Koh Sung Hoon, Lee Sang Chul, Lee Woo Yong, Kim Jongwoo, Park Yongbum
Department of Physical Medicine and Rehabilitation.
Department of Anesthesiology.
Medicine (Baltimore). 2019 May;98(19):e15506. doi: 10.1097/MD.0000000000015506.
Intra-articular hyaluronic acid (HA) is widely used to treat symptomatic osteoarthritis (OA) in the carpometacarpal joint (CMCJ) of the thumb. However, although apparently effective and relatively safe, intra-articular HA injections act relatively slowly. Therefore, a nonsteroidal anti-inflammatory drug could be added for more prompt pain relief. The aim of this study was to compare the efficacy and safety of ultrasound (US)-guided intra-articular injection of HA and ketorolac with that of HA alone in patients with OA of the CMCJ of the thumb.Seventy-four patients identified by chart review to have a diagnosis of OA of the CMCJ of the thumb received either a US-guided intra-articular injection of 0.5 mL of sodium hyaluronate and 0.5 mL of ketorolac (n = 38) or 0.5 mL of sodium hyaluronate and 0.5 mL of saline (n = 36). Disabilities of the arm, shoulder, and hand (DASH) and verbal numeric scale (VNS) pain scores were recorded before and 1, 3, and 6 months after injection. Univariable analyses (using the chi-squared test) and multiple logistic regression analysis were performed to evaluate the relationship between potential predictors of the outcome (treatment allocation, patient age and sex, duration of pain, and Eaton-Littler classification) and therapeutic effects.The DASH and VNS scores were improved at 1, 3, and 6 months postinjection in both groups. The onset of pain relief was significantly more rapid (at 1 month) after the injection containing HA and ketorolac than after the injection containing HA alone. In 55.3% of cases, pain and function were improved postinjection compared with baseline and remained so for up to 6 months. The success rate was not significantly different between the assessments at 1, 3, and 6 months, and the univariable analyses did not identify any statistically significant potential predictors of the outcome. Multiple logistic regression analysis did not identify any independent predictors of a successful outcome at midterm follow-up.The onset of analgesic action was more rapid after an injection containing HA and ketorolac than after 1 containing HA alone in patients with OA of the CMCJ of the thumb. There were no serious complications.
关节内注射透明质酸（HA）被广泛用于治疗拇指掌指关节（CMCJ）的症状性骨关节炎（OA）。然而，尽管关节内注射HA显然有效且相对安全，但其作用起效相对缓慢。因此，可以加用一种非甾体抗炎药以更快地缓解疼痛。本研究的目的是比较超声（US）引导下关节内注射HA和酮咯酸与单独注射HA对拇指CMCJ OA患者的疗效和安全性。通过病历审查确定74例诊断为拇指CMCJ OA的患者，接受了超声引导下关节内注射0.5 mL透明质酸钠和0.5 mL酮咯酸（n = 38）或0.5 mL透明质酸钠和0.5 mL生理盐水（n = 36）。在注射前以及注射后1、3和6个月记录手臂、肩部和手部功能障碍（DASH）和言语数字评分（VNS）疼痛评分。进行单变量分析（使用卡方检验）和多因素逻辑回归分析，以评估结果的潜在预测因素（治疗分配、患者年龄和性别、疼痛持续时间以及伊顿 - 利特勒分类）与治疗效果之间的关系。两组在注射后1、3和6个月时DASH和VNS评分均有所改善。含HA和酮咯酸的注射后疼痛缓解起效明显更快（在1个月时），比单独含HA的注射后更快。在55.3%的病例中，与基线相比，注射后疼痛和功能得到改善，并持续长达6个月。在1、3和6个月的评估中成功率无显著差异，单变量分析未发现任何具有统计学意义的结果潜在预测因素。多因素逻辑回归分析未发现中期随访成功结果的任何独立预测因素。对于拇指CMCJ OA患者，含HA和酮咯酸的注射后镇痛作用起效比单独含HA的注射后更快。未出现严重并发症。
