甲氨蝶呤关节腔注射治疗伴骨髓水肿的膝骨关节炎疗效观察

摘要

Objective:To explore the efficacy of Methotrexate (MTX) through intra‐articular injection for the bone marrow edema(BME) of mild to mo‐derate knee osteoarthritis (OA) .Methods:Forty knee OA pa‐tients who were diagnosed with BME by magnetic resonance imaging (MRI) had been failed by the treatment of NSAIDS combining with intra‐articular injection of sodium hyaluronate .They all received former dose of NSAIDS combing with articular injection of MTX(10mg per week ,5 weeks) .All patients used visual analogue pain scale (VAS) and the western ontario and McMaster universities osteoarthritis index (WOMAC) to survey pain and the joint function scores before、after and 12‐weeks after the treatments separately .Results:The VAS and WOMAC scores of 40 patients were significantly reduced(P<0 .05) after using MTX through imtra‐articular injection .Con‐clusion :Intra‐articular injection of M TX can significantly relieve pain and improve function joint functions of patients who do not respond to the intra‐articular injection of sodium hyaluronate .%目的：探讨关节腔注射甲氨蝶呤对伴骨髓水肿的轻中度膝骨关节炎的疗效。方法：选择非甾体药物联合关节腔注射玻璃酸钠疗效不佳的膝骨关节炎患者40例，行核磁共振（MRI）诊断为BME的膝骨关节炎。在继续原剂量非甾体药物同时，给予患膝关节腔注射甲氨蝶呤10mg／次，1次／周，共5次。40例患者治疗前、治疗结束后及治疗后12周采用视觉模拟评分法（VAS）和WOMAC骨关节炎指数问卷调查进行疼痛和关节功能评分。结果：关节腔注射甲氨蝶呤患者的VAS和WOMAC评分减少（P＜0．05），提示对有BME的KOA患者关节腔注射甲氨蝶呤可有效减轻关节疼痛，改善关节功能。结论玻璃酸钠关节腔注射治疗无效的KOA患者，甲氨蝶呤关节腔注射治疗可有效减轻膝骨关节炎疼痛，改善关节功能。