超声引导下透明质酸联合糖皮质激素关节腔内注射治疗膝关节骨关节炎疗效分析

Ultrasound guided intra-articular injection of hyaluronic acid and glucocorticoid in the treatment of knee osteoarthritis

目的评估超声引导下透明质酸联合糖皮质激素关节腔内注射治疗膝关节骨关节炎(knee osteoarthritis,KOA)疗效。方法选取我院2020年10月至2021年1月收治的60例Kellgren-Lawrence分级Ⅱ~Ⅲ级的KOA患者。根据1∶1随机数字表法分为观察组与对照组,每组各30例。观察组第1周(T1)注射透明质酸1支;第2周(T2)注射透明质酸1支+糖皮质激素1支;第3周(T3)注射透明质酸1支。对照组:3周均注射透明质酸1支。采用西安大略和麦克马斯特大学骨关节炎(Western Ontario McMaster University Osteoarthritis,WOMAC)指数评估患者骨关节炎严重程度。Lequesne指数(Lequesne index)评估患者病情及膝关节功能状态。患者对目标膝关节的整体评价(patient global assessment,PTGA)是评估最近1周内患者对疾病病情活动性的总体主观评价。此外,对患膝进行屈膝活动度检查。结果观察组患者在T1时间点,WOMAC-疼痛、WOMAC-僵硬、WOMAC-功能、WOMAC-总分、Lequesne指数、PTGA分数低于对照组患者(P<0.05),屈膝活动度高于对照组患者(P<0.05)。在T1时间点,观察组患者改善率高于对照组患者(70.0%vs.18.6%,P<0.05)。在T2、T3与T1时间点,观察组患者WOMAC-总分差值低于对照组患者(P<0.05);在T3与T2时间点,观察组患者WOMAC-总分差值低于对照组患者(P<0.05)。结论超声引导下透明质酸联合糖皮质激素关节腔内注射治疗KOA的早期疗效较好,优于单独关节腔内注射透明质酸,但是在中期并未表现出明显临床收益。

Objective To evaluate the efficacy of ultrasound-guided intra-articular injection of hyaluronic acid and glucocorticoid in the treatment of knee osteoarthritis(KOA).Methods From October 2020 to January 2021,60 KOA patients with Kellgren Lawrence gradeⅡ-Ⅲwere selected.According to 1:1 random number table method,they were divided into observation group and control group(30 cases in each group).In the observation group,hyaluronic acid was injected in the first week;in the second week,hyaluronic acid and glucocorticoid were injected;in the third week,hyaluronic acid was injected.The control group was injected with hyaluronic acid for 3 weeks.The severity of osteoarthritis was assessed by Western Ontario and McMaster University Osteoarthritis(WOMAC)index.Lequesne index(Lequesne index)was used to evaluate the patients’condition and knee joint function.Patient global assessment(PTGA)was the overall subjective evaluation of the patients in the last week.In addition,the knee flexion was examined.Results At T1 time point,WOMAC pain,WOMAC stiffness,WOMAC function,WOMAC total score,Lequesne index and PTGA score of the observation group were lower than those of the control group(P<0.05),and knee flexion was better than that of the control group(P<0.05);at T1 time point,the improvement rate of the observation group was higher than that of the control group(70.0%vs.18.6%,P<0.05).At T2,T3 and T1 time points,the difference of WOMAC-total score in the observation group was lower than that in the control group(P<0.05);At T3 and T2 time points,the difference of WOMAC-total score in the observation group was lower than that in the control group(P<0.05).Conclusions Ultrasound guided intra-articular injection of hyaluronic acid and glucocorticoid has better early curative effect than intra-articular injection of hyaluronic acid alone in the treatment of KOA,but it does not show significant clinical benefits in the medium term.