目的：探讨玻璃酸钠关节腔内注射治疗踝关节创伤性关节炎的临床疗效及安全性。方法选择踝关节创伤性关节炎患者38例（共45个踝关节），均给予2 mL玻璃酸钠关节腔内注射，1次/周，连续治疗5周。采用美国矫形外科足踝协会（AOFAS）评分标准对治疗前后的关节疼痛、功能及自主活动等进行评定，并根据AOFAS最后得分分为优秀、良好、合格及差4个级别。治疗后定期进行踝关节X线正侧位摄片检查，观察是否达到影像学愈合标准，结合AOFAS分级及影像学检查结果进行疗效评价。治疗期间，严密观察患者并发症发生情况。结果治疗后，患者AOFAS总分及疼痛、功能和自主活动及支撑情况、最大步行距离、地面步行、反常步态、踝－后足稳定性、足部对线及后足活动各个项目评分均较治疗前显著提高（ P<0.01）；AOFAS评分显示优良率为93.33%，X线摄片检查显示88.89%达到影像学愈合标准，临床有效率为88.89%。7.89%的患者在首次关节腔注射药物后出现关节酸胀感，治疗后1~3 d消失。结论玻璃酸钠关节腔内注射治疗踝关节创伤性关节炎安全有效，不良反应轻微，值得临床推广。%Objective To investigate the clinical efficacy and safety of intra-articular injection of sodium hyaluronate in treating trau-matic ankle arthritis. Methods 38 cases of traumatic ankle arthritis patients(45 ankles)were given intra-articular injection of sodium hyaluronate 2 mL,1 time/week for 5 weeks. The American Orthopaedic Foot and Ankle Society (AOFAS) score of joint pain,function and self activity of the two groups were evaluated before and after treatment,and the patients were graded into 4 classifications of excellent,good,qualified and poor according to the final AOFAS scores. Regular ankle X-ray radiographs examination after treatment was conducted,and the status of standard radiographic healing was observed,then the efficacy was evaluated with the AOFAS classifica-tion and imaging findings. During the course of treatment,the occurrence of complications was closely observed. Results After treatment, the AOFAS score,the situation of pain,function and self activity and support,the maximum walking distance,the ground walking,the abnormal gait,the ankle-hindfoot stability,the foot on the line,and the heel foot activity were significantly higher than before treatment ( P < 0. 01);the AOFAS scores showed the rate of excellent was 93. 33%,X-ray examination showed 88. 89% reached radiographic union standards,the clinical effective rate was 88. 89%. 7. 89% of patients appeared joint soreness after the first intra-articular injec-tion,and the symptoms disappear 1-3 d after the treatment. Conclusion Intra-articular injection of sodium hyaluronate in treating traumatic ankle arthritis is safe and effective,the adverse reactions are mild,and the treatment is worthy of clinical promotion.
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