经皮RFA术与关节腔内MTX-HA注射治疗关节滑膜炎的疗效比较  

Comparison of the Efficacy of Percutaneous RFA with Intra-articular MTX-HA Injection in the Treatment of Synovitis

作　　者：徐琦 朱张茜 刘泽政 朱建碧 丁欢欢 郑洁 Xu Qi;Zhu Zhangqian;Liu Zezheng(Department of Ultrasound,Wenzhou People′s Hospital,Zhejiang 325000,China)

机构地区：[1]温州市人民医院超声科,325000

出　　处：《医学研究杂志》2021年第12期111-116,共6页Journal of Medical Research

基　　金：浙江省温州市科技计划项目(Y20170827)。

摘　　要：目的对比超声引导下经皮关节腔甲氨蝶呤-透明质酸偶合物(MTX-HA)注射与经皮射频消融(RFA)术治疗关节滑膜炎的疗效,初步探讨两种疗法的临床应用前景。方法40只日本大耳白兔分为RFA组、MTX-HA组、对照组,AIA造模后进行RFA术与MTX-HA关节腔注射治疗,观察兔膝关节肿胀、滑膜炎转归情况,术后4周解剖下观察膝关节面,软骨、骨侵蚀半定量评分评价治疗效果。结果RFA组与MTX-HA组手术均成功,术后2周时RFA组膝关节径大于MTX-HA组(P<0.01),至术后4周时两组比较,差异无统计学意义(P>0.05),超声显示,滑膜厚度滑膜炎RFA组和MTX-HA组术后积液均显著降低(P<0.01),但组间比较,MTX-HA组滑膜厚度与滑膜炎评分均高于RFA组(P<0.05),解剖下RFA组手术侧软骨侵蚀半定量评分显著低于对侧(P<0.01)。结论超声引导下滑膜RFA术与关节腔内MTX-HA注射均能明显抑制局部关节滑膜炎症,使局部关节症状好转,阻止关节软骨、骨侵蚀进展,但RFA术的滑膜直接灭活作用优于MTX-HA注射术。Objective To compare the efficacy of ultrasound-guided percutaneous articular methotrexate-hyaluronic acid coupling(MTX-HA)injection and percutaneous radiofrequency ablation(RFA)for the treatment of synovitis,and to explore the prospects of clinical application of the two therapies.Methods Forty Japanese large-eared white rabbits were divided into RFA group,MTX-HA group,and control group,and were treated with RFA procedure and MTX-HA joint cavity injection after AIA mapping to observe the regression of knee swelling and synovitis in rabbits.The knee joint surface was observed under autopsy 4 weeks after surgery,and the treatment effect was evaluated by semi-quantitative score of cartilage and bone erosion.Results The surgery was successful in both the RFA and MTX-HA groups,and the knee diameter in the RFA group was greater than that in the MTX-HA group at 2 weeks postoperatively(P<0.01),and there was no significant difference between the two groups by 4 weeks postoperatively(P>0.05).Ultrasound showed that postoperative effusion and synovial thickness synovitis were significantly lower in both groups(P<0.01),but the synovial thickness and synovitis scores in the MTX-HA group were higher than those in the RFA group(P<0.05),and the semi-quantitative score of cartilage erosion on the surgical side was significantly lower in the RFA group under dissection than on the contralateral side(P<0.01).Conclusion Both ultrasound-guided synovial RFA and MTX-HA intra-articular injection can significantly suppress local synovial inflammation,improve local joint symptoms,and stop the progression of articular cartilage and bone erosion,but the direct synovial inactivation effect of RFA is better than that of MTX-HA injection.

关 键 词：经皮射频消融术 甲氨蝶呤-透明质酸偶合物 滑膜炎 动物实验研究 

分 类 号：R681[医药卫生—骨科学]