CAJ | 학술논문

目的：探讨依那西普联合全髋关节置换术治疗强直性脊柱炎伴髋关节屈曲强直的临床疗效。方法选择医院收治的患者120例，随机分为观察组与对照组，各60例。两组患者均行全髋关节置换术，术后给予抗感染、营养支持及抗凝药物治疗。观察组患者加用依那西普皮下注射，每次25 mg，每周2次，疗程为12周。观察术前及术后第4，8，12周患者临床症状与体征，评估患者强直性脊柱炎病情活动指数( BASDAI )、强直性脊柱炎功能指数( BASFI )、夜间背痛、总体背痛视觉模拟评分（VAS）、患者总体评价( PGA )的变化；测量并记录患者手术前后髋关节活动度、红细胞沉降率( ESR )、C反应蛋白( RP )变化。结果术后第8周，观察组强直性脊柱炎疗效评价标准20反应( ASAS 20)及强直性脊柱炎疗效评价标准50反应( ASAS 50)的改善率均明显高于对照组（ P﹤0.05），第12周两组患者ASAS 20改善率均达到100.00%，观察组ASAS 50的改善率为93.33%，显著高于对照组的81.67%（ P﹤0.05）；与对照组相比，第4，8，12周观察组总体VAS评分与PGA指标降低程度显著（ P﹤0.05），第8，12周BASDAI与BASFI降低程度较对照组差异有统计学意义（ P﹤0.05）；观察组总活动度、内收、内旋及屈曲4项参数较对照组明显提高，ESR及CRP较对照组显著降低，差异均有统计学意义（ P﹤0.05）；观察组不良反应发生率为15.00%，与对照组的11.67%相比，无明显差异（ P﹥0.05），经对症治疗后，均好转。结论依那西普联合全髋关节置换术治疗强直性脊柱炎伴髋关节屈曲强直，疗效更佳，且起效快，可快速、持续缓解患者髋关节疼痛，明显提高患者的生活质量。
목적：탐토의나서보연합전관관절치환술치료강직성척주염반관관절굴곡강직적림상료효。방법선택의원수치적환자120례，수궤분위관찰조여대조조，각60례。량조환자균행전관관절치환술，술후급여항감염、영양지지급항응약물치료。관찰조환자가용의나서보피하주사，매차25 mg，매주2차，료정위12주。관찰술전급술후제4，8，12주환자림상증상여체정，평고환자강직성척주염병정활동지수( BASDAI )、강직성척주염공능지수( BASFI )、야간배통、총체배통시각모의평분（VAS）、환자총체평개( PGA )적변화；측량병기록환자수술전후관관절활동도、홍세포침강솔( ESR )、C반응단백( RP )변화。결과술후제8주，관찰조강직성척주염료효평개표준20반응( ASAS 20)급강직성척주염료효평개표준50반응( ASAS 50)적개선솔균명현고우대조조（ P﹤0.05），제12주량조환자ASAS 20개선솔균체도100.00%，관찰조ASAS 50적개선솔위93.33%，현저고우대조조적81.67%（ P﹤0.05）；여대조조상비，제4，8，12주관찰조총체VAS평분여PGA지표강저정도현저（ P﹤0.05），제8，12주BASDAI여BASFI강저정도교대조조차이유통계학의의（ P﹤0.05）；관찰조총활동도、내수、내선급굴곡4항삼수교대조조명현제고，ESR급CRP교대조조현저강저，차이균유통계학의의（ P﹤0.05）；관찰조불량반응발생솔위15.00%，여대조조적11.67%상비，무명현차이（ P﹥0.05），경대증치료후，균호전。결론의나서보연합전관관절치환술치료강직성척주염반관관절굴곡강직，료효경가，차기효쾌，가쾌속、지속완해환자관관절동통，명현제고환자적생활질량。
Objective To investigate the clinical efficacy of etanercept combined with total hip replacement in treating ankylosing spondylitis with hip flexion stiffness. Methods Totally 120 patients the hospital were selected and randomly divided into the observation group and the control group,60 cases in each group. The two groups were treated with total hip replacement,and received anti infec-tion,nutritional support,and anticoagulant drugs. On this basis,the observation group was added with etanercept(subcutaneous injection of 25 mg/time,2 times/week) for 12 weeks. The clinical symptoms and signs were observed before and after 4,8 and 12 weeks. The changes of BASDAI,BASFI,VAS,and PGA of the two groups were evaluated;the activity of hip joint,ESR,CRP were measured and recorded before and after surgery. Results After 8 weeks of treatment,the improvement rate of ASAS 20 and ASAS 50 in the observa-tion group were significantly higher than those in control group( P ﹤ 0. 05);the improvement rate of ASAS 20 after 12 weeks in the two groups was 100. 00%,and the improvement rate of ASAS 50 in the observation group was 93. 33%,which was significantly higher than 81. 67% in the control group( P ﹤ 0. 05);the total VAS score and PGA index after 4,8,12 weeks of treatment in the observation group were significantly lower than those in the control group( P ﹤ 0. 05),the decreased range of BASDAI and BASFI after 8,12 weeks of treatment in the observation group was more obvionsly( P ﹤ 0. 05);the 4 parameters of activity,adduction,internal rotation and flexion of the observation group increased significantly compared with the control group,ESR and CRP decreased significantly compared with the control group( P ﹤ 0. 05). The occurrence rate of adverse reactions in the observation group was 15. 00% ,which had no significant difference with 11. 67% in the control group ( P ﹥ 0. 05),and by the corresponding treatment,the adverse reactions were improved. Conclusion Etanercept combined with total hip replacement in treating ent of ankylosing spondylitis has better clinical efficacy, can provide sustained relief in patients with hip pain and improve the quality of life.