骨骼肌肉超音波與退化性膝關節炎病患接受玻尿酸治療後的療效之相關性

The association between ultrasound results and the hyaluronic acid treatment response in patients with knee osteoarthritis

目的：研究膝關節退化病患接受玻尿酸治療後的療效與利用骨骼肌肉超音波（骨超）偵測治療療效之關聯。方法：從2012年五月到2013年五月，總共有100位門診退化性膝關節炎病患，於施打玻尿酸治療後四至五周後回門診接受骨超檢查與評估。病患還須接受臨床症狀與放射線X光的評估。結果：男性患者平均年齡為72.6歲，而女性患者平均年齡為63.7歲。大多數是女性（86%），61%的病患表示注射後效果良好，其中有21%的病患經骨超檢查後發現有貝克式囊腫，80%的病人有骨刺，69%的病患有關節積水，44%的人有滑膜增生。治療反應好之病人群與反應差之病人群的骨超影像經邏輯回歸分析（p值<0.05）證實，關節積水、貝克式囊腫和滑膜增生三者是關節腔注射玻尿酸效果差的影響因子。結論：這個研究證實關節積水、貝克式囊腫和滑膜增生三者與關節腔注射玻尿酸效果的好壞有關。如果可以先治療以上三項相關因子，或許可以提昇關節腔注射玻尿酸的療效。

Objective: Knee osteoarthritis (OA) is common in middle-aged and elderly people. Patients with knee OA can use hyaluronic acid (HA) injection therapy if they meet certain requirements. The purpose of this study was to delineate the effects of HA injection in patients with knee OA and to identify factors associating with the efficacy of the injections by using musculoskletal sonography (MUS). Methods: We included 100 patients with knee OA in this study from May 2012 to May 2013. The patients were evaluated using MUS 4 to 5 weeks after receiving a complete course of intraarticular HA injection. Radiographic and overall clinical assessments were conducted and a chi-square test was used to perform statistical analysis. Results: The mean ages of the men and women in the patient group were 72.6 years and 63.7 years, respectively. Most of the patients were women (86%). Approximately 61% of the patients (response group) exhibited favorable responses to the HA injections. The MUS findings indicated that only 21% of the patients exhibited Baker’s cysts, osteophytes were present in 80% of the patients, and 69% had joint effusion. Fewer than half of the patients developed synovial proliferation (44%). The nonresponse group was highly correlated with joint effusion, Baker’s cysts, and synovial proliferation (p < 0.05). Conclusion: Our study indicated that joint effusion, Baker’s cysts, and synovial proliferations should be treated before HA injection in order to obtain better treatment response.