基于MOAKS评分系统对关节腔冲洗治疗膝骨关节炎疼痛预后的相关影响因素分析

Analysis based on MOAKS scoring system for related factors affecting the prognosis of knee osteoarthritis-related pain treated with joint lavage

目的:评估关节腔冲洗(joint lavage,JL)治疗膝骨关节炎(knee osteoarthritis,KOA)病人膝关节疼痛的临床疗效,并基于膝关节MOAKS评分系统及临床特征分析JL治疗预后的相关影响因素。方法:收集2019年4月至2022年5月于山东大学附属省立医院疼痛科接受JL治疗的82例KOA病人的临床资料。回顾性分析病人的数字分级评分法(numerical rating scale,NRS)评分、西安大略和麦克马斯特骨关节炎指数(Western Ontario and McMaster osteoarthritis index,WOMAC)疼痛分量表、镇痛药物使用情况及不良反应。采用MOAKS评分系统对膝关节的MRI影像学资料进行评估。应用多因素二元Logistic回归和ROC曲线分析影响JL疗效的危险因素。结果:研究最终纳入82例病人。JL治疗后出院时、1个月、3个月和6个月的NRS评分均较治疗前显著降低(P<0.001),52例(62.2%)病人在治疗后6个月NRS评分下降程度≥50%。治疗后6个月WOMAC疼痛评分及镇痛药物使用率较治疗前显著降低(P<0.001)。多因素二元Logistic回归分析显示病程(OR=1.022,95%CI:1.003-1.042,P=0.024)、软骨下骨病变评分(OR=1.221,95%CI:1.028-1.450,P=0.023)和关节软骨缺损评分(OR=1.272,95%CI:1.021-1.585,P=0.032)是影响JL治疗预后的独立危险因素。结论:JL对KOA病人的膝关节疼痛治疗有效,长病程、严重软骨下骨病变和关节软骨缺损是JL治疗后疼痛缓解不佳的独立危险因素。

Objective:To evaluate the clinical efficacy of joint lavage(JL)in the treatment of knee osteoarthritis(KOA)-related pain,and to analyze the factors affecting the prognosis after JL treatment,based on knee joint MOAKS scoring system and clinical features.Methods:Clinical data of KOA patients who received JL treatment in the Pain Department of Shandong Provincial Hospital from April 2019 to May 2022 were collected.The patients'numerical rating scale(NRS),Western Ontario and McMaster osteoarthritis index(WOMAC)pain subscale,analgesic medication usage and adverse events were retrospectively analyzed.The MRI imaging data of knee joint were evaluated by MOAKS scoring system.Multivariate Logistic regression and ROC curve were used to analyze the risk factors affecting the efficacy of JL.Results:A total of 82 patients were finally enrolled in this study.The NRS scores at discharge,1 month,3 months,and 6 months after JL treatment were significantly lower than before treatment(P<0.001).At 6 months after treatment,the WOMAC pain score and analgesic medication usage rate significantly decreased compared with before treatment(P<0.001).52 patients(62.2%)showed a decrease of≥50%in NRS scores at 6 months after JL.Multivariate binary logistic regression analysis revealed that duration of pain(OR=1.022,95%CI:1.003-1.042,P=0.024),bone marrow lesion score(OR=1.221,95%CI:1.028-1.450,P=0.023),and cartilage loss score(OR=1.272,95%CI:1.021-1.585,P=0.032)were independent risk factors affecting the prognosis after JL.Conclusion:JL treatment can significantly alleviate pain of patients with KOA.The long duration of pain,severe bone marrow lesion and cartilage loss were independent risk factors for the unsatisfied pain relief after JL.