摘要
目的:观察肌骨超声在针刀治疗膝骨关节炎(KOA)患者中的影像学变化及与临床效果的相关性。方法:随访观察西安凤城医院2019年3月至2021年3月期间收治的疑为KOA的患者110例(124膝)。纳入标准：符合KOA的诊断标准，正常沟通能力，临床资料完整，知情同意。排除标准：明显关节畸形，Kellgren-Lawrence(K-L)分级>Ⅲ级，存在心理精神障碍，近3个月内激素治疗，合并其他关节炎、严重心血管疾病、肝肾功能不全、凝血功能障碍、严重感染者。所有患者均采用针刀治疗，治疗前后行肌骨超声检查及MRI检查，并评价疼痛程度和膝关节功能，治疗前后采用配对t检验；计数资料采用卡方检验；相关性分析采用Pearson相关系数检验。两种方法的一致性比较采用一致性系数Kappa评估。两种方法的检出效能比较采用优势性卡方检验。结果:MRI方法在Ⅰ、Ⅱ和Ⅲ级KOA患者中的阳性正确率(总均88.7%)均高于肌骨超声方法(总均85.5%)；两法的一致性较好，κ＝0.901；治疗后，滑膜厚度、关节软骨厚度和关节积液范围均较治疗前减低(t＝34.717、36.923、49.372，均为P<0.05)；治疗后所有患者VAS评分低于治疗前，差异有统计学意义(t＝14.364，P<0.05)；治疗后，所有患者的跛行、上下楼能力、承受疼痛能力、关节肿痛及下蹲起立得分均较治疗前提高，差异有统计学意义(t＝4.804、6.226、9.955、6.545、6.992、26.355、27.707，均为P<0.05)。KOA患者的滑膜厚度、关节腔积液、内侧半月板膨出、外侧半月板膨出均与VAS评分呈正相关性(r＝0.602、0.539、0.612、0.528，均为P<0.05)，而与Lysholm呈负相关性(r＝－0.215、－0.236、－0.291、－0.242，均为P<0.05) 。结论:肌骨超声指标与VAS评分及关节功能等临床疗效相关性较好，对于KOA治疗效果的评价具有指导意义。
Abstract
Objective:To observe the imaging changes of musculoskeletal ultrasound in patients with knee osteoarthritis (KOA) treated by acupotomy and its correlation with clinical results.Methods:A total of 110 patients (124 knees) suspected of KOA admitted to Xi’an Fengcheng Hospital from March 2019 to March 2021 were followed up, including those who met the diagnostic criteria of KOA, had normal communication and communication skills, had complete clinical data, and signed informed consent. Exclusion criteria: obvious joint deformities, Kellgren-Lawrence rating scale >Ⅲ, psychological, and mental disorders, hormone therapy in the past three months, combined with rheumatism, rheumatoid, suppurative arthritis, severe cardiovascular disease, hepatic and renal insufficiency, coagulation dysfunction, and severe infection. All the patients were treated with acupotomy, musculoskeletal ultrasound and MRI before and after treatment, pain degree and knee joint function were evaluated, and paired t test was used before and after treatment. The statistical data were measured by chi square test. Pearson correlation coefficient test was used for correlation analysis. The consistency of the two methods was evaluated by kappa value. The detection efficiency of the two methods was compared by the dominant chi square test.Results:The positive rate of MRI in patients with KOA of grade Ⅰ, Ⅱ and Ⅲ(88.7%) was higher than that of musculoskeletal ultrasound (85.5%). The consistency of the two methods was better, κ=0.901. After treatment, synovial membrane thickness, articular cartilage thickness and the range of articular effusion were all decreased compared with those before treatment (t=34.717, 36.923, 49.372, all P <0.05). The VAS score of all patients after treatment was lower than that before treatment, and the difference was statistically significant (t=14.364, P <0.05). Comparing with the data before treatment, claudication, ability to go up and down stairs, endurance of pain, joint swelling and pain, and squat-stand up scores of all the patients after treatment improved with statistically significant difference (t=4.804, 6.226, 9.955, 6.545, 6.992, 26.355, 27.707, all P < 0.05). The synovial thickness, articular effusion, medial meniscal swelling and lateral meniscal swelling of KOA patients were all positively correlated with VAS score (r=0.602, 0.539, 0.612, 0.528, all P <0.05). It was negatively correlated with Lysholm score (r=-0.215, -0.236, -0.291, -0.242, all P <0.05).Conclusion:Musculoskeletal ultrasound index has a good correlation with clinical efficacy such as VAS score and joint function, which has guiding significance for the evaluation of the therapeutic effect of KOA.
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