酮咯酸氨丁三醇关节腔内注射对膝骨性关节炎患者镇痛作用研究

Analgesic Effects of the Intra-Articular Injection of Ketorolac Tromethamine in the Patients of Knee Osteoarthritis

目的探讨酮咯酸氨丁三醇关节腔内注射对膝骨性关节炎(KOA)患者的镇痛作用。方法将2016年5月-2017年5月收治的KOA患者51例,按照随机数字表法分为对照组25例和治疗组26例。两组患者均常规皮肤消毒,选取穿刺部位,抽尽关节积液后,对照组单纯给予透明质酸钠(SH)关节腔内注射,2ml/次,1次/周,连续治疗5次为1个疗程。治疗组在第1~3周单纯给予SH关节腔内注射,第4~5周加用酮咯酸氨丁三醇,1 ml/次,1次/周,共治疗5周。观察西大略湖和麦克马斯特(WOMAC)骨关节炎指数评分(包括疼痛、关节僵硬、躯体功能)和视觉模拟评分(VAS)情况。结果两组患者治疗1个疗程后,对照组总有效率为88.0%,治疗组为92.3%,两组比较差异无统计学意义(P>0.05)。两组患者治疗后WOMAC骨关节炎指数评分情况均明显优于本组治疗前(P<0.05),且治疗组治疗后疼痛和总评分情况显著优于对照组(P<0.05)。两组患者治疗1、2、3、4周后VAS评分与本组治疗前比较,差异有统计学意义(P<0.05)。两组患者治疗1、2周VAS评分均明显低于治疗3、4周(P<0.05),且与对照组同期比较也均明显降低(P<0.05);两组治疗3、4周后评分相当,与对照组比较差异无统计学意义(P>0.05)。结论酮咯酸氨丁三醇关节腔内注射治疗KOA安全有效,可迅速缓解疼痛,方法简便易行,值得临床推广应用。

Objective To discuss the analgesic effects of the intra-articular injection of ketorolac tromethamine（ KT） in the patients of knee osteoarthritis（ KOA）. Methods From May 2016 through to May2017,51 cases of KOA were collected and divided into a control group（ 25 cases） and a treatment group（ 26 cases） according to random number table. For the patients in all of the two groups,the local skin was sterilized routinely and the joint effusion was withdrawn before intra-articular injection. In the control group,the sodium hyaluronate（ SH） was used in the injection,2 ml each time,once a week,continuously for 5 times as 1 course. In the treatment group,in the first 1 ~ 3 weeks,SH was used in the intra-articular injection; and in the 4^th to 5^th weeks,KT was added,1 ml each time,once a week,totally for 5 weeks. WOMAC scores（ including pain,joint stiffness and somatic function） and VAS scores were observed. Results After 1 course of treatment,the total effective rate was 88. 0% in the control group and was 92. 3% in the treatment group,without significant difference in comparison（ P〈0. 05）. After treatment,in the two groups,WOMAC scores were remarkably better than the results before treatment（ P〉0. 05）. The score of pain and the total score in the treatment group were significant better than the control group after treatment（ P〈0. 05）. After treatment for 1,2,3 and 4 weeks,VAS scores were significantly different as compared with those before treatment in either group（ P〈0. 05）. VAS scores in the treatment of 1 and 2 weeks were remarkably lower than those in 3 and 4 weeks of treatment（ P〈0. 05）. The scores were reduced remarkably as compared with the control group at the same time period. The scores in 3 and 4 weeks of treatment were similar between the two groups,without remarkably difference as compared with the control group（ P〉0. 05）. Conclusion The intra-articular injection of ketorolac tromethamine（ KT） is safe and effective in the treatment of KOA. It relieves pain rapidly. This therapy is simple in operation and deserves to be promoted in clinical practice.