老年重度骨性关节炎患者膝关节穿刺治疗的临床分析

Clinical analysis of complications for elderly patients with severe knee arthritis after intra-articular injection

目的通过对老年重度骨性关节炎患者膝关节前内侧或前外侧穿刺给予玻璃酸钠及医用几丁糖后的临床疗效观察,分析比较膝关节穿刺治疗并发症的发生情况。方法 2013年2月至2015年4月因膝关节骨性关节炎就诊的971例门诊患者(1 572膝)为研究对象。所有患者膝关节X线K-L关节炎分级为4级,年龄大于65岁,间断口服硫酸氨基葡萄糖胶囊6个月以上效果不佳,患者分为三组:A组医用几丁糖组,411例(723膝),入组后0、2、4周关节前内侧或前外侧局部穿刺注射医用几丁糖,每次1支,同时口服硫酸氨基葡萄糖胶囊;B组玻璃酸钠组,346例(508膝),入组后0、1、2、3、4周关节前内侧或前外侧局部穿刺注射玻璃酸钠,每次1支,同时口服硫酸氨基葡萄糖胶囊;C组患者单纯口服硫酸氨基葡萄糖胶囊,214例(341膝)。对患者进行随访,随访结果包括:膝关节疼痛VAS评分、Lysholm评分以及关节穿刺并发症等,依据统计学软件对上述指标进行分析。结果共371例患者(601膝),符合本组试验要求完成1年随访,其中A组患者159例(257膝),B组患者127例(212膝),C组患者85例(132膝)。与治疗前相比,A和B组患者治疗1、6、12个月后VAS疼痛评分明显降低,膝关节Lysholm功能评分明显增加,在治疗第1个月时最明显,差异均有统计学意义(F=10.238,P<0.05;F=12.156,P<0.05);但C组患者在治疗1、6和12个月后膝关节VAS疼痛评分及膝关节Lysholm功能评分之间差异无统计学意义。膝关节穿刺局部并发症主要是膝关节疼痛、肿胀以及皮下淤血,所有并发症持续时间短。B组患者膝关节穿刺后总并发症发生率为15.09%(33/212),显著高于A组7.39%(19/257,χ~2=7.872,P<0.05),但按照膝关节穿刺次数计算:A和B两组患者并发症发生率之间差异无统计学意义(χ~2=0.681,P>0.05);A组患者前内侧穿刺并发症发生率为3.77%(15/398),显著高于前外侧1.07%(4/373;χ~2=5.825,P<0.05);B组患者前内侧穿刺并发症发生率为4.61%(25/542),显著高于前外侧1.35%(7/518;χ~2=9.285,P<0.05)。A组和B两比较:无论前内侧还是前外侧,其穿刺并发症发生率之间差异均无统计学意义(χ~2=0.401,P>0.05;χ~2=0.163,P>0.05)。结论医用几丁糖及玻璃酸钠局部应用治疗老年重度膝关节骨性关节炎短期内效果可,膝关节局部穿刺的并发症与穿刺次数及部位有关,前外侧为较佳穿刺部位。

Objective To analyze and compare the complications of intra-articular injection with carboxymethylchitin and sodium hyaluronate for elderly patients with severe knee arthritis,through anteromedial and anterolateral parts of knee.Methods 971 cases of outpatients with knee osteoarthritis were selected from February 2013 to April 2015 for the study.Their Kellgren-Lawrence(K-L) radiographic grade of knee was 4,and poor effect on intermittent oral Glucosamine Sulfate Capsules over 6 months.These patients were divided into three groups,namely group A,B and C.Group A included 411cases with 723 knees,whose knees applied an intra-articular injection with carboxymethylchitin through anteromedial and anterolateral parts of knee.At 0,2,4 weeks,group B included 346 cases with 508 knees,whose knees applied an intra-articular injection with sodium hyaluronate through anteromedial and anterolateral parts of knee.At 0,1,2,3,4 weeks,group C included 214 cases,341 knees,who continued to use oral glucosamine sulfate capsules.Patients were followed up,Lysholm knee score and VAS pain score were recorded before treatment and after 1,6,12 months,and the complications were recorded at the same time,then to analyze the clinical efficacy.Results 371 cases of patients(601 knees)were completed follow-up for one year,including 159 cases of patients(257 knees)in group A,127 patients(212 knees)in group B,85 patients(132 knees)in group C,compared with the previous treatment,the VAS pain score at1,6,12 months after treatment in group A and group B patients was significantly reduced,and Lysholm score increased,especially after the first month of treatment,and the difference was statistically significant(F=10.238,P<0.05;F=12.156,P<0.05).But the knee pain relief and function was insignificantly different in group C,after treatment within 1,6 and 12 months.The main local complications of intra-articular injection were knee pain,swelling,and skin congestion,but with short time and no serious complications.The rate of complications of intra-articular injection in group B was insignificantly higher than in group A(χ~2=7.872,P<0.05).But when compared with number of intra-articular injection,the difference was statistically insignificant(χ~2=0.681,P>0.05).Whether in group A or in group B,the anteromedial rate of complications of intra-articular injection was significantly higher than the anterolateral rate,and the difference was statistically significant(χ~2=5.825,P<0.05;χ~2=9.285,P<0.05).The difference of the rate of complications was insignificant,whether in anteromedial or in anterolateral intra-articular injection both in group A and B(χ~2=0.401,P>0.05;χ~2=0.163,P>0.05).Conclusions The short term effect of chitosan and sodium hyaluronate on treatment of elderly severe osteoarthritis of knee is perfect,the complications of intra-articular injection are related to the site and number of injection,and anterolateral location is a better injection point.