玻璃酸钠关节腔内注射结合倍他米松痛点注射改善骨性膝关节炎患者的疼痛症状(英文)

Combination of intraarticular injection of hyaluronate and pain-point injection of betamethasone for improving the pain symptom in patients with osseous gonarthritis

背景:骨性膝关节炎保守治疗一直以尽量减少膝关节负重及保持肌肉锻炼为主,急性发作时辅以非类固醇抗炎镇痛药。目的:探讨玻璃酸钠膝关节腔内注射结合倍他米松痛点注射对骨性膝关节炎疼痛症状的缓解效应。设计:开放性实验。单位:首都医科大学附属北京天坛医院。对象:纳入首都医科大学附属北京天坛医院疼痛门诊2004-01/10就诊的骨性膝关节炎患者45例,年龄40～85岁。方法:采用玻璃酸钠注射液行患膝关节腔内注射,2.5mL/次,1次/周,5周为1个疗程。详细体格检查,寻找膝关节周围痛点。使用消炎镇痛液行痛点注射,每一痛点用药2.0～3.0mL。每周治疗前重复体格检查,若有痛点则继续行痛点注射,若经过治疗已经没有痛点则仅行玻璃酸钠关节腔内注射治疗。主要观察指标:①安静时、运动时疼痛评分。②疼痛消失时间和应用倍他米松治疗的次数。结果:纳入的45例患者均进入结果分析。①联合治疗1周后安静时疼痛和运动时疼痛较治疗前明显降低(P<0.01),安静时疼痛较运动时疼痛缓解为著(P<0.01)。②疼痛平均于治疗后(17.07±6.00)d消失,应用倍他米松治疗的次数平均为(2.42±0.78)次。③病例中无一例出现注射后局部关节疼痛等不良反应。结论:玻璃酸钠关节腔内注射联合倍他米松痛点注射可有效缓解骨性膝关节炎的疼痛症状,且无明显不良反应发生。

BACKGROUND： Conservative treatment of osseous gonarthritis （OG） is mainly to reduce the loading of knee joint and maintain muscle exercise, and non-steroidal anti-inflammatory drugs serve as supplements in case of acute occurrence. OBJECTIVE： To investigate the effect of combination of intraarticular injection of hyaluronate and pain-point injection of betamethasone in improving the pain symptom in patients with OG. DESIGN： Open experiment. SETTING： Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences. PARTICIPANTS： We selected 45 OG patients, who were aged 40 to 85 years and received treatment in the clinic of Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences between January 2004 and October 2004. METHODS： OG parenteral solution was intraarticularly injected into the knee joint, 2.5 mL once a week, 5 weeks set as a disease course. Pain points around knee joint were searched for following thorough physical examination. Anti-inflammatory analgesic solution of 2.0-3.0 mL was injected at each pain point. Physical examination was repeated before treatment in each week. Injection at pain points was maintained if they were still present. Intraarticular injection of hyaluronate was performed only when the pain points disappeared after treatment. MAIN OUTCOME MEASURES： ① Pain score at rest and at exercise. ② Time when pain disappeared and times of betamethasone administration. RESULTS： Totally 45 patients entered the result analysis. ① Pain at rest and at exercise l week after combination treatment of intraarticular injection of hyaluronate and pain-point injection of betamethasone was significantly lessened compared to that before treatment （P 〈 0.01）. Pain relief was more significant at rest than at exercise （P 〈 0.01）. ② Pain disappeared at （17.07±6.00）days after treatment on average. The average times of betamethasone administration was （2.42±0.78） times. ③ No local joint pain and other adverse reactions occurred after administration in any case. CONCLUSION： Combination of intraarticular injection of hyaluronate and pain-point injection of betamethasone can effectively relieve the pain symptom of osseous gonarthritis, with no obvious adverse reactions.