【摘要】 目的应用玻璃酸钠联合复方倍他米松髋关节腔注射治疗强直性脊柱炎(AS)髋关节病变,探讨其对髋关节功能及影像学表现的影响。方法采用随机对照研究,选取64例活动期强直性脊柱炎伴髋关节病变患者,放射学评分为1~3分改变者,分为2组(试验组44例,男性36例,女性8例;年龄17~34岁;对照组20例,男性16例,女性4例;年龄18~35岁),均在规范抗风湿药物治疗基础上,试验组予玻璃酸钠联合复方倍他米松髋关节注射,每周1次(复方倍他米松仅于第1次应用),连续5周为一疗程,对照组仅于第1天予肌肉注射复方倍他米松,治疗后24周重复一个疗程。关节穿刺选取髋关节前入路,患者平卧,下肢伸直外旋位,腹股沟韧带与股动脉交叉外下方2.5~4.0 cm处为穿刺点,垂直刺入,抽吸无回血,若有关节积液,抽尽后,第1次注射注入复方倍他米松注射液1 ml,玻璃酸钠注射液2 ml。第2至第5次仅应用玻璃酸钠注射液。分别于治疗前和治疗后24周及治疗后52周时对髋关节功能改变采用Harris评分、髋关节放射学改变采用Bath AS放射学评分(BASRI-hip)进行评价。结果试验组和对照组患者髋关节Harris评分分别对比,试验组:治疗前为65.44±12.04,治疗后24周为80.94±15.99,治疗后52周为73.55±12.89,治疗后24周及52周与治疗前比较差异有统计学意义(P<0.01);对照组治疗前为65.47±11.08;治疗后24周为73.19±14.69,治疗后52周为68.25±12.37,治疗后24周较治疗前差异有统计学意义(P<0.05),但治疗后52周时与治疗前比较,差异无统计学意义。髋关节X线评估:试验组治疗前及治疗后24周、52周时BASRI-hip比较无显著变化,P>0.05,对照组治疗后24周无显著变化,但治疗后52周时较治疗前有进展,χ2=12.23,P<0.01,差异有统计学意义。2组治疗后52周比较,χ2=8.66,P<0.05,差异有统计学意义。结论玻璃酸钠联合复方倍他米松髋关节注射治疗AS髋关节病变能明显改善髋关节功能,延缓髋关节X线进展。更多还原

【Abstract】 Objective To study the clinical effectiveness of combined intra-articular injection of sodium hyaluronate and compound betamethasone on the function of hip joint and imaging characters in patients with ankylosing spondylitis( AS)hip joint lesion. Methods Sixty-four cases of AS with unilateral or bilateral hip joints pain and limitation of joint motion were included into this study and divided into two groups( experimental group,EG,n = 44; control group,CG,n = 20). All patients were administrated with methotrexate( MTX) and nabumetone or combined with sulfasalazine( SSZ) as the basal treatments. Intra-articular injection of sodium hyaluronate( SH) and compound betamethasone were carried out once a week in patients of EG,Each case received 5 injections in all,only in first injection combined with compound betamethasone. A course was repeated 24 weeks later. The 20 patients in CG were given one injection of compound betamethasone intramuscularly at first day and the 24 th week of the treatment. The clinical treatment parameters included symptoms,Harris hip score,Bath Ankylosing Spondylitis Radiology Index-hip( BASRI-hip). Results Harris score before the therapy in EG was( 65. 44 ± 12. 04),24 w after therapy was( 80. 94 ± 15. 99),52 weeks after therapy was( 73. 55 ± 12. 89) vs Harris score in CG before the therapy( 68. 25 ± 12. 37),24 weeks after therapy( 73. 19 ± 14. 69) and 52 weeks after therapy( 65. 47 ± 11. 08). Harris hip score showed the changes obviously after the treatment. BASRI-hip showed worse changes in patients of CG( P < 0. 01) after 52 weeks of treatment,less changes in patients of EG than which of CG( P < 0. 05). Conclusion Combined intra-articular injection of sodium hyaluronate and compound betamethasone can improve hip function,retard worse changes in imaging in patients with AS hip joint lesions.更多还原