010:886-888.
[6]Reiman MP,Mather RC,Hash TW,et al.Examination of acetabular labral tear:a continued diagnostic challenge[J].Br J Sports Med,2014,48(4):311-319.
[7]Yazbek PM,Ovanessian V,Martin RL,et al.Nonsurgical treatment of acetabular labrum tears:a case series[J].J Orthop Sports Phys Ther,2011,41(5):346-353.
[8]Shankar H.Ultrasound guided hip joint injections:a new scanning routine for easy methodical training[J].Pain Practice,2012,12(1):80-81.
[9]Smith J,Handle MF,Weingarten TN.Accuracy of sonographicauy guided intra-article injections in the native adult hip[J].Ultrasound Med,2009,28(3):329-335.
[10]Sotka CM,Saboeim G,Adler RS.Ultrasound-guilded adult hip injections[J].Vasc Interv Radiol,2005,16(8):1121-1123.
[11]左辉,赵树恩,姚军,等.得宝松的药理作用、临床应用及不良反应的评价[J].实用疼痛学杂志,2004,12(2):40-42.
[12]Freeman K,Dewitz A,Baker WE.Ultrasound guided hip arthrocentesis in the ED.Am J Emerg Med,2007,25(1):80-86.
[2]Wenger DE,Kendell KR,Miner MR,et al.Acetabular labral tears rarely occur in the absence of bony abnormalities[J].Clin Orthop Relat Res,2004,(426):145-150.
[3]Leunig M,Ganz R.Femoroacetabular impingement.Acommon cause of hip complaints leading to arthrosis[J].Unfallchirurg,2005,108(1):9-10.
[4]Lynch TS,Terry MA,Bedi A,et al.Hip arthroscopic surgery:patient evaluation,current indications,and outcomes.Am J Sports Med,2013,41(5):1174-89.
[5]陈孝平.八年制外科学[M].第2版.北京:人民卫生出版社,2010:886-888.
[6]Reiman MP,Mather RC,Hash TW,et al.Examination of acetabular labral tear:a continued diagnostic challenge[J].Br J Sports Med,2014,48(4):311-319.
[7]Yazbek PM,Ovanessian V,Martin RL,et al.Nonsurgical treatment of acetabular labrum tears:a case series[J].J Orthop Sports Phys Ther,2011,41(5):346-353.
[8]Shankar H.Ultrasound guided hip joint injections:a new scanning routine for easy methodical training[J].Pain Practice,2012,12(1):80-81.
[9]Smith J,Handle MF,Weingarten TN.Accuracy of sonographicauy guided intra-article injections in the native adult hip[J].Ultrasound Med,2009,28(3):329-335.
[10]Sotka CM,Saboeim G,Adler RS.Ultrasound-guilded adult hip injections[J].Vasc Interv Radiol,2005,16(8):1121-1123.
[11]左辉,赵树恩,姚军,等.得宝松的药理作用、临床应用及不良反应的评价[J].实用疼痛学杂志,2004,12(2):40-42.
[12]Freeman K,Dewitz A,Baker WE.Ultrasound guided hip arthrocentesis in the ED.Am J Emerg Med,2007,25(1):80-86.