膝关节MOAKS评分对关节腔冲洗治疗膝骨性关节炎疼痛预后的影响分析

Effect of knee MOAKS score on prognosis of osteoarthritis-related knee pain treated with joint lavage

摘要:

目的:评估关节腔冲洗(Joint lavage,JL)对膝骨性关节炎(knee osteoarthritis,KOA)患者膝关节疼痛的影响,并分析影响疗效的基线膝关节MRI影像学特征。 方法:收集2019年4月至2022年5月于山东省立医院疼痛科接受JL治疗的KOA患者的临床资料。回顾性分析患者的数字评分量表(Numeric Rating Scale,NRS)、西安大略和麦克马斯特骨关节炎指数(Western Ontario and McMaster 目的：评估关节腔冲洗（Joint lavage，JL）对膝骨性关节炎（knee osteoarthritis，KOA）患者膝关节疼痛的影响，并分析影响疗效的基线膝关节MRI影像学特征。 方法：收集2019年4月至2022年5月于山东省立医院疼痛科接受JL治疗的KOA患者的临床资料。回顾性分析患者的数字评分量表（Numeric Rating Scale，NRS）、西安大略和麦克马斯特骨关节炎指数（Western Ontario and McMaster Osteoarthritis Index，WOMAC）疼痛分量表、镇痛药物使用情况、不良反应及膝关节MRI影像资料。 结果：研究最终纳入82例患者。JL治疗后出院、1月、3月和6月的NRS评分均较治疗前显著降低（P<0.001），52例（62.2%）患者在治疗后6月NRS下降程度≥50%。治疗后6月WOMAC疼痛评分及镇痛药物使用率较治疗前显著降低（P<0.001）。多因素二元Logistic回归分析显示病程（OR=1.022，95%CI：1.003-1.042，P=0.024）、骨髓病变评分（OR=1.221，95%CI：1.028-1.450，P=0.023）和软骨缺损评分（OR=1.272，95%CI：1.021-1.585，P=0.032）是影响JL疗效的独立危险因素。 结论：在JL治疗后，KOA患者的膝关节疼痛近期内可获缓解。对于长病程、严重软骨下骨髓病变和关节软骨缺损的患者，JL提供的益处有限。

Abstract:

Objective: To evaluate the clinical efficacy of joint lavage (JL) in the treatment of knee osteoarthritis(KOA)-related pain and to analyse the risk factors affecting the outcome based on MR imaging. Methods: The patients who were diagnosed with KOA and received JL in the Department of Pain Management in Shandong Provincial Hospital from April 2019 to May 2022 were included. The clinical data including numeric rating scale (NRS), Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain subscale, analgesic medication usage, adverse events and Magnetic resonance imaging (MRI) images of knee joint were recorded and retrospectively analyzed. Results: A total of 82 patients were finally enrolled in this study. The NRS scores significantly decreased after JL and remained steady till 6 months (P<0.001). The WOMAC pain scores and the percentage of patients who needed analgesic drugs for knee pain significantly decreased at 6 months compared to baseline (P<0.001). At 6 months after JL, 51(62.2%) patients experienced ≥50% improvement in their NRS scores. Multivariate binary logistic regression analysis revealed that duration of pain (OR=1.022, 95%CI:1.003-1.042, P=0.024), bone marrow lesion score (OR=1.221, 95%CI:1.028-1.450, P=0.023), and cartilage loss score(OR=1.272, 95%CI:1.021-1.585, P=0.032) significantly influenced the therapeutic effect of JL. Conclusion: JL treatment can significantly alleviate pain of patients with KOA. The long duration of pain, severe bone marrow lesions and cartilage loss were independent risk factors for the unsatisfied effect of JL.