皮质类固醇注射联合电干针疗法用于踝关节骨性关节炎的临床研究

Clinical study of corticosteroid injection combined with electroacupuncture for ankle osteoarthritis

目的比较皮质类固醇注射联合电干针治疗踝关节骨性关节炎(ankle osteoarthritis,AOA)的临床疗效。方法选取2022年9月至2022年12月于徐州医科大学附属医院疼痛科就诊的60例AOA患者,按随机数字表法分为对照组和试验组(每组30例)。两组患者均接受皮质类固醇注射治疗,试验组在此基础上行电干针治疗。记录两组患者治疗前及治疗后1 d、1周、1个月、3个月时的VAS疼痛评分、美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足评分、踝关节主动活动范围(active range of motion,AROM)(包括跖屈、背伸、内翻、外翻),记录两组患者治疗前及治疗后3个月时健康调查简表(Short From Health Survey,SF-36)评分(包括生理功能、躯体疼痛、精神健康),记录两组患者住院期间使用氨酚曲马多补救镇痛发生率以及与治疗相关不良反应发生率。结果与治疗前比较:两组患者治疗后1 d、1周、1个月、3个月时VAS疼痛评分降低,AOFAS踝-后足评分升高,AROM(跖屈、背伸、内翻、外翻)增加(P<0.05);治疗后3个月SF-36评分(生理功能、躯体疼痛、精神健康)升高(P<0.05)。试验组治疗后3个月VAS疼痛评分低于对照组,AROM(跖屈、背伸)、SF-36评分(生理功能、躯体疼痛、精神健康)高于对照组(P<0.05);治疗后1 d、1周、1个月、3个月AOFAS踝-后足评分高于对照组(P<0.05);治疗后1 d AROM(内翻)高于对照组(P<0.05);治疗后1个月、3个月AROM(外翻)高于对照组(P<0.05)。其余指标比较差异无统计学意义(P>0.05)。结论皮质类固醇注射联合电干针治疗AOA,在踝关节疼痛缓解、功能活动以及远期生活质量等方面,均较单纯皮质类固醇注射治疗有更好的疗效和更加持久的状况改善。

Objective To compare the clinical effect of corticosteroid injection combined with electroacupuncture in the treatment of ankle osteoarthritis(AOA).Methods A total of 60 AOA patients who were admitted to Department of Pain,the Affiliated Hospital of Xuzhou Medical University from September 2022 to December 2022 were enrolled.According to the random number table method,they were divided into two groups(n=30):a control group and an experimental group.Patients in both groups underwent corticosteroid injection treatment,whereas the experimental group additionally received electric dry needle treatment.Their Visual Analogue Scale(VAS)scores,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores,and active range of motion(AROM)(including plantar flexion,dorsiflexion,varus,and valgus)of ankle were recorded before and at postoperative 1 day,1 week,1 month,and 3 months.Their Short From Health Survey(SF-36)scores(including physiological function,physical pain,and mental health)were recorded before and at postoperative 3 months.The incidence of rescue analgesia with paracetamol and tramadol during hospitalization and the incidence of treatment related adverse reactions were recorded.Results Compared with those before treatment,patients in both groups showed decreases in VAS scores,increases in AOFAS ankle-hindfoot scores,and increases in AROM(plantar flexion,dorsiflexion,varus,and valgus)at postoperative 1 day,1 week,1 month,and 3 months(P<0.05).After treatment for 3 months,their SF-36 scores(physiological function,physical pain,and mental health)increased(P<0.05).Furthermore,after treatment for 3 months,the VAS pain scores in the experimental group was lower than that in the control group,while the AROM(plantar flexion and back extension)and SF-36 scores(physiological function,physical pain,and mental health)were higher than those in the control group(P<0.05).The experimental group showed higher AOFAS ankle-hindfoot scores than the control group at postoperative 1 day,1 week,1 month,and 3 months(P<0.05),higher AROM(varus)than the control group at postoperative 1 day(P<0.05),and higher AROM(valgus)than the control group at postoperative 1 month and 3 months(P<0.05).There was no statistical difference in other indicators(P>0.05).Conclusions Treatment of AOA with corticosteroid injection combined with electric dry needle has better effect and more lasting improvement than corticosteroid injection alone in terms of ankle pain relief,functional activities and long-term quality of life.