玻璃酸钠关节腔注射治疗不同放射学特性的膝骨性关节炎疗效分析

发布时间：2019-03-28 06:06

【摘要】：门诊收集膝骨性关节炎患者,根据影像学特征进行分组,分组后接受玻璃酸钠(斯沛特)一个疗程的治疗,治疗前与治疗后进行膝关节WOMAC评分,计算得出各组改善率,了解玻璃酸钠治疗不同影像学特征的膝骨性关节炎患者的临床疗效并分析其原因,以期指导膝骨性关节炎的临床治疗,提高玻璃酸钠治疗膝骨性关节炎疗效。方法:收集膝骨性关节炎病例,根据纳入标准遴选出膝骨性关节炎患者并接受关节腔注射玻璃酸钠治疗的113例膝骨性关节炎患者,拍摄双膝关节正侧位片后根据其影像学特征将其分为关节软骨下硬化骨形成伴胫骨髁间棘变尖组(A组),骨赘形成组(B组),关节间隙变窄组(C组)。分组后填写个人信息并进行膝关节WOMAC评分,再接受一个疗程关节腔注射玻璃酸钠治疗,治疗后第一个月、第六个月进行随访再次接受膝关节WOMAC评分,计算治疗前与治疗后的评分差值得出各组玻璃酸钠治疗改善率。本临床实验使用WOMAC关节功能评分,治疗前与治疗后之间的评分差值与治疗前评分之比的百分比即为关节功能改善率(RIS),RIS25%为治疗有效,RIS≤25%为治疗无效。观察不同影像学特征所对应的膝骨性关节炎患者的膝关节的疼痛特征及其他临床体征,将不同影像学特征所对应的膝骨性关节炎患者接受玻璃酸钠治疗的临床改善率进行统计学比较并分析其原因。结果:纳入实验的113例膝关节骨性关节炎患者出现膝关节疼痛的疼痛特点以下楼痛及下蹲痛为主,其他还可出现上楼痛、起立痛以及平地走痛,下楼痛、下蹲痛、上楼痛、起立痛及平地走痛的发生率依次为90.2%、87.6%、81.4%、78.9%、39.8%。下楼痛及下蹲痛较其他疼痛特点发生率高。放射学特性为关节下硬化骨形成伴胫骨髁间棘变尖的A组关节腔注射玻璃酸钠一个疗程结束后第1个月的有效率为80.7%,第6个月的有效率为84.6%;放射学特性为骨赘形成的B组关节腔注射玻璃酸钠一个疗程结束后第1个月的有效率为60.0%,第6个月的有效率为80.0%;放射学特性为关节间隙变窄的C组关节腔注射玻璃酸钠一个疗程结束后第1个月的有效率为54.1%,第6个月的有效率为27.0%。A组和B组关节症状改善率即治疗有效率随玻璃酸钠治疗疗程结束后时间的增加而逐渐增加,C组关节改善率即治疗有效率随玻璃酸钠治疗疗程结束后时间的增加而逐渐而降低。关节腔内注射玻璃酸钠治疗膝关节骨性关节炎第6个月后的总体治疗有效率为63.7%。通过X2检验进行依据影像学特征分组后组间治疗效果比较,X2=32.191,P0.005,组间在第6个月后治疗效果差异有统计学意义。A组关节腔注射玻璃酸钠疗程结束后第1个月有效率为80.7%。疗程结束后第6个月有效率为84.6%,通过X2检验(四格表)依据放射学特性分组的A组患者玻璃酸钠治疗后第1月与第6个月治疗效果比较,X2=5.778,P0.05,A组玻璃酸钠治疗后第1月与第6个月治疗效果的差异有统计学意义。B组关节腔注射玻璃酸钠疗程结束后第1个月有效率为60.0%,第6个月有效率为80.0%,通过X2检验(四格表)进行依据放射学特性分组的B组患者治疗后第1月与第6个月治疗效果比较,X2=4.762,P0.05,B组玻璃酸钠治疗后第1月与第6个月治疗效果的差异有统计学意义。C组关节腔注射玻璃酸钠疗程结束后第1个月有效率为54.1%,第6个月有效率为27.0%,通过X2检验(四格表)进行依据放射学特性分组的C组患者治疗后第1月与第6个月的治疗效果比较,X2=5.606,P0.025,C组玻璃酸钠治疗后第1月与第6个月治疗效果的差异有统计学意义。结论:1、影像学特征为软骨下硬化骨形成伴胫骨髁间棘变尖的A组患者及骨赘形成的B组患者较影像学特征为关节间隙变窄的C组患者治疗有效率高。2、影像学特征为软骨下硬化骨形成伴胫骨髁间棘变尖及骨赘形成的A、B组患者的关节症状改善率随玻璃酸钠治疗疗程结束后时间的增加而逐渐增加;影像学特征为关节间隙变窄的C组患者治疗有效率随玻璃酸钠治疗疗程结束后时间的增加而逐渐而降低。
[Abstract]:The patients with knee osteoarthritis collected in the clinic were grouped according to the imaging features, and then treated with a treatment course of sodium hyaluronate (Speth) after the grouping, and the knee joint WOMAC score was performed before and after the treatment, and the improvement rate of each group was calculated. To study the clinical effect of sodium hyaluronate in the treatment of knee osteoarthritis with different imaging features and to analyze its causes, in order to guide the clinical treatment of knee osteoarthritis, and to improve the curative effect of sodium hyaluronate in the treatment of knee osteoarthritis. Methods: The cases of knee osteoarthritis were collected, and 113 patients with knee osteoarthritis were selected from the patients with knee osteoarthritis and treated with sodium hyaluronate in the joint cavity. After the two-knee-knee positive-side patch was taken, it was divided into the subchondral-hardened bone formation with the intercondylar acanthrene group (group A), the osteophyte formation group (group B) and the joint gap narrowing group (group C) according to the imaging characteristics. after the grouping, the personal information is filled and the knee joint WOMAC score is carried out, a treatment course joint cavity is used for the treatment of the sodium hyaluronate, the first month after the treatment and the sixth month after the treatment, the knee joint WOMAC score is again accepted, And calculating the improvement rate of the sodium hyaluronate in each group according to the difference between the pre-treatment and the post-treatment score. The clinical trial uses the WOMAC joint function score, the percentage of the score difference between the pre-treatment and the post-treatment and the pre-treatment score is the joint function improvement rate (RIS), the RIS25% is the treatment effective, and the RIS-25% is the treatment effect. The pain characteristics and other clinical signs of knee osteoarthritis patients with different imaging features were observed, and the clinical improvement rates of the patients with knee osteoarthritis corresponding to different imaging features were statistically compared and their causes were analyzed. Results: The pain of knee joint pain in 113 cases of knee osteoarthritis in the experiment was characterized by the pain of the stairs, the pain of the lower crouching, and the other cases, such as the pain of the stairs, the pain of the rising and the pain of the ground, the pain of the stairs, the squat pain and the pain of the stairs. The incidence of up-and-down pain was 90.2%, 87.6%, 81.4%, 78.9% and 39.8%, respectively. The rate of down-stairs pain and lower squatting pain is higher than that of other pain features. The effective rate was 80.7% in the first month after the end of one treatment course and 84.6% in the 6th month. The effective rate was 60.0% in the first month after the end of one treatment course, and the effective rate was 80.0% in the 6th month. the effective rate of the first month after the end of one treatment course of the C-group joint cavity with the radiographic characteristics of narrowing the joint gap is 54.1%, The effective rate was 27.0% in the sixth month. The improvement rate of the joint symptoms in group A and group B was gradually increased with the increase of the time after the end of the treatment course of the sodium hyaluronate, and the improvement rate of the C group, that is, the effective rate of the treatment was gradually decreased with the increase of the time after the end of the treatment course of the sodium hyaluronate. The total effective rate of intra-articular injection of sodium hyaluronate in the treatment of knee osteoarthritis was 63.7%. The effect of X2 test on the treatment effect between the two groups according to the imaging characteristics was compared, X2 = 32.191, P <005, and the treatment effect was statistically significant between the two groups after the 6th month. In group A, the effective rate was 80.7% in the first month after the end of treatment of sodium hyaluronate. The effective rate was 84.6% in the 6th month after the end of the treatment course, and the treatment effect was compared with the treatment effect of the first month and the 6th month after the treatment of sodium hyaluronate in group A by the X2 test (four-cell table), X2 = 5.778, P0.05, The difference of treatment effect between the first month and the sixth month after the treatment of sodium hyaluronate in group A was of statistical significance. In group B, the effective rate was 60.0% in the first month after the end of treatment, the effective rate was 80.0% in the 6th month, and the treatment effect of group B in group B according to the radiological characteristics was compared with the treatment effect in the first month and the 6th month after treatment with the X2 test (four-cell table), X2 = 4.762, P0.05, The difference of treatment effect between the first month and the sixth month after the treatment of sodium hyaluronate in group B was of statistical significance. In group C, the effective rate was 54.1% in the first month after the end of treatment, the effective rate was 27.0% in the 6th month, and the treatment effect of the group C in group C according to the radiological characteristics was compared with the treatment effect of the first month and the 6th month after treatment with the X2 test (four-cell table), X2 = 5.606, P.025, The difference of treatment effect between the first month and the sixth month after the treatment of sodium hyaluronate in group C was of statistical significance. Conclusion:1. The imaging feature is the effective rate of the treatment of the C-group with the narrowing of the joint gap in the group A and the B-group with the image features of the group A with the subchondral-hardened bone and the intercondylar-tip of the tibia and the B-group with the osteophyte formation. The imaging features showed that the improvement rate of the joint symptoms of the patients with subchondral-hardened bone formation with the intercondylar and osteophyte formation in the group A and B gradually increased with the increase of the time after the end of the treatment course of the sodium hyaluronate. The effective rate of treatment for C-group with narrowing of the joint gap was gradually decreased with the increase of the time after the end of the treatment course of the sodium hyaluronate.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R684.3

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