内热针配合髋关节灌注治疗髋关节滑膜炎效果观察

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　　 【摘要】 目的：观察内热针配合髋关节灌注治疗髋关节滑膜炎的临床效果。方法：回顾性分析2015年7月-2018年7月在咸宁市中心医院康复医学、疼痛科治疗的60例成人髋关节滑膜炎患者，将其按照治疗方式的不同分为两组，治疗组30例采用内热针配合关节腔灌注甲氨蝶呤治疗，对照组30例采用关节腔灌注甲氨蝶呤治疗，两组均以治疗1次为1个治疗周期，观察比较两组临床疗效、疼痛明显缓解时间及VAS评分。结果：治疗组疼痛明显缓解时间为（3.10±0.50）d，对照组疼痛明显缓解时间为（7.40±2.50）d，组间比较差异有统计学意义（P<0.05）。治疗后，治疗组VAS评分低于对照组，差异有统计学意义（P<0.05）。治疗组治疗总有效率为93.33%，对照组治疗总有效率为80.00%，治疗组治疗总有效率优于对照组，差异有统计学意义（P<0.05）。结论：内热针配合髋关节灌注甲氨蝶呤治疗髋关节滑膜炎效果显著，值得临床应用与推广。
　　 【关键词】 髋关节滑膜炎; 内热针; 关节腔灌注; 甲氨蝶呤
　　 【Abstract】 Objective：To observe the clinical effect of internal heat needle combined with hip joint perfusion in the treatment of hip synovitis.Method：A retrospective analysis of 60 adult patients with hip synovitis treated in rehabilitation medicine and pain department of our hospital from July 2015 to July 2018 were enrolled.They were divided into two groups according to different treatment methods.30 patients in the treatment group were treated with internal heat needle combined with joint cavity perfusion of Methotrexate，while 30 patients in the control group were treated with joint cavity perfusion of Methotrexate.Both groups were treated once as a treatment cycle.The clinical efficacy，pain relief time and VAS score of the two groups were observed and compared.Result：The pain relief time in the treatment group was （3.10±0.50）days，while that in the control group was （7.40±2.50）days，there were significant differences between two groups（P<0.05）.After treatment，the VAS score of the treatment group was lower than that of the control group，the difference was statistically significant（P<0.05）.The total effective rate of the treatment group was 93.33%，and that of the control group was 80.00%.The total effective rate of the treatment group was better than that of the control group，the difference was statistically significant（P<0.05）.Conclusion：The effect of internal heat needle combined with hip joint infusion of Methotrexate on hip synovitis is significant and worthy of clinical application and promotion.
　　 【Key words】 Hip synovitis; Internal heat needle; Joint cavity perfusion; Methotrexate
　　 髖关节滑膜炎是由于髋关节损伤或者炎症导致关节微循环不畅，进而关节腔积液形成而引发关节疼痛、肿胀、功能受限等症状的临床综合征，以儿童或者成人多发病，一般分为急性、慢性滑膜炎两种，关节退变，机械应力刺激，病毒或者细菌感染及内分泌代谢紊乱等是其常见发病原因[1]，属于中医痹症范畴，也叫关节痹痛、尪痹、历节、筋骨痹等。《杂病源流犀烛》曰：“忽然闪挫，必为气之震，震而激，激则雍……”，《内经》指出：“脾主肌肉四肢，肝主筋，肾主骨。”多由于感风、寒、湿邪，慢性劳损，跌倒扭伤，引起关节气血痹阻，津液散步不均，痰湿内聚。治疗多以舒筋活血、利水渗湿为主。选取2015年7月-2018年7月笔者所在科应用内热针配合甲氨蝶呤关节腔灌注治疗髋关节滑膜炎患者60例，经临床观察及随访效果满意，现报道如下。
　　1 资料与方法
　　1.1 一般资料
　　 回顾性分析2015年7月-2018年7月于咸宁市中心医院康复医学、疼痛科住院治疗的成人髋关节滑膜炎患者60例，其中男25例，女35例;年龄25～65岁，平均（31.25±7.58）岁;病程1周～0.5年;单侧48例，双侧12例;治疗中发现双侧下肢不等长25例，双侧足弓塌陷8例。排除标准：（1）诊断其他风湿性髋关节炎患者：风湿、类风湿性关节炎、强直性脊柱炎等;（2）关节感染：结核性髋关节炎、细菌性髋关节炎等;（3）合并有严重心脑血管疾病，局部肿瘤，严重肝肾功能障碍和凝血功能障碍等不适宜进行穿刺治疗者;（4）髋关节骨折引起的创伤性髋关节痛患者;（5）晕针或者对内热针恐惧患者，对甲氨蝶呤过敏或者对甲氨蝶呤有严重不良反应患者;（6）依从性差、临床资料不全及不能坚持治疗者。根据治疗方式的不同分为两组，各30例。
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