髋关节内注射治疗髋关节外侧疼痛。

Intra-articular hip injections for lateral hip pain.

作者信息

Bessette Matthew C, Olsen Joshua R, Mann Tobias R, Giordano Brian D

机构信息

Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA.

出版信息

J Hip Preserv Surg. 2014 Oct 8;1(2):71-6. doi: 10.1093/jhps/hnu012. eCollection 2014 Oct.

Abstract

Occult intra-articular hip pathology is commonly found in patients with greater trochanteric pain syndrome, and may be a possible pain generator in patients with recalcitrant lateral hip pain. We investigated the effect of intra-articular hip injections in patients with recalcitrant lateral hip pain. Between September 2012 and May 2013, patients over the age of 18 with a history lateral hip pain who had received prior treatment with non-steroidal anti-inflammatory medications, physical therapy and peritrochanteric corticostroid injections were enrolled. Treatment consisted of an ultrasound guided intra-articular corticosteroid injection followed by a course of directed physical therapy and a non-steroidal anti-inflammatory medication. Patients performed GaitRite analysis at baseline and 12 weeks following the injection. In addition, the Modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Scores (HOS), Short Form 36 (SF-36) and a visual analogue pain score (VAS) were collected at baseline, 1, 6 and 12 weeks.A total of 16 patients were studied. Patients experienced significant improvements from their baseline mHHS at 1 and 12 weeks (P = 0.03, P = 0.04). The minimal clinically important difference (MCID) was exceeded at multiple timepoints on various clinical outcome surveys. Velocity and stride length were not significantly improved at 12 weeks. Intra-articular hip injections may decrease pain and improve function in patients with recalcitrant lateral hip pain, and occult intra-articular hip pathology should be considered in the etiology of lateral hip pain. Though low enrollment numbers left this study underpowered, MCID comparisons demonstrated potential benefit from this treatment.

摘要

隐匿性髋关节内病变常见于大转子疼痛综合征患者,可能是顽固性髋关节外侧疼痛患者的疼痛根源。我们研究了髋关节内注射对顽固性髋关节外侧疼痛患者的影响。在2012年9月至2013年5月期间,纳入年龄超过18岁、有髋关节外侧疼痛病史、曾接受过非甾体类抗炎药治疗、物理治疗和转子周围皮质类固醇注射治疗的患者。治疗包括超声引导下髋关节内皮质类固醇注射,随后进行一个疗程的针对性物理治疗和服用一种非甾体类抗炎药。患者在基线时以及注射后12周进行GaitRite分析。此外,在基线、第1、6和12周收集改良Harris髋关节评分(mHHS)、非关节炎髋关节评分(NAHS)、髋关节结局评分(HOS)、简明健康状况调查量表(SF-36)和视觉模拟疼痛评分(VAS)。共研究了16例患者。患者在第1周和第12周时,其基线mHHS有显著改善(P = 0.03,P = 0.04)。在多个时间点的各种临床结局调查中均超过了最小临床重要差异(MCID)。12周时速度和步长没有显著改善。髋关节内注射可能会减轻顽固性髋关节外侧疼痛患者的疼痛并改善其功能,在髋关节外侧疼痛的病因中应考虑隐匿性髋关节内病变。尽管入组人数较少使本研究的效能不足,但MCID比较显示了这种治疗的潜在益处。

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