小柯机器人

英国基尔大学医学院Zoe Paskins团队研究了超声引导下关节内皮质类固醇和局部麻醉剂注射联合建议和教育治疗髋关节骨关节炎的临床效果。该项研究成果发表在2022年4月6日出版的《英国医学杂志》上。

为了比较在成人髋关节骨关节炎患者的建议和教育中，在超声引导下髋关节内单次注射皮质类固醇和局部麻醉剂的临床效果，研究组在英格兰的两个社区肌肉骨骼服务机构进行了一项务实、三臂、平行组、单盲、随机对照试验。

共招募了199名年龄≥40岁且至少有中度疼痛的髋关节骨性关节炎患者，将其随机分组，67名接受建议和教育（最佳当前治疗[BCT]），66名接受BCT加超声引导下注射曲安奈德和利多卡因，66名接受BCT加超声引导下注射利多卡因。

三组的干预措施分别为单用BCT，BCT加超声引导髋关节内注射曲安奈德40mg和1%利多卡因4ml，或BCT加超声引导髋关节内注射1%利多卡因5ml。超声引导组双盲接受注射。主要结局是在六个月内自我报告当前髋关节疼痛强度（0-10数字评分量表）。在两周、两个月、四个月和六个月时自我报告结果。

研究样本的平均年龄为62.8岁，女性有113例（57%）。跨时间点的平均加权随访率为93%。与BCT组相比，BCT+超声曲安奈德-利多卡因组治疗六个月后髋关节疼痛强度的平均改善更大，两组评分相差-1.43分。与BCT+超声利多卡因组相比，BCT+超声曲安奈德-利多卡因组在六个月内的髋关节疼痛强度没有差异。

超声证实滑膜炎或积液的存在与BCT+超声曲安奈德-利多卡因的显著交互作用有关。BCT+超声曲安奈德-利多卡因组的一名参与者在介入治疗四个月后死于亚急性细菌性心内膜炎，被认为可能与试验治疗有关。

研究结果表明，超声引导下髋关节内注射曲安奈德联合BCT是髋关节骨关节炎患者的一种治疗选择。

附：英文原文

Title: Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): single blind, parallel group, three arm, randomised controlled trial

Author: Zoe Paskins, Kieran Bromley, Martyn Lewis, Gemma Hughes, Emily Hughes, Susie Hennings, Andrea Cherrington, Alison Hall, Melanie A Holden, Kay Stevenson, Ajit Menon, Philip Roberts, George Peat, Clare Jinks, Jesse Kigozi, Raymond Oppong, Nadine E Foster, Christian D Mallen, Edward Roddy

Issue&Volume: 2022/04/06

Abstract:

Objective To compare the clinical effectiveness of adding a single ultrasound guided intra-articular hip injection of corticosteroid and local anaesthetic to advice and education in adults with hip osteoarthritis.

Design Pragmatic, three arm, parallel group, single blind, randomised controlled trial.

Setting Two community musculoskeletal services in England.

Participants 199 adults aged ≥40 years with hip osteoarthritis and at least moderate pain: 67 were randomly assigned to receive advice and education (best current treatment (BCT)), 66 to BCT plus ultrasound guided injection of triamcinolone and lidocaine, and 66 to BCT plus ultrasound guided injection of lidocaine.

Interventions BCT alone, BCT plus ultrasound guided intra-articular hip injection of 40 mg triamcinolone acetonide and 4 mL 1% lidocaine hydrochloride, or BCT plus ultrasound guided intra-articular hip injection of 5 mL 1% lidocaine. Participants in the ultrasound guided arms were masked to the injection they received.

Main outcome measures The primary outcome was self-reported current intensity of hip pain (0-10 Numerical Rating Scale) over six months. Outcomes were self-reported at two weeks and at two, four, and six months.

Results Mean age of the study sample was 62.8 years (standard deviation 10.0) and 113 (57%) were women. Average weighted follow-up rate across time points was 93%. Greater mean improvement in hip pain intensity over six months was reported with BCT plus ultrasound-triamcinolone-lidocaine compared with BCT: mean difference 1.43 (95% confidence interval 2.15 to 0.72), P<0.001; standardised mean difference 0.55 (0.82 to 0.27). No difference in hip pain intensity over six months was reported between BCT plus ultrasound-triamcinolone-lidocaine compared with BCT plus ultrasound-lidocaine (0.52 (1.21 to 0.18)). The presence of ultrasound confirmed synovitis or effusion was associated with a significant interaction effect favouring BCT plus ultrasound-triamcinolone-lidocaine (1.70 (3.10 to 0.30)). One participant in the BCT plus ultrasound-triamcinolone-lidocaine group with a bioprosthetic aortic valve died from subacute bacterial endocarditis four months after the intervention, deemed possibly related to the trial treatment.

Conclusions Ultrasound guided intra-articular hip injection of triamcinolone is a treatment option to add to BCT for people with hip osteoarthritis.

DOI: 10.1136/bmj-2021-068446

Source: https://www.bmj.com/content/377/bmj-2021-068446

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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