| Objective:To assess the efficacy of ultrasound-guided intra-articular injection of hypertonic glucose for prolotheraty combined with perineural injection treatment on alleviating pain of knee osteoarthritis,and to observe whether the combined treatment is better than prolotherathy alone by comparing it with intra-articular injection of hypertonic dextrose alone,then to explore its possible mechanism.Methods:Using the random number table method,40 patients that diagnosed with knee osteoarthritis were randomly assigned into test group(intra-articular injection of hypertonic dextrose+5%dextrose perineural injection)and control group(intra-articular injection of hypertonic dextrose+Pseudo-stimulation)by the ratio of 1:1.Both groups of patients were injected 20%dextrose 8ml into the suprapatellar capsule under the guidance of ultrasound.Four deep nerve branches(saphenous nerve,in frapatellar branch of saphenous nerve,superomedial genicular nerve,superolateral genicular nerve)were localized under ultrasound guidance and injected 5%dextrose 2ml around each nerve in the experimental group,with a total 8ml.The control group used the passivated syringe needle for the same ultrasonic positioning and injection action as the experimental group.When the patient felt skin pain,it stopped immediately.This action will not damage the patient’s skin except causing slight pain sensation.Injections were administered on the first day of enrollment,2 and 4 weeks after the first injection,all the patients were injected 3 times in total.Then,the changes of the VAS score,WOMAC index and pressure pain threshold were evaluated and recorded before injection and 2,4,8 weeks after the intervention,and record adverse reactions during treatment and follow-up.Results:1.In this experiment,40 patients were recruited,and 3 of them were lost to follow-up were excluded,19 patients were finally assigned to the test group and 18 to the control group.There were no differences in baseline data such as gender,age,BMI and course of disease between the two groups(P>0.05).2.There were no difference in the VAS score between the test and control groups before injection(P>0.05).the VAS score of the test and control groups were satisfactory relief than those before injection at 2,4 and 8 weeks after injections(P<0.05);and the VAS score of the test group were reduced remarkably than the control group at 2,4 and 8 weeks after the injection(P<0.05).3.There were no noticeable difference in the WOMAC index between two groups before injection(P>0.05).the WOMAC index of the test and control groups were satisfactory relief than those before injection at 2,4 and 8 weeks after injections(P<0.05);and the WOMAC index of the test group were reduced remarkably than the control group at 2,4 and 8 weeks after the injection(P<0.05).4.There were no difference in the pressure pain threshold between the test and control groups before injection(P>0.05);the pressure pain threshold of the test group were much higher at 2,4 and 8 weeks after treatment than before injection(P<0.05),meanwhile,there was no significant change in 2 weeks after treatment(P>0.05),and it was improved in the 4 and 8 weeks compared to before the intervention in the control group(P<0.05);the pressure pain threshold of the test group were obviously higher than the control group at 2,4 and 8 weeks after injection.(P<0.05).5.All patients did not experience adverse reactions such as increased pain,bruising,and allergy during treatment and follow-up.Conclusion:Ultrasound-guided intra-articular injection of hypertonic glucose for prolotheraty combined with perineural injection of knee innervation can effectively alleviate the pain and enhance the jiont function in patients with KOA,its effect is better than single-agent therapy of prolotherapy or perineural Injection.It can become an effective method for clinical treatment of knee osteoarthritis pain. |
