玻璃酸钠对单侧踝关节骨性关节炎的疗效及患者本体感觉的影响  

Efficacy of intra-articular injection of hyaluronate for unilateral ankle osteoarthritis and its effect on proprioception of patients

作　　者：陈成帷[1] 潘哲尔[1] 沈翠华[1] 周也立 张超[1] 徐风 周海波[1] 刘彩龙[1] 陈雷[1] CHEN Chengwei;PAN Zhe＇er;SHEN Cuihua(Department of Orthopedics,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院骨科,325000

出　　处：《浙江医学》2018年第17期1945-1948,1955,共5页Zhejiang Medical Journal

基　　金：温州市科技计划项目(Y20160387)

摘　　要：目的探讨玻璃酸钠踝关节腔内注射治疗对单侧踝关节骨性关节炎患者本体感觉的影响。方法纳入单侧踝关节骨性关节炎患者50例,采用随机数字表法分为玻璃酸钠组33例和0.9%氯化钠溶液组17例,同时招募性别、年龄、BMI匹配的无下肢疾患的健康者50例作为空白对照组。玻璃酸钠组和0.9%氯化钠溶液组患者分别接受3次间隔1周的踝关节腔内玻璃酸钠和0.9%氯化钠溶液注射治疗。对两组患者的本体感觉进行评估,包括4项临床平衡测试和位置觉。比较两组患者注射前、完成第1次、第2次和第3次注射1周后踝关节骨性关节炎评分(AOS)和美国足与踝关节协会踝与后足功能评分(AOFAS)。结果 46例患者完成研究,其中玻璃酸钠组31例,0.9%氯化钠溶液组15例。患者组治疗前本体感觉基线数据较空白对照组均出现减退,差异均有统计学意义(均P<0.05)。玻璃酸钠组患者治疗后各随访时点4项临床平衡测试指标均较0.9%氯化钠溶液组改善,AOS总分、AOS疼痛评分和AOS伤残评分均较0.9%氯化钠溶液组下降,AOFAS评分均较0.9%氯化钠溶液组升高,第3次注射后1周随访时绝对角误差值较0.9%氯化钠溶液组明显改善,差异均有统计学意义(均P<0.05)。两组患者均未发生严重不良反应。结论 3次间隔1周的玻璃酸钠踝关节腔内注射短期内能明显改善踝关节骨性关节炎患者的本体感觉、疼痛及功能状态。Objective To investigate the efficacy of intra-articular injection of hyaluronate for unilateral ankle osteoarthritisand effect on proprioception in patients. Methods Fifty patients with unilateral ankle osteoarthritis participated in a prospectiveblinded cohort study and 50 healthy subjects served as controls. Patients were randomly assigned to receive intraarticularinjection of hyaluronate（n=33） or 0.9% saline（n=17） for 3 times at a week interval. The proproiceptive sense was examined byposture sense test and4 clinical tests before and after injection. The efficacy was evaluated by the Ankle Osteoarthritis Scale（AOS） and the American Orthopedic Foot ＆ Ankle Society（AOFAS） Ankle-Hindfoot score before and after each injection.Results Forty six patients completed the study （31 in hyaluronate group and 15 in saline group）. The proprioceptive sense wassignificantly lower in the patients than that in health controls before treatment（P〈0.05）. For osteoarthritis patients , theproprioception in hyaluronate group was significantly improved after treatment compared to saline group as shown in all fourbalance tests（all P〈0.05）. The AOS scores were reduced at 1 week after each injection compared with 0.9% saline group（all P〈0.05）. The mean AOFAS scores were improved at each follow-up compared with 0.9% saline group（all P〈0.05） and posturesense improved at the 3rd follow-up compared with 0.9% saline group（P〈0.05）. No serious adverse events were observed.Conclusion The study indicates that the intra-articular injection of hyaluronate is safe and effective in pain relief and improvingproprioception for patients with unilateral ankle osteoarthritis.

关 键 词：踝关节骨性关节炎 本体感觉 玻璃酸钠 

分 类 号：R687.3[医药卫生—骨科学]