發(fā)布時(shí)間：2018-05-15 12:38

  本文選題：玻璃酸鈉腔內(nèi)注射 + 髖關(guān)節(jié)骨性關(guān)節(jié)炎�。� 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的骨關(guān)節(jié)炎是常見(jiàn)的慢性骨與關(guān)節(jié)疾病,是一種以關(guān)節(jié)軟骨退變、繼發(fā)骨質(zhì)增生為特征,以關(guān)節(jié)反復(fù)發(fā)作疼痛、腫脹、逐漸加重,出現(xiàn)關(guān)節(jié)畸形、活動(dòng)障礙為主要臨床表現(xiàn)的疾病。隨著人口老齡化進(jìn)程加速,退變性骨性關(guān)節(jié)炎患者越來(lái)越多,作為人體負(fù)重大關(guān)節(jié),髖關(guān)節(jié)患病率僅次于膝關(guān)節(jié)。因髖關(guān)節(jié)部位深、關(guān)節(jié)囊致密、血管神經(jīng)豐富的解剖結(jié)構(gòu)特殊性,在疾病發(fā)展的早中期缺乏有效的保護(hù)手段,疾病發(fā)展到晚期嚴(yán)重影響生活質(zhì)量而必須行人工關(guān)節(jié)置換手術(shù),給家庭造成額外的經(jīng)濟(jì)負(fù)擔(dān)。因此,在髖OA早中期進(jìn)行有效、可行的非手術(shù)干預(yù)措施來(lái)緩解臨床癥狀、改善關(guān)節(jié)運(yùn)動(dòng)障礙、延緩關(guān)節(jié)結(jié)構(gòu)退變、避免或延遲關(guān)節(jié)置換手術(shù)等,具有積極的臨床意義。目前對(duì)于癥狀性髖OA患者,臨床常用針灸、推拿、玻璃酸鈉關(guān)節(jié)腔注射、口服氨基葡萄糖膠囊及康復(fù)功能鍛煉等保守治療手段,然而由于單一療法臨床效果有限,因此臨床上常常綜合多種手段。本實(shí)驗(yàn)課題選擇隨機(jī)對(duì)照的研究方法,針對(duì)髖OA患者,以髖關(guān)節(jié)腔穿刺注射玻璃酸鈉治療為對(duì)照組,研究分析影像引導(dǎo)下髖關(guān)節(jié)腔穿刺玻璃酸鈉腔內(nèi)注射聯(lián)合內(nèi)熱針對(duì)髖OA的臨床療效,驗(yàn)證內(nèi)熱針配合關(guān)節(jié)腔玻璃酸鈉注射治療髖OA的臨床可行性、安全性及優(yōu)越性,為目前髖OA早中期保守治療提供一種思路,并希望其能在臨床上推廣應(yīng)用。方法選取十堰市太和醫(yī)院康復(fù)中心2015年05月2017年02月收治療的確診為髖骨性關(guān)節(jié)炎的患者共85例,按隨機(jī)數(shù)字表法分為對(duì)照組42例,給予玻璃酸鈉針腔內(nèi)注射治療;觀察組43例,給予玻璃酸鈉腔內(nèi)注射聯(lián)合內(nèi)熱針治療。觀察記錄兩組患者治療前后及隨訪入組4w、12w后臨床療效、VAS疼痛評(píng)分、Harris髖關(guān)節(jié)評(píng)分、WOMAC評(píng)分,隨訪結(jié)束對(duì)各觀察指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果兩組患者治療結(jié)束后,觀察數(shù)據(jù)采用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行分析,結(jié)果:(1)入組4w、12w后對(duì)照組總有效率分別為50%和72.5%,實(shí)驗(yàn)組分別為72.5%和90%,兩組患者總有效率均升高,組內(nèi)比較遠(yuǎn)期療效均優(yōu)于近期療效,差異均具有統(tǒng)計(jì)學(xué)意義(P0.01);且同時(shí)間點(diǎn)組間比較實(shí)驗(yàn)組總有效率均明顯高于對(duì)照組,差異均具有統(tǒng)計(jì)學(xué)意義(P0.01);(2)治療前、入組4w后、入組12w后,對(duì)照組患者VAS疼痛評(píng)分分別為7.31±1.23、5.16±1.34、3.98±0.85;WOMAC評(píng)分分別為55.86±11.36、34.46±7.58、25.57±7.63;Harris評(píng)分分別為55.13±3.17、63.06±2.04、70.32±3.00;實(shí)驗(yàn)組患者VAS疼痛評(píng)分分別為6.66±1.43、3.99±1.02、1.97±0.55;WOMAC評(píng)分分別為54.00±3.88、21.78±10.37、13.24±7.12;Harris評(píng)分分別為54.29±1.91、66.66±3.31、86.17±4.26;兩組患者VAS評(píng)分及WOMAC評(píng)分均逐步明顯降低,Harris評(píng)分均逐步明顯升高,同組組內(nèi)比較遠(yuǎn)期療效均優(yōu)于近期療效,差異均具有統(tǒng)計(jì)學(xué)意義(P0.01);且同時(shí)間點(diǎn)組間比較實(shí)驗(yàn)組均優(yōu)于對(duì)照組,差異均具有統(tǒng)計(jì)學(xué)意義(P0.01);表明關(guān)節(jié)腔注射玻璃酸鈉在緩解髖OA患者疼痛癥狀、增加髖關(guān)節(jié)活動(dòng)度及恢復(fù)髖關(guān)節(jié)功能方面,遠(yuǎn)期療效均優(yōu)于近期療效,且關(guān)節(jié)腔注射玻璃酸鈉聯(lián)合內(nèi)熱針治療效果更佳;結(jié)論采用影像引導(dǎo)下進(jìn)行髖關(guān)節(jié)腔穿刺,可以精準(zhǔn)定位,提高穿刺成功率。玻璃酸鈉關(guān)節(jié)腔內(nèi)注射聯(lián)合內(nèi)熱針治療髖骨性關(guān)節(jié)炎,既可以潤(rùn)滑關(guān)節(jié)、營(yíng)養(yǎng)軟骨、改善關(guān)節(jié)活動(dòng)度,恢復(fù)關(guān)節(jié)內(nèi)正常代謝平衡,又可以緩解關(guān)節(jié)外軟組織肌張力過(guò)高、有效減輕疼痛。本研究中玻璃酸鈉關(guān)節(jié)腔注射聯(lián)合內(nèi)熱針組治療髖OA臨床療效確切,治愈率高,且明顯優(yōu)于單獨(dú)關(guān)節(jié)腔注射玻璃酸鈉組,是一種安全有效、可行性高的治療思路,值得臨床上推廣應(yīng)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.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R684.3

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