髋关节液体松解术治疗强直性脊柱炎的疗效观察

Observe the clinical effect on ankylosing spondylitis by hip joint fluid relax operation

目的观察髋关节液体松解术对强直性脊柱炎髋关节活动度的改善及延缓关节间隙变窄的临床疗效。方法将华中科技大学同济医学院附属协和医院风湿免疫科2003—2004年112例强直性脊柱炎患者随机分成对照组(52例)和治疗组(60例),对照组仅使用药物治疗,治疗组在药物治疗基础上加用髋关节液体松解术。比较治疗前后髋关节功能评分、髋关节疼痛评分(VAS评分)、髋关节病变CT分期、炎性指标(C-反应蛋白、血沉)的变化。结果治疗后两组髋关节功能评分及疼痛评分均较治疗前有改善(P均<0.05),而治疗组较对照组改善更显著(P<0.05);两组髋关节病变CT分期在治疗前后均无明显变化,两组之间比较差异亦无显著性意义;炎性指标(C-反应蛋白、血沉)两组均较治疗前有改善(P<0.05),但两组之间比较差异无显著性意义。结论髋关节液体松解术联合药物治疗在减轻强直性脊柱炎患者的关节疼痛和改善关节功能方面优于单用药物治疗。对延缓髋关节变形的作用还需要观察。

Objective To observe the clinical effect on hip involvement on patients with ankylosing spondylitis by hip joint fluid relax operation. Methods 112 patients with ankylosing spondylitis and hip involvement were selected from the Department of Rheumatology and Immunology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from 2003 to 2004. The patients were randomly assigned into curative group of 60 patients and control group of 52 patients. The patients in both groups took medication, and those in the curative group were treated with hip joint fluid relax operation besides the drug treatment. Compare the change of the following index（ the hip joint function, CT staging of hip joint involvement, VAS point, erythrocyte sedimentation and plasma reactive protein）assessment between the two groups before treatment and after treatment of-one year and two years. Results Score of hip joint function and VAS point were obviously higher before treatment than after treatment of one year and two years in beth groups（ P 〈 0. 05 ） ,furthermore, the curative group was obviously better than control group （ P 〈 0. 05 ）. Changes of hip involvement CT staging was not obviously changed at each time point and between both groups. Comparison of inflammatory indexes was obviously lower at the 1 st and 2nd year of follow-up before treatment in both groups;it was close at each time point between the two groups. Conclusion Hip joint combined with drug therapy, which could relieve the hip pain and improve the hip joint function.effectively, is better than pure drug therapy for the involved hip joints in the patients with ankylosing spondylitis. It needs more time to observe the effect on postponing the deterioration of the hip lesion.