Krych Aaron J, Griffith Timothy B, Hudgens Joshua L, Kuzma Scott A, Sierra Rafael J, Levy Bruce A
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
Knee Surg Sports Traumatol Arthrosc. 2014 Apr;22(4):750-5. doi: 10.1007/s00167-014-2862-3. Epub 2014 Feb 1.
Intra-articular (IA) hip cortisone injection is commonly performed as a therapeutic modality in patients with femoral acetabular impingement (FAI). To our knowledge, there is no published data evaluating the clinical benefit of these injections. The purpose of this study was to assess the efficacy of therapeutic IA cortisone injection in these patients.
At our institution, patients with FAI and labral tear prospectively recorded their numerical rating scale (NRS) pain scores pre-injection, during post-injection anaesthetic phase, and at 14 days post-injection. From this cohort, all patients treated with guided IA cortisone injection, no radiographic evidence of arthritis (Tönnis grade 0 or 1) and pain relief during the anaesthetic phase of the IA injection were included. An absolute change of two points on the NRS score was considered the minimal amount of clinically significant pain relief. Pain scores were compared between the different types of steroid injected.
Fifty-four patients (35 females, 19 males) with a mean age of 32 ± 12 years were included. Average median pre-injection NRS score was 7.0 (range 2.5-10.0), post-injection anaesthetic phase was 1.0 (range 0.0-5.0), and 14 day post-injection was 5.0 (range 0.0-10.0). As a group, NRS scores significantly diminished from post-injection anaesthetic phase to 14 days post-injection (p < 0.001). At 14 days post-injection, only 20 patients (37 %) and at 6 weeks, only 3 patients (6 %) reported a clinically significant decrease in pain. Average duration of pain relief was 9.8 days. There was no difference in pain reduction between steroid preparations.
In patients with symptomatic FAI and labral tear, intra-articular cortisone injection has limited clinical benefit as a therapeutic modality. However, anaesthetic-only IA injections for patients who may be candidates for hip arthroscopy can be a useful diagnostic tool.
关节内（IA）注射皮质醇常用于治疗股骨髋臼撞击症（FAI）患者。据我们所知，尚无已发表的数据评估这些注射的临床益处。本研究的目的是评估IA注射皮质醇治疗这些患者的疗效。
在我们机构，患有FAI和盂唇撕裂的患者前瞻性记录了注射前、注射后麻醉期及注射后14天的数字评定量表（NRS）疼痛评分。从该队列中，纳入所有接受引导下IA皮质醇注射治疗、无关节炎影像学证据（Tönnis分级0或1）且在IA注射麻醉期疼痛缓解的患者。NRS评分绝对变化2分被认为是临床上有显著意义的最小疼痛缓解量。比较了不同类型类固醇注射后的疼痛评分。
纳入54例患者（35例女性，19例男性），平均年龄32±12岁。注射前NRS评分中位数平均为7.0（范围2.5 - 10.0），注射后麻醉期为1.0（范围0.0 - 5.0），注射后14天为5.0（范围0.0 - 10.0）。作为一个整体，NRS评分从注射后麻醉期到注射后14天显著降低（p < 0.001）。注射后14天，只有20例患者（37%），6周时只有3例患者（6%）报告疼痛有临床显著减轻。疼痛缓解的平均持续时间为9.8天。不同类固醇制剂之间的疼痛减轻情况无差异。
对于有症状的FAI和盂唇撕裂患者，关节内注射皮质醇作为一种治疗方式临床益处有限。然而，对于可能适合髋关节镜检查的患者，仅注射麻醉剂的IA注射可作为一种有用的诊断工具。
