超声引导下关节腔穿刺注射术治疗风湿免疫性关节炎的效果分析

Efficiency analysis of ultrasound-guided articular cavity injection in treating rheumatoid immune arthritis

目的探讨实时超声引导下关节腔穿刺注射术在风湿免疫性关节炎中的应用价值。方法选取在超声科进行关节腔穿刺注药的102例患者,术前均行超声检查,观察拟行穿刺关节的骨表面、软骨、滑膜、关节腔是否有积液,以及关节周围肌腱、腱鞘及滑囊情况。采用视觉模拟评分法(VAS)进行拟穿刺关节疼痛的评估,穿刺1 d后再次以VAS法对穿刺注药关节进行疼痛评估,1周后复查关节超声,尤其注意观察滑膜厚度及滑膜血供情况是否改善。结果 102例超声引导下的关节腔穿刺注药术均1次成功,术中可清晰显示针尖及药物注入关节腔全过程,术后未出现出血、感染、神经损伤等并发症。96例患者感觉药物注射后疼痛程度降低;术前平均VAS评分(3. 8±2. 1)分,术后(2. 4±0. 7)分;术后滑膜血供评级下降者88例;术前滑膜厚度(4. 2±1. 7) mm,术后(2. 8±1. 5) mm;术后的疼痛程度、滑膜血供、VAS评分、滑膜厚度与术前比较,差异均有统计学意义(P <0. 05或P <0. 01)。结论超声引导下关节腔穿刺术成功率高,安全可靠,局部关节腔穿刺注药术后可有效缓解局部疼痛,减轻关节炎性改变。

Objective To study value of articular cavity injection guided by real-time ultrasound in rheumatoid immune arthritis. Methods A total of 102 patients underwent arthroscopic injection in department of ultrasonography receiving preoperative ultrasonography, and whether there was hydrops on the bone surface, cartilage, synovial membrane and articular cavity of puncture joint were observed, and the conditon of surrounding tendons, tenosynovial sheath and synovial bursa were observed. Visual analogue scale （VAS） was used to evaluate the pain of the puncture joint. After 1 day of puncture, the injection joints were evaluated by VAS method again. After 1 week, joint ultrasonography was reviewed, especially whether the synovial thickness and synovial blood supply were improved. Results All the 102 cases were successfully injected by ultrasound-guided drug injection. The whole process of needle tip and drug injection into the articular cavity could be clearly displayed during the operation. No complications such as bleeding, infection and nerve injury occurred after the operation. There were 96 cases with decreased pain degree after drug injection. VAS scores before surgery was decreased from（3.8±2.1） in preoperation to （2.4±0.7） points after operation. There were 88 cases with postoperative synovial blood supply rating decrease. Preoperative synovial thickness was （4.2±1.7） mm, and was （2.8±1.5） mm after operation. Pain degree and synovial blood supply, VAS score, synovial thickness after surgery showed significnat diffeence compared with preoperation （ P 〈0.05 or P 〈0.01）. Conclusion Ultrasound-guided puncture of joint cavity is safer and reliable, and has higher successful rate, local knee cavity injection can relieve the local pain, and inflammatory change of knee cavity.