膝关节封闭试验结合WOMAC评分在腰-膝综合征中的应用

Application of a diagnostic blocking test of knee joints combined with WOMAC scores in the knee -spine syndrome

目的探讨膝关节封闭试验结合WOMAC评分在腰-膝综合征中的应用。方法30例患有腰-膝综合征（膝关节骨性关节炎合并腰椎退行性疾病）的患者，膝关节内注射复方倍他米松注射液1ml加1％利多卡因10ml行封闭治疗，2天后观察疗效并填写WOMAC评分表，记录下肢症状改善情况并计算封闭前后膝关节功能改善指数。综合评估后决定治疗方案。结果膝关节封闭试验后有效组21例（膝关节功能改善指数≥0．5），20例行全膝关节置换术（TKA），术后效果满意，术后WOMAC评分（11．6±7．3）分，与封闭试验后（11．1±6．4）分比较差异无统计学意义（P〉0．05）。无效组5例（膝关节功能改善指数〈0．25），4例行腰椎手术，术后疗效满意。好转组（膝关节功能改善指数0．25～0．5）4例，2例行腰椎手术，2例行TKA，症状较术前均好转。结论对于腰-膝综合征的患者，膝关节封闭试验结合WOMAC评分可以帮助临床医师认清膝关节疼痛的来源，严格把握手术适应证，同时能对TKA的术后疗效做出准确而全面的预测，提高患者的满意度和减少医患纠纷的产生。

Objective To evaluate the application of a diagnostic blocking test of knee joints combined with the Western Ontario and McMaster universities arthritis index （WOMAC） in the knee - spine syndrome. Methods A total of 30 patients with the knee - spine syndrome were selected. The patients were intra - articularly injected with 10 ml of 1% lidocaine and 1 ml betamethasone for blocking therapy. Two days later, their efficacy was recorded. Meanwhile, the patients were scored using WOMAC scales and their conditions of the lower limb were recorded. The improvement index of knee joint function before and after blocking was also calculated. Then, therapeutic procedures were determined after integrative evaluation. Results After blocking, there were 22 effective cases with ≥0.5 of the improvement index. Meanwhile, 20 patients underwent total knee arthroplasty （TKA） and showed satisfactory efficacy with a WOMAC score of （ 11.6 ±7.3 ） which was not significantly different from the WOMAC score of （ 11.1 ±6.4） in patients after blocking （P 〉 0.05）. There were 5 ineffective cases with 〈 0.25 of the improvement index, where 4 of the patients were subject to lumbar spine surgery and showed satisfactory efficacy. Moreover, there were 2 improved cases with the improvement index from 0.25 to 0.5, in which 2 of the patients underwent lumbar spine surgery and another 2 underwent TKA and showed improved symptom compared with the pre - operative condition. Conclusions For patients with the knee - spine syndrome, the diagnostic blocking test of knee joints combined with WOMAC scores can be adopted by clinical surgeons for better determining of the location of pain within the knee joints and guaranteeing that therapeutic strategies were selected based on the indications. Meanwhile, the combined therapy can facilitate an accurate and comprehensive prediction of TKA efficacy, which then improves patient satisfaction and reduces medical disputes.