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关节内类固醇治疗髋关节骨关节炎; 三种对比技术的回顾性队列研究。

Intra-articular steroids for the treatment of coxarthrosis; a retrospective cohort study comparing three contrast techniques.

机构信息

Trauma & Orthopaedic Department, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, L35 5DR, UK.

出版信息

Arch Orthop Trauma Surg. 2024 Jul;144(7):2935-2943. doi: 10.1007/s00402-024-05371-w. Epub 2024 May 29.


DOI:10.1007/s00402-024-05371-w
PMID:38809344
Abstract

INTRODUCTION: Intra-articular steroid injections (IAS) are a treatment for coxarthrosis. This study examines the efficacy of three fluoroscopy-guided IAS contrast techniques for coxarthrosis: contrast-assisted (Iohexol), air arthrogram-assisted and blind (contrast/air free) and stratifies efficacy based on multiple patient variables. MATERIALS AND METHODS: A cohort of 307 hip IAS was retrospectively analysed over a four-year period. The primary outcome was efficacy of IAS between each technique group, defined by duration of symptomatic relief. The secondary outcome was efficacy based on multiple patient variables. Variables included age, BMI, gender, type of osteoarthritis, grade of osteoarthritis, smoking status, co-morbidity index and duration of pre-injection symptoms. Chi-squared, Pearson, One Way ANOVA and F-tests were used for statistical analysis. RESULTS: Total failure (< 1 week symptomatic relief) was 20% (contrast 20%, air 14%, blind 26%). >3 months of symptomatic relief was experienced by 35%, with the air arthrogram technique containing the largest proportion of IAS achieving > 3months of relief within its own group (contrast 35%, air 38%, blind 28%). Non-smokers experienced a longer duration of symptomatic relief in the air arthrogram group (p = 0.04). Older patients had a longer duration of symptomatic relief with the blind technique (p = < 0.001). There were no significant differences between the three techniques based on the other patient variables. CONCLUSION: Air arthrogram is an effective method of confirming injection placement in hip IAS for coxarthrosis and the use of a contrast agent (e.g., Iohexol) may not be required. Non-contrast techniques may produce longer duration of symptomatic relief in non-smokers and in older patients.

摘要

简介:关节内类固醇注射(IAS)是治疗髋关节骨关节炎的一种方法。本研究探讨了三种透视引导下髋关节 IAS 对比技术治疗髋关节骨关节炎的疗效:对比辅助(碘海醇)、空气关节造影辅助和盲法(无对比/空气),并根据多个患者变量对疗效进行分层。 材料和方法:回顾性分析了四年期间的 307 例髋关节 IAS 病例。主要结局是每种技术组的 IAS 疗效,通过症状缓解持续时间来定义。次要结局是根据多个患者变量的疗效。变量包括年龄、BMI、性别、骨关节炎类型、骨关节炎程度、吸烟状况、合并症指数和注射前症状持续时间。使用卡方检验、皮尔逊检验、单因素方差分析和 F 检验进行统计分析。 结果:总失败率(<1 周症状缓解)为 20%(对比组 20%,空气组 14%,盲法组 26%)。35%的患者获得了>3 个月的症状缓解,其中空气关节造影技术组中获得>3 个月症状缓解的 IAS 比例最大(对比组 35%,空气组 38%,盲法组 28%)。非吸烟者在空气关节造影组中获得了更长的症状缓解持续时间(p=0.04)。盲法组中年龄较大的患者症状缓解持续时间更长(p<0.001)。根据其他患者变量,三种技术之间没有显著差异。 结论:空气关节造影是髋关节 IAS 治疗髋关节骨关节炎的一种有效方法,可能不需要使用造影剂(如碘海醇)。非对比技术可能会使非吸烟者和年龄较大的患者获得更长的症状缓解持续时间。

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本文引用的文献

[1]
Minimal disease activity and remission in patients with psoriatic arthritis with elevated body mass index: an observational cohort study in the Swiss Clinical Quality Management cohort.

BMJ Open. 2022-9-17

[2]
Osteoarthritis and chronic pain: Interleukin-6 as a common denominator and therapeutic target.

Sci Signal. 2022-7-26

[3]
How does hip osteoarthritis differ from knee osteoarthritis?

Osteoarthritis Cartilage. 2022-1

[4]
Gender and Sex Are Key Determinants in Osteoarthritis Not Only Confounding Variables. A Systematic Review of Clinical Data.

J Clin Med. 2021-7-19

[5]
Predicting outcomes in patients undergoing intra-articular corticosteroid hip injections.

Skeletal Radiol. 2021-7

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Int J Mol Sci. 2020-5-24

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Osteoarthritis Cartilage. 2019-9-3

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Nicotine Attenuates Osteoarthritis Pain and Matrix Metalloproteinase-9 Expression via the α7 Nicotinic Acetylcholine Receptor.

J Immunol. 2019-5-31

[9]
Epidemiology of osteoarthritis: literature update.

Curr Opin Rheumatol. 2018-3

[10]
Risk factors and clinical characteristics of deep knee infection in patients with intra-articular injections: A matched retrospective cohort analysis.

Semin Arthritis Rheum. 2017-10-20

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