Waseem M, Sadiq S, Gambhir A K, Lim J, Maxwell S, Bamford D J
Stepping Hill Hospital, Stockport - UK.
Hip Int. 2002 Oct-Dec;12(4):378-382. doi: 10.1177/112070000201200405.
The aim of the present study was twofold: a) to establish the therapeutic efficacy of the hip injection with marcaine and steroid; (b) to establish the safety of the procedure with respect to possible bacterial contamination at the time of passage of needle into the hip joint. Thirty-five patients with osteoarthritis of the hip were injected. All patients were admitted as day cases and the procedure was performed in a laminar flow theatre under full aseptic conditions. The hip was aspirated before injection. Aspirate and injecting needles were sent for microbiological examination. Both aerobic and anaerobic cultures were performed. All patients were followed up for three months after hip injection. Microbiology results were not revealed to reviewing clinicians. All patients were reviewed at two weeks and at twelve weeks. Thirty-three patients (94.3%) had no growth in the samples. Two cases out of thirty-five hips had a positive culture but none of the patients went on to develop clinical sepsis. Patient response for pain in the hip was graded using a 10 point visual analogue scale (VAS) with 10 point as maximum pain and 0 points as no pain. Pre-injection the patient VAS for pain was a mean value of 6.4 0.77 (median, 6). The mean value of VAS score at 2 weeks dropped to 2.6 2.7 with median of 2. This difference was highly significant (p=0.003). At 12 weeks mean VAS score was 2.7 2.5 with median value of 2 (p=001). Three patients were worse after the injection. We found the hip injection to be safe. The risk of bacterial contamination is low provided a strict aseptic protocol is observed. In this study, one third of the patients had excellent pain relief for 3 months after the injection but in two thirds of cases it failed to provide complete, long-term pain relief (> 3 months). (Hip International 2002; 4: 378-82).
a）确定用布比卡因和类固醇进行髋关节注射的治疗效果；（b）确定在将针插入髋关节时可能发生细菌污染情况下该操作的安全性。对35例髋关节骨关节炎患者进行了注射。所有患者均作为日间病例入院，该操作在层流手术室的完全无菌条件下进行。注射前对髋关节进行抽吸。将抽吸针和注射针送去进行微生物学检查。进行了需氧和厌氧培养。所有患者在髋关节注射后随访三个月。微生物学结果未告知参与评估的临床医生。所有患者在两周和十二周时接受复查。33例患者（94.3%）的样本没有培养出细菌生长。35个髋关节中有2例培养结果呈阳性，但没有患者发展为临床败血症。使用10分视觉模拟量表（VAS）对患者髋关节疼痛反应进行评分，10分为最大疼痛，0分为无疼痛。注射前患者疼痛的VAS平均值为6.4±0.77（中位数为6）。两周时VAS评分平均值降至2.6±2.7，中位数为2。这种差异具有高度统计学意义（p = 0.003）。十二周时VAS评分平均值为2.7±2.5，中位数为2（p = 0.01）。有3例患者在注射后情况变差。我们发现髋关节注射是安全的。只要严格遵守无菌操作规范，细菌污染的风险就很低。在本研究中，三分之一的患者在注射后3个月疼痛得到了极好的缓解，但三分之二的病例未能提供完全的长期疼痛缓解（>3个月）。（《髋关节国际》2002年；4：378 - 82）
