膝关节骨关节炎患者关节灌洗与关节灌洗加皮质类固醇疗效评估

Assessment of the efficacy of joint lavage versus joint lavage plus corticoids in patients with osteoarthritis of the knee.

作者信息

Frías Gabriel, Caracuel Miguel Angel, Escudero Alejandro, Rumbao Jose, Pérez-Gujo Veronica, del Carmen Castro Maria, Font Pilar, González José, Collantes Eduardo

机构信息

Rheumatology Service, 'Reina Sofía' University Hospital, Córdoba, Spain.

出版信息

Curr Med Res Opin. 2004 Jun;20(6):861-7. doi: 10.1185/030079904125003656.

DOI:10.1185/030079904125003656

PMID:15200744

Abstract

PURPOSE

Joint lavage (JL), involves the passage of cold sterile 0.9% saline through the knee joint in order to have the fluid reach the inside of the joint capsule. This technique was evaluated as a local treatment for osteoarthritis (OA) of the knee alone (JL) and in combination with intra-articular infiltration with glucocorticoids (JLC).

PATIENTS AND METHODS

An overall 299 knees belonging to 205 patients (22% males, 78% females) with a mean age of 67 +/- 8 years and osteoarthritis of the knee of radiological grade II or III on the Kellgren scale were randomised in the ratio of 1:4 into two therapeutic groups, namely: JL (n = 62) and JLC (n = 237). All patients received joint lavage on day 0; in those of the JLC group, joint lavage was followed by infiltration of 40 mg of triamcinolone acetonide. The efficacy of both treatments was assessed by recording the corresponding values for the following variables: pain strength as measured by a visual analogy scale (VAS), effusion, crepitation, restricted motion, of osteoarthritis of the knee. spontaneous pain, pain on pressure, pain on passive motion and pain on active motion; all of these were recorded at the onset of the study, and after 1 and 3 months.

RESULTS

There were no significant differences in the values of the variables at the different followup times. Also, pain severity was similar in both treatment groups. Thus, VAS for pain was 7.3 +/- 0.3 for the JL group and 7.1 +/- 0.2 for the JLC group at the onset, and decreased to 3.0 +/- 0.3 in the former and 2.8 +/- 0.2 in the latter after 1 month; the decrease was statistically significant in both cases. After 3 months, the JL and JLC groups had a VAS of 3.5 +/- 0.3 and 3.8 +/- 0.2, respectively.

CONCLUSIONS

The results of this work suggest the absence of significant differences between the two treatments, such that both joint lavage alone and with infiltration with corticoids can be concluded as similarly effective for the symptomatic management

摘要

目的

关节灌洗（JL）是将冷的无菌0.9%生理盐水通过膝关节，以使液体到达关节囊内部。该技术被评估为单独用于膝关节骨关节炎（OA）的局部治疗方法（JL），以及与糖皮质激素关节内注射联合使用的治疗方法（JLC）。

患者和方法

共有205例患者（22%为男性，78%为女性）的299个膝关节，平均年龄为67±8岁，且膝关节骨关节炎在Kellgren分级中为II级或III级，按1:4的比例随机分为两个治疗组，即：JL组（n = 62）和JLC组（n = 237）。所有患者在第0天接受关节灌洗；JLC组患者在关节灌洗后注射40mg曲安奈德。通过记录以下变量的相应值来评估两种治疗方法的疗效：用视觉模拟量表（VAS）测量的疼痛强度、积液、摩擦音、膝关节骨关节炎的活动受限、自发疼痛、压痛、被动运动疼痛和主动运动疼痛；所有这些变量均在研究开始时、1个月后和3个月后记录。

结果

在不同随访时间，各变量值无显著差异。此外，两个治疗组的疼痛严重程度相似。因此，JL组在开始时疼痛的VAS评分为7.3±0.3，JLC组为7.1±0.2，1个月后前者降至3.0±0.3，后者降至2.8±0.2；两种情况下降均具有统计学意义。3个月后，JL组和JLC组的VAS评分分别为3.5±0.3和3.8±0.2。