玻璃酸鈉關(guān)節(jié)腔注射治療不同放射學(xué)特性的膝骨性關(guān)節(jié)炎療效分析
發(fā)布時間：2019-03-28 06:06
【摘要】：門診收集膝骨性關(guān)節(jié)炎患者,根據(jù)影像學(xué)特征進行分組,分組后接受玻璃酸鈉(斯沛特)一個療程的治療,治療前與治療后進行膝關(guān)節(jié)WOMAC評分,計算得出各組改善率,了解玻璃酸鈉治療不同影像學(xué)特征的膝骨性關(guān)節(jié)炎患者的臨床療效并分析其原因,以期指導(dǎo)膝骨性關(guān)節(jié)炎的臨床治療,提高玻璃酸鈉治療膝骨性關(guān)節(jié)炎療效。方法:收集膝骨性關(guān)節(jié)炎病例,根據(jù)納入標準遴選出膝骨性關(guān)節(jié)炎患者并接受關(guān)節(jié)腔注射玻璃酸鈉治療的113例膝骨性關(guān)節(jié)炎患者,拍攝雙膝關(guān)節(jié)正側(cè)位片后根據(jù)其影像學(xué)特征將其分為關(guān)節(jié)軟骨下硬化骨形成伴脛骨髁間棘變尖組(A組),骨贅形成組(B組),關(guān)節(jié)間隙變窄組(C組)。分組后填寫個人信息并進行膝關(guān)節(jié)WOMAC評分,再接受一個療程關(guān)節(jié)腔注射玻璃酸鈉治療,治療后第一個月、第六個月進行隨訪再次接受膝關(guān)節(jié)WOMAC評分,計算治療前與治療后的評分差值得出各組玻璃酸鈉治療改善率。本臨床實驗使用WOMAC關(guān)節(jié)功能評分,治療前與治療后之間的評分差值與治療前評分之比的百分比即為關(guān)節(jié)功能改善率(RIS),RIS25%為治療有效,RIS≤25%為治療無效。觀察不同影像學(xué)特征所對應(yīng)的膝骨性關(guān)節(jié)炎患者的膝關(guān)節(jié)的疼痛特征及其他臨床體征,將不同影像學(xué)特征所對應(yīng)的膝骨性關(guān)節(jié)炎患者接受玻璃酸鈉治療的臨床改善率進行統(tǒng)計學(xué)比較并分析其原因。結(jié)果:納入實驗的113例膝關(guān)節(jié)骨性關(guān)節(jié)炎患者出現(xiàn)膝關(guān)節(jié)疼痛的疼痛特點以下樓痛及下蹲痛為主,其他還可出現(xiàn)上樓痛、起立痛以及平地走痛,下樓痛、下蹲痛、上樓痛、起立痛及平地走痛的發(fā)生率依次為90.2%、87.6%、81.4%、78.9%、39.8%。下樓痛及下蹲痛較其他疼痛特點發(fā)生率高。放射學(xué)特性為關(guān)節(jié)下硬化骨形成伴脛骨髁間棘變尖的A組關(guān)節(jié)腔注射玻璃酸鈉一個療程結(jié)束后第1個月的有效率為80.7%,第6個月的有效率為84.6%;放射學(xué)特性為骨贅形成的B組關(guān)節(jié)腔注射玻璃酸鈉一個療程結(jié)束后第1個月的有效率為60.0%,第6個月的有效率為80.0%;放射學(xué)特性為關(guān)節(jié)間隙變窄的C組關(guān)節(jié)腔注射玻璃酸鈉一個療程結(jié)束后第1個月的有效率為54.1%,第6個月的有效率為27.0%。A組和B組關(guān)節(jié)癥狀改善率即治療有效率隨玻璃酸鈉治療療程結(jié)束后時間的增加而逐漸增加,C組關(guān)節(jié)改善率即治療有效率隨玻璃酸鈉治療療程結(jié)束后時間的增加而逐漸而降低。關(guān)節(jié)腔內(nèi)注射玻璃酸鈉治療膝關(guān)節(jié)骨性關(guān)節(jié)炎第6個月后的總體治療有效率為63.7%。通過X2檢驗進行依據(jù)影像學(xué)特征分組后組間治療效果比較,X2=32.191,P0.005,組間在第6個月后治療效果差異有統(tǒng)計學(xué)意義。A組關(guān)節(jié)腔注射玻璃酸鈉療程結(jié)束后第1個月有效率為80.7%。療程結(jié)束后第6個月有效率為84.6%,通過X2檢驗(四格表)依據(jù)放射學(xué)特性分組的A組患者玻璃酸鈉治療后第1月與第6個月治療效果比較,X2=5.778,P0.05,A組玻璃酸鈉治療后第1月與第6個月治療效果的差異有統(tǒng)計學(xué)意義。B組關(guān)節(jié)腔注射玻璃酸鈉療程結(jié)束后第1個月有效率為60.0%,第6個月有效率為80.0%,通過X2檢驗(四格表)進行依據(jù)放射學(xué)特性分組的B組患者治療后第1月與第6個月治療效果比較,X2=4.762,P0.05,B組玻璃酸鈉治療后第1月與第6個月治療效果的差異有統(tǒng)計學(xué)意義。C組關(guān)節(jié)腔注射玻璃酸鈉療程結(jié)束后第1個月有效率為54.1%,第6個月有效率為27.0%,通過X2檢驗(四格表)進行依據(jù)放射學(xué)特性分組的C組患者治療后第1月與第6個月的治療效果比較,X2=5.606,P0.025,C組玻璃酸鈉治療后第1月與第6個月治療效果的差異有統(tǒng)計學(xué)意義。結(jié)論:1、影像學(xué)特征為軟骨下硬化骨形成伴脛骨髁間棘變尖的A組患者及骨贅形成的B組患者較影像學(xué)特征為關(guān)節(jié)間隙變窄的C組患者治療有效率高。2、影像學(xué)特征為軟骨下硬化骨形成伴脛骨髁間棘變尖及骨贅形成的A、B組患者的關(guān)節(jié)癥狀改善率隨玻璃酸鈉治療療程結(jié)束后時間的增加而逐漸增加;影像學(xué)特征為關(guān)節(jié)間隙變窄的C組患者治療有效率隨玻璃酸鈉治療療程結(jié)束后時間的增加而逐漸而降低。
[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.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R684.3
本文編號：2448608
[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.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R684.3
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