膝关节关节腔内药物注射治疗KOA的进展

目的 查阅膝关节关节腔内药物注射治疗KOA的相关文献,总结临床治疗方法及机理。方法 检索2014年至2019年期间CNKI数据库中SCI、CSCD来源的采用关节腔内药物注射治疗KOA的相关文献,筛选出代表性强、治疗方法较新的文献,将各种治疗方法进行分类,总结该疗法临床应用的现状并分析其治疗机制。结果 国内对关节腔内药物注射治疗KOA的报道主要集中在单一药物关节腔内注射、混合药物关节腔内注射这两个方面,其中以玻璃酸钠、富血小板浆应用最为广泛。治疗机理可归纳为以下3个方面：1.润滑关节,减轻摩擦。2. 保护、修复关节软骨。3. 抑制炎性反应。结论 膝关节关节腔内药物注射治疗KOA在临床中应用广泛,短期疗效显著,可以缓解KOA临床症状。     

关节清理术结合透明质酸钠治疗膝骨性关节炎的临床研究

目的比较应用膝关节清理术、关节腔内注射透明质酸钠、两者结合应用三种方法治疗膝部骨性关节炎疗效。方法 150例膝骨性关节炎患者随机分为3组：A组采用关节腔内注射透明质酸钠,每周一次,连续注射5次;B组采用关节镜下关节清理术;C组行关节清理术后1周开始,每周注射透明质酸钠一次,共5次。在6个月后比较三种方法的治疗效果。结果关节清理术结合透明质酸钠治疗膝骨性关节炎的疗效与单独应用关节清理术或关节腔内注射透明质酸钠治疗膝骨性关节炎的疗效差异有统计学意义（t分别=15.12、16.64,P均〈0.05）,而单独应用关节清理术和单独应用关节腔注射透明质酸钠两者之间的疗效差异无统计学意义（t=1.22,P〉0.05）。结论关节清理术结合透明质酸钠治疗膝骨性关节炎的疗效优于单独应用关节清理术或关节腔内注射透明质酸钠治疗膝骨性关节炎的疗效,是治疗膝骨性关节炎的一种较好的方法 。     

关节液中HA检测

HA(透明质酸)是关节滑液及软骨基质的主要成分,属黏多糖物质。应用HA进行关节腔内注射治疗在我院骨科临床应用研究已三年,检测关节腔中HA的含量对于临床指导用药具有极其重要的作用。1材料与方法1.1对象半月板损伤患者70例,均为本院骨科门诊及住院病人。其中男46例,女24例,年龄16~54y,平均年龄35y;病程1mo~2y,轻度损伤者1例,中度损伤者22例,严重损伤47例。1.2药物关节腔内注射用HA的钠盐(透明质酸钠),地塞米松等。HA注射液每支为2ml,含HA20mg,为无色高黏弹性液体。含HA分子量大于7.5×105,蛋白质含量低于     

膝关节镜术后注射透明质酸钠对关节功能恢复的探讨

目的：通过临床随机对照研究探讨膝关节镜术后关节腔内注射透明质酸钠治疗的效果。方法：对关节镜手术118例于手术结束时在关节腔内注射透明质酸钠2ml，术后第4天抽出关节积液，再注入透明质酸钠2ml；1次/周，连续4次为1个疗程，根据病情注射一二个疗程。观察患关节疼痛（休息及运动痛）、肿胀、压痛、活动度及行走情况6个项目综合评分。与同期手术未用药的58例进行比较。结果：用药组术后疼痛程度、关节肿胀、压痛、活动度评分均低于未用药组。结论：透明质酸钠在膝关节镜手术后关节腔内注射是一种行之有效的关节保护剂和生物止痛剂，有助于关节功能恢复。     

手法配合臭氧-玻璃酸钠关节腔内注射治疗肩周炎58例分析

目的观察手法配合臭氧（O3）、玻璃酸钠关节腔内注射治疗肩周炎的临床疗效。方法对56例肩周炎患者采用手法配合臭氧、玻璃酸钠关节腔内注射治疗,观察治疗前后患者疼痛、关节活动等变化。结果经手法配合臭氧一玻璃酸钠关节腔内注射治疗1个疗程后治愈41例,显效13例,有效3例,无效1例,总有效率98．28％。结论手法配合臭氧一玻璃酸钠关节腔内注射治疗肩周炎能有效减轻疼痛,改善关节活动,临床疗效显著。     

关节腔内注射曲安奈德／透明质酸治疗颞下颌关节紊乱病的疗效比较

目的探讨关节腔内注射糖皮质激素曲安奈德、粘弹剂透明质酸钠或二者联合使用治疗颞下颌关节紊乱病的疗效。方法应用半随机同期对照设计对3种治疗方案进行比较：①关节腔内单纯注射曲安奈德3次（8mg／次），②关节腔内单纯注射透明质酸钠（1％，1ml／次）4次，③关节腔内先注射曲安奈德2次再注射透明质酸钠2次。均为关节上腔灌洗后注射药物，每10日注射1次。第1个月、12个月及24个月进行随访，综合症状体征改善情况评定为优、良者计为有效，比较各组有效率。结果每组均纳入188例颞下颌关节紊乱病患者，24个月失访率为6．9％～10．1％。治疗1个月时，曲安奈德组有效率最高达92．0％：治疗12个月、24个月时透明质酸钠组有效率高于曲安奈德组（12个月84．6％vs．54．1％，24个月83．4％vs．40．4％），合并用药组有效率在12个月、24个月分别为90．4％和66．3％。结论关节腔内注射糖皮质激素曲安奈德关治疗颞下颌关节紊乱病短期疗效较好，关节腔内注射透明质酸钠则具有较好的远期效果.     

联合用药关节腔内注射康复治疗骨性关节炎41例报告

目的：康复治疗骨性关节炎。方法：联合用药关节腔内注射。结果：关节疼痛,关节积液,关节活动受限均得到改善。结论：联合用药关节腔内注射是治疗骨性关节炎的有效方法。     

膝关节内药物注射治疗改良穿刺方法探讨

我院门诊外科于 1999年 6月～ 2 0 0 0年 2月收治双膝骨关节炎病人 5 8例 ,共 116个关节 ,采用经膝眼穿刺和经外侧髌股关节间隙穿刺两种不同方法关节腔内注射玻璃酸钠治疗 480次 ,比较两种不同穿刺关节内给药的结果 ,探讨其优缺点 ,以寻找最佳膝关节注射给药方法。提高膝关节内注射药物的治疗成功率、有效率。1　病例资料5 8例双膝关节骨关节门诊就诊病人 ,男 16例 ,女 42例 ,年龄 :5 6～ 76岁。经骨科专科医生确诊为“双膝骨关节炎” ,主要给予关节腔内注射玻璃酸纳治疗及其它综合治疗。2　方法2 1　分组 :5 8例病人双侧膝关节分别交替采…     

膝关节功能障碍的综合康复疗效分析

目的：研究保守治疗膝关节功能障碍的临床疗效。方法：对３１例膝关节功能障碍患者进行关节功能牵引、肌力训练、关节内注射和理疗等综合治疗。结果：关节活动度治疗有效率９０．３％,肌力训练有效率６７．７％。结论：对于膝关节功能障碍采用保守治疗仍能取得一定的疗效。等速训练可能有助于扩大关节活动度。     

透明质酸钠治疗颞下颌关节紊乱病的定量系统评价

目的:系统评价颞下颌关节腔内注射透明质酸钠治疗颞下颌关节紊乱病的有效性和安全性。方法:计算机检索Pubmed数据库、Cochrane临床试验注册中心、EMBASE数据库和中国生物医学文献数据库等,检索时间截至2013年12月。收集关节腔内注射透明质酸钠治疗颞下颌关节紊乱病的随机对照试验,由2名研究者独立进行文献质量评价和资料提取,运用Revman 5.0进行Meta分析。结果:共纳入19个随机对照试验,1422例患者。Meta分析结果显示与阴性对照相比,透明质酸钠改善颞下颌关节紊乱病患者短期及长期的最大张口度和临床总体评价差异有统计学意义(P<0.05);但在疼痛缓解和不良反应方面两组差异无统计学意义(P>0.05)。与糖皮质激素组相比,透明质酸钠能够改善颞下颌关节紊乱病患者临床总体评价和短期最大开口度(P<0.05);但在疼痛缓解、改善长期最大张口度及注射后不良反应方面,两组差异无统计学意义。结论:颞下颌关节腔内注射透明质酸钠治疗颞下颌关节紊乱病具有一定的有效性和安全性,但尚需更多高质量的临床随机对照试验支持。     

Treatment of knee osteoarthritis

Knee osteoarthritis is a common disabling condition that affects more than one-third of persons older than 65 years. Exercise, weight loss, physical therapy, intra-articular corticosteroid injections, and the use of nonsteroidal anti-inflammatory drugs and braces or heel wedges decrease pain and improve function. Acetaminophen, glucosamine, ginger, S-adenosylmethionine (SAM-e), capsaicin cream, topical nonsteroidal anti-inflammatory drugs, acupuncture, and tai chi may offer some benefit. Tramadol has a poor trade-off between risks and benefits and is not routinely recommended. Opioids are being used more often in patients with moderate to severe pain or diminished quality of life, but patients receiving these drugs must be carefully selected and monitored because of the inherent adverse effects. Intra-articular corticosteroid injections are effective, but evidence for injection of hyaluronic acid is mixed. Arthroscopic surgery has been shown to have no benefit in knee osteoarthritis. Total joint arthroplasty of the knee should be considered when conservative symptomatic management is ineffective.     

Corticosteroid therapy for rheumatoid arthritis. Benefits and limitations.

Oral corticosteroids, despite their potential side effects, have a select role in the treatment of rheumatoid arthritis. For articular disease, these drugs must be targeted to short-term goals, such as symptom relief. Close attention to the indications and potential hazards of steroid therapy may ensure optimal benefit and reduced risk. Intra-articular steroid injections can provide local symptomatic relief when only one or a few joints are swollen. Septic arthritis is most important to exclude before injection of a joint. Complications of intra-articular injection are few, and relief may be long-lasting.     

A thermally responsive biopolymer for intra-articular drug delivery.

Intra-articular drug delivery is the preferred standard for targeting pharmacologic treatment directly to joints to reduce undesirable side effects associated with systemic drug delivery. In this study, a biologically based drug delivery vehicle was designed for intra-articular drug delivery using elastin-like polypeptides (ELPs), a biopolymer composed of repeating pentapeptides that undergo a phase transition to form aggregates above their transition temperature. The ELP drug delivery vehicle was designed to aggregate upon intra-articular injection at 37 degrees C, and form a drug 'depot' that could slowly disaggregate and be cleared from the joint space over time. We evaluated the in vivo biodistribution and joint half-life of radiolabeled ELPs, with and without the ability to aggregate, at physiological temperatures encountered after intra-articular injection in a rat knee. Biodistribution studies revealed that the aggregating ELP had a 25-fold longer half-life in the injected joint than a similar molecular weight protein that remained soluble and did not aggregate. These results suggest that the intra-articular joint delivery of ELP-based fusion proteins may be a viable strategy for the prolonged release of disease-modifying protein drugs for osteoarthritis and other arthritides.     

Intra-articular lidocaine for the reduction of posterior shoulder dislocation

Anterior shoulder dislocations are the most common major joint dislocation seen in emergency departments. Intra-articular lidocaine is a useful method of analgesia for facilitating the reduction of anterior shoulder dislocations. Posterior shoulder dislocations represent a small minority of shoulder dislocations. We present the case of a posterior shoulder reduction in an elderly female whose reduction was performed following the intra-articular injection of lidocaine. Intra-articular lidocaine represents a useful alternative to facilitate the reduction of shoulder dislocations, particularly in patients at higher risk for complications from sedation.     

玻璃酸钠联合氨基葡萄糖胶囊治疗骨性膝关节炎临床研究

目的明确玻璃酸钠联合氨基葡萄糖胶囊治疗膝关节骨关节炎(OA)的临床疗效。方法膝OA的患者240例,随机分为2组,治疗组采用玻璃酸钠膝关节腔内注射,1次/周,5次为一个疗程,联合氨基葡萄糖胶囊,口服,240mg/次,3次/d,5周为一个疗程。对照组采用氨基葡萄糖胶囊,口服,240mg/次,3次/d,5周为一个疗程。结果患者治疗前后关节疼痛、僵硬度、身体功能障碍等评分改善情况,两组均能改善上述症状,治疗组在疼痛与关节活动度改善疗效均优于对照组,组间疗效有显著性差异(P<0.05)。结论玻璃酸钠结合氨基葡萄糖胶囊在缓解患者疼痛、改善关节活动度,促进骨关节面的修复方面具有显著优越性,且疗效优于单纯口服氨基葡萄糖胶囊。     

关节腔内注射间充质干细胞治疗半月板损伤的研究进展

背景：半月板损伤治疗效果的欠佳严重影响人们的生活质量,对于运动员而言可能意味着职业生涯的终止。目的：探讨关节腔内注射间充质干细胞治疗半月板缺损的有效性。方法：由第一作者应用计算机检索PubMed、中国期刊全文数据库（CNKI）、维普数据库和万方数据库1980年5月至2012年8月相关文献。在标题、摘要、关键词中以“meniscus, mesenchymal stem cells （MSCs）,intra-articular injection, regeneration”或“半月板,间充质干细胞,关节腔内注射,再生”为检索词进行检索。选择文章内容与关节腔内注射有关者,同一领域文献则选择近期发表在权威杂志文章。初检得到181篇文献,根据纳入标准选择关于半月板损伤的间充质干细胞治疗的62篇文献进行综述。结果与结论：间充质干细胞行关节腔内注射后黏附于半月板损伤部位,并定向分化为半月板纤维软骨细胞,有效促进半月板损伤的修复和半月板的再生。关节腔内注射间充质干细胞治疗半月板损伤具有重要的临床应用价值。     

Intra-articular injections

Intra-articular injections are one method that physicians may use to treat joint pain. This method offers direct access to the source of pain for the troubled patient. Substances ranging from steroids to hyaluronic acid have been injected successfully into the various joints of the body in an attempt to provide relief for chronic joint pain. Anesthesiologists and orthopedic surgeons have begun to use intra-articular injections of local anesthetics for postoperative analgesia. This history, agents, and methods of intra-articular injections are reviewed.     

骨科局部应用抗生素对局部细胞的作用

背景：治疗骨与软组织感染,抗生素局部应用有低血药浓度、高局部药物浓度的优点,但是局部高浓度抗生素可能通过对局部细胞不同程度的作用影响愈合过程。目的：了解抗生素对局部细胞的不同作用及作用原因和减轻不利影响的方法。方法：检索Pubmed和中国生物医学文献数据库（CBM）中1990/2011收录的抗生素对骨科局部细胞作用的相关文献,选择针对性强、代表性好的40篇文献进行综述,分析抗生素对局部细胞的作用。结果与结论：高浓度抗生素对细胞存活、增殖、代谢和分化主要表现为抑制作用,少数抗生素在特定剂量下表现为促进作用。不同抗生素作用不一。不同来源的细胞敏感性也不同。在去除抗生素后一段时间,细胞可表现出不同程度的恢复。调整局部pH值或者加入骨形态发生蛋白等方法可减轻细胞的抑制。对于骨科局部应用抗生素对局部细胞影响的研究使可以选择合适的抗生素及剂量治疗骨科局部感染,减少对局部愈合的影响,但仍需进一步深入研究。     

Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial

Hsieh L-F, Hsu W-C, Lin Y-J, Chang H-L, Chen C-C, Huang V. Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial.ObjectiveTo compare the efficacy of intra-articular hyaluronic acid (HA) injections plus physical therapy (PT) with that of PT alone for the treatment of adhesive capsulitis (AC) of the shoulder.DesignProspective, randomized controlled trial.SettingRehabilitation and orthopedics department of a private teaching hospital.ParticipantsPatients (N=70) with AC of the shoulder were randomly placed into either of the following treatment groups: group 1, HA injections with PT (HAPT group); or group 2, PT alone (PT group).InterventionsThe patients in group 1 received intra-articular glenohumeral joint injections of HA, 20mg, once per week for 3 consecutive weeks and also participated in a PT program for 3 months. The patients in group 2 received PT alone.Main Outcome MeasuresActive and passive range of motion (ROM) of the affected shoulder, pain, disability, and quality of life.ResultsBoth groups experienced improvements in terms of pain, disability, and quality of life after the treatments; furthermore, the active and passive ROM improved linearly with increasing treatment duration. When the groups were compared, no significant group effect was found for any of the outcome measurements.ConclusionsIntra-articular HA injections did not produce added benefits for patients with AC of the shoulder who were already receiving PT. Thus, the use of intra-articular HA injections for patients with AC of the shoulder should be carefully assessed to reduce unnecessary medical expenditures.     

膝骨关节炎关节液中丙二醛、超氧化物歧化酶在玻璃酸钠注射前后的变化

背景：玻璃酸钠关节腔注射是治疗膝骨关节炎的一种有效方法,疗效显著,不良反应少,但其作用机制尚不明确。目的：通过检测玻璃酸钠注射前后膝骨关节炎关节液中丙二醛、超氧化物歧化酶水平,评价玻璃酸钠治疗膝骨关节炎的具体机制。方法：纳入膝骨关节炎患者37例（40膝）,根据日本膝骨关节炎指征等级分轻度组10例10膝、中度组17例18膝、重度组10例12膝,患膝关节注入玻璃酸钠25 mg,每周注射1次,连续5次为1个疗程。注射前及注射4周后检测关节液丙二醛、超氧化物歧化酶水平,以及按照日本膝骨关节炎指征等级对所有患者治疗前后行临床评分。结果与结论：轻度组、中度组注射4周后临床评分较注射前显著降低（P〈0.05）,重度组注射前后临床评分比较差异无显著性意义。3组注射4周后关节液丙二醛水平均较注射前显著下降（P 〈0.05）,关节液超氧化物歧化酶水平均较注射前显著升高（P 〈0.05）。结果表明玻璃酸钠可通过降低关节液中丙二醛水平、升高超氧化物歧化酶水平治疗膝骨关节炎,并且更适用于轻、中度患者。