高频彩色多普勒超声引导下局部注射TNF-α抑制剂治疗强直性脊柱炎髋关节病变的临床研究

The application of local injection of TNF-α inhibitors guided by high-frequency color Doppler ultrasound in the treatment of hip joint lesions in patients with ankylosing spondylitis

目的:探讨高频彩色多普勒超声在局部注射肿瘤坏死因子(TNF)-α抑制剂治疗强直性脊柱炎患者髋关节病变中的应用价值。方法:对风湿免疫科确诊为强直性脊柱炎且有髋关节病变35例患者64个髋关节在超声定位引导下穿刺注射TNF-α受体抗体融合蛋白,穿刺目标靶区为髋关节的关节间隙,记录穿刺成功所需次数、不良反应,以及治疗前与治疗7周后股骨头软骨厚度及髋关节疼痛的视觉模拟评分(VAS)。结果:髋关节的关节间隙在高频彩超下均可清晰显示,64个髋关节93.8%可以一次顺利穿刺注药到达关节间隙内;治疗前软骨厚度(0.78±0.16)mm、VAS评分(5.80±0.89)分,治疗7周后软骨厚度(0.90±0.18)mm、VAS评分(1.67±0.66)分,治疗前后差异均有统计学意义(P<0.01);术中及术后未出现明显不良反应。结论:高频彩色多普勒超声引导下髋关节注射TNF-α受体抗体融合蛋白是一种治疗强直性脊柱炎髋关节病变安全有效的介入治疗方法。

Objective：To explore the value of local injection of tumor necrosis factor（ TNF）-a inhibitors guided by high-frequency color Doppler ultrasound in the treatment of hip joint lesions in patients with ankylosing spondylitis. Methods： The antibody fusion protein of TNF-a receptor were injected into 64 hip joint lesions in 35 patients with ankylosing spondylitis from Rheumatology department guided by color Doppler ultrasound, the hip joint space as puncturing area was used. The successful puncture number, adverse reactions,femoral head cartilage thickness before treatment and in 7 weeks after treatment and visual analogue score（VAS） of hip pain in all patients were recorded. Results： Joint space of hip joint could be clearly showed in high-frequency color Doppler ultrasound,the drug could be successfully injected into 93.8% of 64 hip jionts space at one-time. The cartilage thickness before treatment and in 7 weeks after treatment were （ 0.78 ± 0. 16 ） mm and （ 0.90± 0. 18 ） mm, respectively, the difference of which was statistical significance （P 〈 0. 01 ）. The VAS score before treatment and in 7 weeks after treatment were （5.80 ± 0.89 ） and （ 1.67 ±0. 66）, respectively, the difference of which was statistical significance （ P 〈 0. 01 ）. No obviously intraoperative and postoperative adverse reactions were found. Conclusions：The injection of antibody fusion protein of TNF-a guided by high-frequency color Doppler ultrasound in the treatment of hip joint lesions in patients with ankylosing spondylitis is a safe and effective interventional therapy