影像学引导下髋关节腔注射玻璃酸钠联合内热针治疗髋骨性关节炎疗效观察

发布时间：2018-05-15 12:38

本文选题：玻璃酸钠腔内注射 + 髋关节骨性关节炎　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的骨关节炎是常见的慢性骨与关节疾病,是一种以关节软骨退变、继发骨质增生为特征,以关节反复发作疼痛、肿胀、逐渐加重,出现关节畸形、活动障碍为主要临床表现的疾病。随着人口老龄化进程加速,退变性骨性关节炎患者越来越多,作为人体负重大关节,髋关节患病率仅次于膝关节。因髋关节部位深、关节囊致密、血管神经丰富的解剖结构特殊性,在疾病发展的早中期缺乏有效的保护手段,疾病发展到晚期严重影响生活质量而必须行人工关节置换手术,给家庭造成额外的经济负担。因此,在髋OA早中期进行有效、可行的非手术干预措施来缓解临床症状、改善关节运动障碍、延缓关节结构退变、避免或延迟关节置换手术等,具有积极的临床意义。目前对于症状性髋OA患者,临床常用针灸、推拿、玻璃酸钠关节腔注射、口服氨基葡萄糖胶囊及康复功能锻炼等保守治疗手段,然而由于单一疗法临床效果有限,因此临床上常常综合多种手段。本实验课题选择随机对照的研究方法,针对髋OA患者,以髋关节腔穿刺注射玻璃酸钠治疗为对照组,研究分析影像引导下髋关节腔穿刺玻璃酸钠腔内注射联合内热针对髋OA的临床疗效,验证内热针配合关节腔玻璃酸钠注射治疗髋OA的临床可行性、安全性及优越性,为目前髋OA早中期保守治疗提供一种思路,并希望其能在临床上推广应用。方法选取十堰市太和医院康复中心2015年05月2017年02月收治疗的确诊为髋骨性关节炎的患者共85例,按随机数字表法分为对照组42例,给予玻璃酸钠针腔内注射治疗;观察组43例,给予玻璃酸钠腔内注射联合内热针治疗。观察记录两组患者治疗前后及随访入组4w、12w后临床疗效、VAS疼痛评分、Harris髋关节评分、WOMAC评分,随访结束对各观察指标进行统计学分析。结果两组患者治疗结束后,观察数据采用SPSS21.0统计软件进行分析,结果:(1)入组4w、12w后对照组总有效率分别为50%和72.5%,实验组分别为72.5%和90%,两组患者总有效率均升高,组内比较远期疗效均优于近期疗效,差异均具有统计学意义(P0.01);且同时间点组间比较实验组总有效率均明显高于对照组,差异均具有统计学意义(P0.01);(2)治疗前、入组4w后、入组12w后,对照组患者VAS疼痛评分分别为7.31±1.23、5.16±1.34、3.98±0.85;WOMAC评分分别为55.86±11.36、34.46±7.58、25.57±7.63;Harris评分分别为55.13±3.17、63.06±2.04、70.32±3.00;实验组患者VAS疼痛评分分别为6.66±1.43、3.99±1.02、1.97±0.55;WOMAC评分分别为54.00±3.88、21.78±10.37、13.24±7.12;Harris评分分别为54.29±1.91、66.66±3.31、86.17±4.26;两组患者VAS评分及WOMAC评分均逐步明显降低,Harris评分均逐步明显升高,同组组内比较远期疗效均优于近期疗效,差异均具有统计学意义(P0.01);且同时间点组间比较实验组均优于对照组,差异均具有统计学意义(P0.01);表明关节腔注射玻璃酸钠在缓解髋OA患者疼痛症状、增加髋关节活动度及恢复髋关节功能方面,远期疗效均优于近期疗效,且关节腔注射玻璃酸钠联合内热针治疗效果更佳;结论采用影像引导下进行髋关节腔穿刺,可以精准定位,提高穿刺成功率。玻璃酸钠关节腔内注射联合内热针治疗髋骨性关节炎,既可以润滑关节、营养软骨、改善关节活动度,恢复关节内正常代谢平衡,又可以缓解关节外软组织肌张力过高、有效减轻疼痛。本研究中玻璃酸钠关节腔注射联合内热针组治疗髋OA临床疗效确切,治愈率高,且明显优于单独关节腔注射玻璃酸钠组,是一种安全有效、可行性高的治疗思路,值得临床上推广应用。
[Abstract]:Osteoarthritis is a common chronic bone and joint disease. It is a disease characterized by articular cartilage degeneration and secondary bone hyperplasia, with repeated episodes of pain, swelling, gradual aggravation, joint malformation, and activity disorder as the main clinical manifestation. As the heavy joint of the body, the incidence of hip joint is second only to the knee joint. The hip joint is deep, the joint capsule is dense and the vascular nerve is rich in anatomical structure. It is lack of effective protection means in the early and middle period of the development of the disease. It has an additional economic burden. Therefore, it has positive clinical significance in the early and mid-term hip OA, which is effective, feasible and nonoperative intervention to relieve clinical symptoms, improve joint movement disorders, delay joint structural degeneration, avoid or delay joint replacement surgery. Sodium joint injection, oral administration of glucosamine capsule and rehabilitative functional exercise are used for conservative treatment. However, due to the limited clinical effect of single therapy, many methods are often used in clinical. The randomized controlled study on hip OA patients with sodium hyaluronate injection is used as the control group. The clinical efficacy of intra-articular injection of sodium hyaluronate combined with endotherm injection combined with internal heat for hip OA was investigated and analyzed. The clinical feasibility, safety and superiority of endotherm needle combined with sodium hyaluronate injection in the treatment of hip OA was verified. It provided a way of thinking for the early and mid-term conservative treatment of hip OA, and hoped that it could be popularized in clinical practice. Methods a total of 85 patients with hip osteoarthritis treated in Shiyan Taihe Hospital rehabilitation center in 2015, 2017, 2017, were divided into 42 cases in the control group and treated with sodium hyaluronate injection. 43 cases in the observation group were treated with sodium hyaluronate intracavitary injection combined with internal heat needle treatment. Two groups were observed and recorded in the observation group. Before and after treatment, the clinical efficacy, VAS pain score, Harris hip joint score, WOMAC score, and the end of follow-up were statistically analyzed. Results after the treatment of two groups, the observation data were analyzed with SPSS21.0 software, and the results were as follows: (1) the total effective rate in the group of 4W, 12W and the control group was 50, respectively, 50. % and 72.5%, the experimental group was 72.5% and 90% respectively, the total effective rate of the two groups increased, the long-term effect of the group was better than the short-term effect, the difference was statistically significant (P0.01), and the total effective rate of the experimental group was significantly higher than the control group at the same time point group, the difference was statistically significant (P0.01); (2) before the treatment, after the group 4W, enter the group. After group 12W, the score of VAS pain in the control group was 7.31 + 1.23,5.16 + 1.34,3.98 + 0.85, and the WOMAC score was 55.86 + 11.36,34.46 + 7.63, respectively, and Harris score was 55.13 + 3.17,63.06 + 2.04,70.32 + 3, and the VAS pain score of the experimental group was 6.66 + 3 + 0.55, respectively, 54 + 3.88, respectively. 21.78 + 10.37,13.24 + 7.12; Harris score was 54.29 + 1.91,66.66 + 3.31,86.17 + 4.26, respectively, the VAS score and WOMAC score in the two groups were gradually reduced, and the Harris score increased gradually. The long-term effect of the same group was better than the short-term effect, the difference was statistically significant (P0.01), and the comparison experiment at the same time point group was compared. All the groups were superior to the control group, and the difference was statistically significant (P0.01). The results showed that the joint cavity injection of sodium hyaluronate was better than the short-term effect in alleviating the pain symptoms of hip OA, increasing the hip joint activity and restoring the hip joint function, and the effect of the joint cavity injection of sodium hyaluronate combined with the internal heat needle was better. Under the guidance of the hip joint puncture, it can be accurately positioned to improve the success rate of puncture. Intraarticular injection of sodium hyaluronate combined with internal heat needle for the treatment of hip osteoarthritis can not only lubricate joints, nourishment cartilage, improve joint activity, restore normal metabolic balance within the joint, but also relieve the excessive soft tissue muscle tension of the joint, and effectively alleviate the soft tissue muscle tension. In this study, the sodium hyaluronate joint cavity injection combined with internal heat needle group in the treatment of hip OA is effective, cure rate is high, and obviously better than the single articular injection of sodium hyaluronate group. It is a safe, effective and feasible treatment idea, which is worthy of clinical application.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684.3

【参考文献】