玻璃酸钠的临床研究应用进展

对玻璃酸钠（SH）作为眼科手术的粘弹性保护剂、关节腔内注射治疗骨关节炎（OA）、软组织创伤的促愈合剂及药物的载体等诸方面的应用、机理探讨及研究进展进行了概述。SH具有便于手术操作、保护角膜等限内组织免受器械损伤从而提高手术成功率的作用。关节腔内注射SH治疗OA可缓解患者的关节疼痛、肿胀、运动障碍等症状，促进软骨的修复和愈合，且具有一定的远期疗效。同甾体激素、非甾体消炎止痛药配伍，治疗OA疗效更好。SH为伤口愈合过程中必需的氨基葡聚糖，可加速创面的愈合。用SH预防术后粘连已有溶液、膜及粉雾剂的研究报道。作为药物载体，应用于滴眼液、注射液中，可提高药物生物利用度。SH同抗癌药物、激素及消炎药的配伍，具有很好的开发前景。     

膝骨关节炎的玻璃酸钠治疗及其护理

目的 探讨玻璃酸钠（SH）治疗膝骨关节炎（OA）及其护理。方法 常规膝关节腔注入SH。根据膝OA患者的特点,治疗前详细评估患者全身情况,做好心理护理,治疗前准备;治疗后除观察惠肢情况外,加强全身情况观察,早期行股四头肌肌力和关节活动的功能锻炼。结果 62例患者对治疗效果满意,膝关节肿痛症状减轻或消失,关节功能明显改善,治疗后未出现关节内血肿、感染、过敏等不良反应和并发症。结论 SH为治疗膝OA安全有效的方法,良好的护理干预和循序渐进的康复功能锻炼,保证了治疗效果。     

透明质酸钠关节内注射治疗膝关节骨关节炎的临床疗效观察

骨关节炎（osteoarthritis，OA）是中老年人常见的关节病。虽然治疗膝OA有许多选择，但至今仍缺乏满意的治疗方法。我院从1999年10月至2004年12月应用山东福瑞达制药有限公司研制生产的透明质酸钠（商品名施沛特，以下称SH）注射治疗膝OA（双膝OA未包括在内）174例。现将临床效果总结如下。     

玻璃酸钠注射治疗膝、踝骨关节炎的疗效观察

骨关节炎（Osteoarthritis，OA）是影响人类健康的常见的关节疾病之一，近年来应用玻璃酸钠（SH）关节腔内注射治疗骨关节炎效果显著。我科自2000年应用玻璃酸钠治疗156例膝关节、踝关节骨关节炎患者，取得满意的效果。     

关节腔内注射透明质酸钠治疗髋关节骨性关节炎对关节液氧自由基的影响

目的探讨应用关节腔内注射透明质酸钠（sodium hyaluronate,SH）治疗髋关节骨性关节炎（osteoarthritis,OA）的临床疗效及对氧自由基（oxygen free radicals,OFR）的影响。方法应用SH对32例髋OA患者行关节腔内注射,20mg／次,1次／周,连续5周,检测治疗前及治疗3个月后抽取的关节液中一氧化氮（NO）、超氧化物歧化酶（SOD）、丙二醛（MDA）的含量。应用Harris评分比较治疗前后功能和症状改善情况。结果随访3个月,治疗后关节液中NO、MDA含量较治疗前明显下降（P〈0．01）,SOD含量升高（P〈0．05）,Harris评分较治疗前明显升高（P〈0．01）。结论SH关节腔内注射治疗髋OA,可缓解临床症状,改善关节功能,其作用可能是通过降低关节液中OFR等炎性介质的水平而实现的。     

玻璃酸钠关节腔内注射治疗膝骨关节炎

对30例骨关节炎（OA）患者的30个膝关节腔内注射1％玻璃酸钠（SH）注射液，观察其疗效及维持时间。每周给药1次，每次2ml，连续给药5周。给药5周后考察步行能力、日常动作、疼痛、肿胀等临床症状的改善情况以判定药物的疗效，实验室检查血、尿以考察安全性。停止治疗的16个月内对疗效进行追踪考察。结果表明，治疗5周后，患者除关节积液外各项临床症状均获得显著性改善，总有效率为96．7％，未见明显的毒副反应。停药16个月，70．0％患者症状未复发。结果提示，SH可能为治疗膝OA的有效药物。     

玻璃酸钠治疗膝骨关节炎的疗效观察

膝骨关节炎（OA）是临床常见的疾病，好发于中老年人，发病率随年龄增加而增多。表现为膝关节疼痛、肿胀、活动受限，长期发展可导致关节功能下降和肌肉萎缩。目前临床最常用的治疗方法为口服非甾体消炎药，但只能短期缓解症状，而不能阻碍疾病的发展。2005年3月至2006年10月我院骨科门诊采用关节腔内注射玻璃酸钠（SH）治疗膝OA患者70例，取得了较好效果，现报告如下。     

两种穿刺点注射玻璃酸钠治疗骨性膝关节炎对比观察

目的：探讨玻璃酸钠（sodium hyaluronate，SH）膝关节腔内注射对减轻症状、促进功能恢复作用，比较两种穿刺点选择优劣。方法：将110例骨性膝关节炎（osteo arthirtis，OA）患者按自身配对原则分为两组，对照组从内侧骸骨中点髌股关节间隙为穿刺点，观察组则选择髌骨上缘水平切线与髌骨外缘垂直切线交界处为穿刺点，两组膝关节腔内每次注射SH2ml（20mg）。结果：120个患病膝关节治疗4周后疗效优良率92．1％。观察组和对照组在一次性穿刺成功率、疼痛程度及穿刺时间差异有显著性（P〈0．01）。结论：SH膝关节腔内注射，对膝OA有良好疗效。在提高一次性穿次成功率．减轻穿刺疼痛及缩短穿刺时间等方面观察组优于对照组。     

镜下关节清理术加透明质酸钠注射治疗膝骨性关节炎

目的探讨关节镜下关节清理术和透明质酸钠（SH）关节腔内注射治疗膝骨性关节炎（OA）的效果。方法87例127膝骨性关节炎采取关节镜下清理术，并在术后给予关节腔内注射SH。结果关节清理术加SH关节内注射能有效缓解或消除骨性关节炎的症状。结论关节清理术加透明质酸钠关节内注射是治疗骨性关节炎的理想方法。     

透明质酸钠治疗膝骨性关节炎的临床效果及分析

目的通过观察透明质酸钠(SH)对膝骨性关节炎(OA)的临床疗效,探讨其作用机制。方法选择79例OA患者共95膝,根据病变程度分为轻、中、度3组(分别为41、29、25个患膝),予关节腔内注射SH,每周1次,连用5次,比较治疗前后临床症状,评定临床疗效,检测治疗前后关节液中IL-6、IL-8、TNF-α的变化。结果 OA的严重程度影响SH治疗效果,治疗后,3组患者临床症状均有不同程度的改善,IL-6、IL-8、TNF-α均有不同程度的降低。结论 SH对OA有确切的治疗作用,其机制可能与抑制炎性因子的表达及释放有关,同时,我们应提倡OA的早期治疗。     

Intra-articular injections for the treatment of osteoarthritis: focus on the clinical use of hyaluronic acid

Osteoarthritis (OA), also called degenerative joint disease, is the most frequently occurring chronic musculoskeletal disease, particularly affecting the aging population. The use of viscosupplementation, i.e. intra-articular (IA) hyaluronic acid (HA) drug therapy, to treat OA, is growing worldwide, due to important results obtained from several clinical trials, which reported IA HA-related improvements in functional activity and pain management. This review is an update of the IA use of this compound in the treatment of OA, with clinical evidence from the last few years being discussed and used to delineate new trends for the future.     

国产与进口玻璃酸钠关节内注射治疗膝关节骨关节炎的疗效分析

目的比较进口与国产玻璃酸钠治疗膝关节骨关节炎(OA)的疗效。方法纳入198例膝关节的患者,分为2组,A组采用进口玻璃酸钠,B组采用国产玻璃酸钠,膝关节腔内注射,1次·周-1,4次为1个疗程。结果对疼痛、炎症、关节活动等疗效观察指标进行评估,两组均能改善上述症状,而A组产品在疼痛与关节活动度改善疗效均优于B组,两组疗效间有显著性差异(P<0.05)。结论玻璃酸钠注射对膝骨关节炎的治疗确有疗效,进口玻璃酸钠在疗效上优于国产玻璃酸钠。     

玻璃酸钠联合复方倍他米松应用治疗膝骨性关节炎的疗效观察

目的:为寻找更有效使用玻璃酸钠(SH)与复方倍他米松关节腔内注射补充治疗膝关节骨性关节炎(OA)的方法。方法:2009年3月-2010年3月治疗160例膝骨性关节炎引起的轻度到重度疼痛的患者,随机分成2组。治疗组每周进行膝关节内注射玻璃酸钠1次,共5周,并在前3周同时注射复方倍他米松。对照组每周进行膝关节内注射玻璃酸钠1次,共5周。治疗结束后随访半年。结果:治疗组的显效率46.3%,有效率为30.0%,对照组显效率31.3%,有效率为15.0%,2组差异有显著性(P<0.05)。结论:关节腔内注射玻璃酸钠和复方倍他米松治疗膝关节骨性关节炎疼痛能快速、持久缓解疼痛,改善膝关节功能,同时没有额外的并发症。     

玻璃酸钠治疗膝关节骨关节炎临床分析

目的:探讨玻璃酸钠治疗膝关节骨关节炎的疗效。方法:回顾性分析膝关节内注射透明质酸钠治疗膝关节骨性关节39例的资料,观察治疗前后患者疼痛、关节活动等的变化。结果:本组39例共43个膝关节,经治疗优15例,占38.5%,良21例,占53.8%,差3例,占7.7%,总有效率92.3%。治疗过程中未出现玻璃酸钠的不良反应。结论:玻璃酸钠治疗膝关节骨性关节炎临床效果好。     

国产与进口玻璃酸钠治疗膝关节骨关节炎疗效比较

目的 :比较进口与国产玻璃酸钠 (SH)治疗膝关节骨关节炎 (OA)的疗效。方法 :患OA病人 4 2例 ,分 2组 ,进口组 2 8例 ,男性 3例 ,女性 2 5例 ,年龄 58a±s 6a。国产组 14例 ,男性 3例 ,女性 11例 ;年龄 59a± 6a。进口与国产SH 2 5mg ,膝关节内注射 ,每周 1次 ,5次为一个疗程。结果 :按疼痛、炎症、活动障碍评估 ,进口组与国产组SH对OA均可改善上述症状 ,而进口组对疼痛改善优于国产组 ,P <0 .0 5。结论 :进口SH在治疗OA方面优于国产SH。     

Viscosupplementation with hyaluronans for osteoarthritis of the knee: clinical efficacy and economic implications

Treatment with intra-articular viscosupplementation with hyaluronan (hyaluronic acid) and its derivatives is an important component of the management of osteoarthritis (OA) of the knee. Several intra-articular hyaluronan formulations are now available that vary in their physical properties, duration of effect and treatment schedules. Although aspects regarding their mechanism of action are not completely understood, numerous clinical trials, systematic reviews and meta-analyses have confirmed the efficacy of intra-articular hyaluronan therapies for relieving OA-related pain and improving joint function. Data indicate that intra-articular hyaluronan preparations provide OA pain relief that is comparable to or greater than that observed with conventional treatment, NSAID medications, intra-articular corticosteroids, arthroscopic lavage, physical therapy and exercise. Other studies indicate that multiple courses of hyaluronan are effective. Intra-articular hyaluronan formulations are well tolerated and are associated with a low incidence of adverse effects, usually localised to the injected joint. Local adverse events associated with intra-articular hyaluronan products are typically mild to moderate in severity, benign and transient, although their aetiology is unknown. The cost effectiveness of intra-articular hyaluronan has been demonstrated, but only in a limited number of studies. Cost savings with intra-articular hyaluronan can also be realised with reduction of NSAID medication use and the possibility of delaying total knee replacement, which can reduce the need for costly revision procedures. Because different intra-articular hyaluronan formulations require different numbers of injections and office visits, are associated with variable treatment costs, and provide varying degrees of efficacy, not all intra-articular hyaluronan formulations may be equally cost effective over time.     

Efficacy study of two novel hyaluronic acid-based formulations for viscosupplementation therapy in an early osteoarthrosic rabbit model

Viscosupplementation (VS) is a therapy for osteoarthrosis (OA) consisting of repetitive intra-articular injections of hyaluronic acid (HA). It is known to be clinically effective in relieving pain and increasing joint mobility by restoring joint homeostasis. In this study, the effects of two novel HA-based VS hydrogel formulations were assessed and challenged against a pure HA commercial formulation for the first time and this in a rabbit model of early OA induced by anterior cruciate ligament transection (ACLT). The first formulation tested was a hybrid hydrogel composed of HA and reacetylated chitosan, a biopolymer considered to be chondroprotective, assembled thanks to an ionic shielding. The second formulation consisted of a novel HA polymer grafted with antioxidant molecules (HA-4AR) aiming at decreasing OA oxidative stress and increasing HA retention time in the articulation.ACLT was performed on rabbits in order to cause structural changes comparable to traumatic osteoarthrosis. The protective effects of the different formulations were observed on the early phase of the pathology in a full randomized and blinded manner. The cartilage, synovial membrane, and subchondral bone were evaluated by complementary investigation techniques such as gross morphological scoring, scanning electron microscopy, histological scoring, and micro-computed tomography were used.In this study, ACLT was proven to successfully reproduce early OA articular characteristics found in humans. HA and HA-4AR hydrogels were found to be moderately protective for cartilage as highlighted by μCT. The HA-4AR was the only formulation able to decrease synovial membrane hypertrophy occurring in OA. Finally, the hybrid HA-reacetylated chitosan hydrogel surprisingly led to increased subchondral bone remodeling and cartilage defect formation. This study shows significant effects of two innovative HA modification strategies in an OA rabbit model, which warrant further studies toward more effective viscosupplementation formulations.     

玻璃酸钠治疗早、中期膝关节骨性关节炎的疗效分析

目的探讨玻璃酸钠(SH)关节腔内注射对膝关节骨性关节炎的疗效。方法将84例患者随机分为玻璃酸钠注射组(SH)和物理治疗组(对照组),对两组患者治疗前后进行膝关节功能综合评分,并对68例随访患者分别于治疗后3个月、6个月、1年时评定疗效。结果治疗时间太短膝关节功能综合评分两组无统计学差异;随访结果疗效优良率SH组明显优于对照组。结论关节腔内注射玻璃酸钠治疗早、中期膝关节骨关节炎远期疗效持久、稳定。