关节镜术后注射透明质酸钠治疗骨性关节炎

目的观察关节镜术后注射透明质酸钠(HA)治疗膝骨性关节炎的效果。方法对380例膝骨性关节炎首先行关节镜手术,术后注射HA,每周1次,5周一疗程,在治疗前和治疗后第4周进行体格检查及问卷式调查,评价患者治疗前后的临床症状和日常活动能力的改善情况。结果患者采用该疗法治疗前后静息痛、行走痛、上下楼梯痛、伸屈痛、压迫痛、关节肿胀、髌骨撞击、10min步行、下蹲拾物和端坐地面的评分,经Wilcoxon配对秩和检验,P<0.01;滑液渗出量和关节伸屈度经配对t检验,P<0.01。结论关节镜术后注射HA治疗膝骨性关节炎效果非常显著,值得推广。     

联合玻璃酸钠与氨基葡萄糖治疗膝骨关节炎

目的观察关节腔注射玻璃酸钠与口服氨基葡萄糖治疗膝骨性关节炎的效果。方法对58例膝骨性关节炎患者,关节腔注射玻璃酸钠针,1次/周,连续5次为一疗程。同时口服氨基葡萄糖片,1片/次,2次/d。在治疗后6周及6个月,对患者随访,进行体检,评价治疗前后的基础临床症状和日常活动能力的改善情况。结果采用该疗法治疗前后,关节疼痛或压痛、关节积液、骨擦(感)音、日常关节活动能力的评分,经Wilcoxon配对序和试验,P0.01。结论该疗法对改善膝骨性关节炎在基础临床症状和日常活动能力效果显著,是目前治疗膝骨关节炎的一种较理想方法。     

膝关节灌洗结合透明质酸钠治疗膝关节骨性关节炎疗效观察

目的 探讨关节灌洗对透明质酸钠治疗膝骨性关节炎疗效的影响.方法 对64例膝关节骨性关节炎分别应用透明质酸钠或关节灌洗合并透明质酸钠治疗.结果 配合关节灌洗的关节腔注射透明质酸钠在治疗开始后1周症状明显改善,5周疗效达到最佳效果,9个月后疗效明显下降.单纯关节腔注射透明质酸钠在治疗开始后1周症状改善较不明显,在5周疗效达到最佳效果,6个月后疗效明显下降.结论 关节灌洗可以明显提高透明质酸钠关节腔注射对膝关节骨性关节炎的疗效,配合关节腔灌洗的关节腔注射透明质酸钠较单纯关节腔注射透明质酸钠起效更快、疗效更好,疗效持续时间更长.     

透明质酸钠关节内注射配合口服盐酸氨基葡萄糖胶囊治疗膝关节骨性关节炎的疗效分析

目的探讨透明质酸钠关节内注射配合口服盐酸氨基葡萄糖胶囊治疗膝关节骨性关节炎的临床疗效。方法2007年9月至2009年3月收治膝关节骨性关节炎患者181例217膝,男86例101膝,女95例1 16膝;年龄43～73岁,平均57岁。单膝145例,双膝发病36例。随机分为治疗组及对照组。治疗组112膝,采用透明质酸钠关节内注射配合口服盐酸氨基葡萄糖胶囊治疗;对照组105膝,采用透明质酸钠关节内注射治疗。结果患者膝关节疼痛均显著减轻,功能明显改善,其中治疗组优于对照组,差异有统计学意义（P〈0.01）。结论透明质酸钠关节内注射配合口服盐酸氨基葡萄糖胶囊治疗膝关节骨性关节炎是一种行之有效的方法。     

关节冲洗术联合透明质酸钠治疗K-L Ⅱ、Ⅲ期膝关节骨性关节炎疗效分析

目的 观察关节冲洗术联合膝关节腔注射透明质酸钠治疗膝关节骨性关节炎的临床疗效.方法 纳入自2018-12-2020-02诊治的77例Kellgren-Lawrence Ⅱ、Ⅲ期膝关节骨性关节炎,40例采用关节冲洗术联合透明质酸钠注射治疗(观察组),37例单纯于关节腔注射透明质酸钠治疗(对照组).比较2组治疗后1周、2周...     

关节镜下分型治疗膝关节骨性关节炎450例

目的 探讨关节镜下分型治疗膝关节骨性关节炎联合术后关节内注射透明质酸的效果.方法 选择非手术治疗失败的骨性关节炎450例,根据患者膝关节骨性关节炎症状表现以及疼痛部位,行关节镜下微创分型治疗,术后1个月注射透明质酸,观察联合治疗的效果.结果 显效218例,有效198例,无效32例,加重2例,总有效率92.4%.结论 细致检查症状表现,关节镜下分型治疗,术后结合关节内注射透明质酸,是治疗膝关节骨性关节炎的一个良好选择.     

膝骨性关节炎的综合治疗

自1998年1月至2001年1月采用关节内注射透明质酸钠配合关节持续被动活动(CPM)及功能锻炼治疗膝关节骨性关节炎患者64例100膝,近期疗效显著.     

关节镜清理术联合透明质酸钠治疗膝关节骨性关节炎

目的分析关节镜清理术联合透明质酸钠治疗膝关节骨性关节炎的临床价值。方法对52例膝关节骨性关节炎患者在关节镜有限清理术后给予关节腔内注射透明质酸钠。观察治疗前后及随访期间的并发症发生情况。依据Lysholm评分和改良HSS膝关节评分标准对膝关节恢复情况和总体治疗效果进行评定。结果 52例患者术后切口愈合良好,未发生关节感染、血管神经损伤、下肢深静脉血栓形成等并发症。术后均获12~18个月的随访,其中术后6个月和12个月的Lysholm评分明显高于术前,差异有统计学意义(P0.05)。末次随访依据疗效评判标准,本组治疗总有效率为88.46%(46/52)。结论关节镜清理术联合透明质酸钠治疗膝关节骨性关节炎,创伤小、并发症发生率低、临床症状改善明显,并可有效促进膝关节功能的恢复。     

中西医结合治疗膝关节骨性关节炎

目的　研究关节内注入透明质酸钠加痛点阻滞与口服筋骨痛消丸加超短波或电脑中频治疗膝关节骨性关节炎的临床疗效。方法　 88例患者治疗组 4 8例 6 4个膝关节透明质酸钠 2 ml关节腔注射每周一次、3周为一个疗程 ,同时进行痛息通、利多卡因、维生素 B1 2 混合液膝关节痛点阻滞 ,对照组 4 0例 5 6个膝关节口服筋骨痛消丸连续一个月、同时运用超短波或电脑中频治疗 ,一天一次连续三周 2 0天。结果　两组患者经约 2 0天的治疗 ,两组膝关节疼痛程度、日常动作能力、屈曲功能及综合情况与治疗前比较均有改善 ,但治疗组效果更明显 ,两组比较 P <0 .0 1,治疗次数与对照组比较明显减少 P <0 .0 1。结论　关节内注入透明质酸钠加痛点阻滞与口服筋骨痛消丸加理疗是治疗膝关节骨关节炎有效方法     

膝关节冲洗、注射透明质酸钠治疗骨性关节炎

目的 膝关节骨性关节炎常规治疗效果不满意，探讨一种有效的非手术治疗途径。方法对膝关节骨性关节炎的患者用生理盐水进行关节腔冲洗，使冲洗液变清，然后向膝关节腔注入透明质酸钠2ml，连续治疗3-5次。结果 按照疼痛、关节活动范围、主动伸展受限、内外翻畸形、步行能力及日常生活活动6项综合评分，优良率为85．4％。结论膝关节骨性关节炎经过冲洗，可改善关节内环境，祛除炎性致痛物质I注入透明质酸钠，是一个全新的医学概念，可以营养关节软骨，改变关节滑液的流变学状态，恢复滑液粘弹性。     

透明质酸钠辅助治疗踝关节粉碎性骨折的临床研究

目的　探讨透明质酸钠对踝关节粉碎性骨折的辅助治疗作用。方法　 1998年 4月～ 2 0 0 0年 11月对 37例 41个踝关节粉碎性骨折患者 ,按常规行手术复位固定术 ,术毕缝合前关节腔内注入透明质酸钠注射液 2 m l,固定受累关节。术后第 3天 ,踝关节腔内再次注射透明质酸钠 2 ml。此后每周注射一次 ,直至 4周拆除石膏。通过随访评价疗效。结果　所有患者术后随访 6～ 2 7个月 ,30例踝关节粉碎性骨折完全愈合 ,功能恢复正常 ;4例剧烈活动时踝关节隐痛 ,2例行走超过 1km或阴雨天时即感觉踝关节隐痛 ;1例压陷型粉碎性骨折者 ,由于骨折复位不良 ,术后治疗效果不满意。结论　踝关节腔内注射透明质酸钠对踝关节粉碎性骨折具有很好的辅助治疗作用     

透明质酸钠治疗膝骨性关节炎的临床效果及分析

目的　观察透明质酸钠 (sodium hyaluronate,SH)关节腔内注射治疗膝骨性关节炎 (osteoarthritis,OA)的临床效果及治疗前后关节液中自由基和炎性介质含量的变化。　方法　 92例 (111膝 ) OA患者 ,其中男 30例 ,女6 2例 ;年龄 2 1～ 71岁 ,平均 4 7.5岁。分轻度组 5 1膝 ,中度组 35膝 ,重度组 2 5膝。关节内每周注射 SH2 0 mg一次 ,共 5次 ,按 L ysholm膝关节功能评分比较治疗前后关节症状和功能的改善情况 ,并测定第 1、2和 5周 SH注射前和注射后 3个月抽取的关节液中一氧化氮 (nitric oxide,NO)、超氧化物歧化酶 (superoxide dismutase,SOD)、丙二醛 (malonicdialodehyde,MDA)和白细胞介素 1β(interlukin1β,IL- 1β)、肿瘤坏死因子 α(tumour necrosis factorα,TNF- α)的含量。　结果　随访 3个月 ,治疗效果优 4 2膝 ,良 38膝 ,可 2 1膝 ,差 10膝 ,优良率 72 .1%。病情越轻 ,治疗见效越早 ,疗效越好。SH治疗后轻、中度组患者关节液中 ,氧自由基含量和 IL- 1β、TNF- α含量明显下降 (P<0 .0 5 ) ,重度组变化不显著 (P>0 .0 5 ) ;SH对 NO含量影响较小 ,只有轻度组治疗后 3个月较治疗前明显减少 (P<0 .0 5 ) ,中、重度组变化不大 (P>0 .0 5 )。　结论　 SH关节腔内注射治疗膝 OA,可缓解临床症状 ,改善     

Subject‐specific modeling of muscle force and knee contact in total knee arthroplasty

Understanding the mechanical loading environment and resulting joint mechanics for activities of daily living in total knee arthroplasty is essential to continuous improvement in implant design. Although survivorship of these devices is good, a substantial number of patients report dissatisfaction with the outcome of their procedure. Knowledge of in vivo kinematics and joint loading will enable improvement in preclinical assessment and refinement of implant geometry. The purpose of this investigation was to describe the mechanics of total knee arthroplasty during a variety of activities of daily living (gait, walking down stairs, and chair rise/sit). Estimates of muscle forces, tibial contact load, location, and pressure distribution was performed through a combination of mobile fluoroscopy data collection, musculoskeletal modeling, and finite element simulation. For the activities evaluated, joint compressive load was greatest during walking down stairs; however, the highest contact pressure occurred during chair rise/sit. The joint contact moment in the frontal plane was mainly varus for gait and walking down stairs, while it was valgus during chair rise/sit. Excursion of the center of pressure on the tibial component was similar during each activity and between the medial and lateral sides. The main determinants of center of pressure location were internal–external rotation, joint load, and tibial insert conformity. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1576–1587, 2016.     

关节镜清理联合透明质酸钠治疗膝骨关节炎的短期疗效

目的探究关节镜下清理术联合透明质酸钠腔内注射治疗早中期膝关节骨关节炎的短期临床效果及血清相关指标的变化。 方法回顾性分析广州中医药大学附属佛山市中医院骨科2017年7月至2019年5月收治的膝关节骨关节炎患者。共有108例纳入本研究,采用随机数字表法分为对照组(n＝54)和观察组(n＝54)。两组患者均接受关节镜下膝关节清理术,对照组术后给予安慰剂关节腔内注射,观察组术后给予透明质酸钠关节腔内注射,治疗时间4周,治疗后随访6个月。比较两组治疗前后的疼痛视觉模拟评分(VAS)、日常生活活动量表(ADL)及Lysholm膝关节评分、血清基质金属蛋白酶(MMP-1)、软骨寡聚基质蛋白(COMP)、白介素-1(IL-1)、一氧化氮(NO)和血沉(ESR)的水平,采用t检验比较两组之间的差异。记录两组并发症情况,采用卡方检验评估两组间差异。 结果治疗6个月后,两组ADL及Lysholm评分较治疗前显著升高,治疗后观察组高于对照组(t＝8.390、11.690,P<0.05)。治疗4周后,两组血清MMP-1、COMP、IL-1、NO、ESR水平和VAS评分较治疗前显著降低,治疗后观察组低于对照组(t＝26.284、4.293、5.023、10.508、5.351、8.701, P<0.05)。治疗4周后,观察组并发症发生率为5.56%,与对照组(16.67%)相比,差异无统计学意义(χ²＝2.352,P>0.05)。 结论关节镜下清理术联合透明质酸钠腔内注射治疗早中期膝关节骨关节炎,能在短期内缓解膝关节疼痛、促进关节功能恢复、减轻炎症反应、改善软骨代谢,但远期效果尚需进一步探索和验证。     

Debridement and continuous irrigation for the treatment of pyogenic arthritis caused by the use of intra-articular injection in the osteoarthritic knee: indications and outcomes

PURPOSE: To discuss the indications and therapeutic outcomes of synovectomy, debridement, and continuous irrigation for the treatment of pyogenic arthritis caused by intra-articular injection used in the treatment of osteoarthritis of the knee. METHODS: Records of 41 patients with infectious arthritis of the knee who presented to our hospital from 1981 were reviewed. 11 of them had a history of intra-articular injection. They underwent synovectomy, debridement, and continuous irrigation using a Salem double-lumen tube after confirmation that one side of the femorotibial joint cartilage was basically healthy. RESULTS: The infection was successfully treated in 9 of the 11 patients. Of these 9 patients, one died after 3 years and 2 underwent total knee arthroplasty after 3 and 8 years. The remaining 6 patients were followed up for 5 to 15 years. Five of them had deteriorating arthropathy, and the condition was unchanged in the others. Two of these 6 patients had pain while walking, and their Japanese Orthopaedic Association scores were 70. The remaining 4 had good knee function and reduction of pain, with a mean Japanese Orthopaedic Association score of 91 and a mean range of motion of 131 degrees. CONCLUSION: Arthrodesis is frequently considered the treatment for osteoarthritis if the joint destruction has affected the weight-bearing surface. However, in our experience, even when inflammatory granulation develops in the cartilage surface of one side of the femorotibial joint, good results can still be obtained by synovectomy, debridement, and continuous irrigation. After the pyogenic arthritis has subsided, if osteoarthritis has advanced and bowleg has exacerbated, further treatment options are available, such as tibial resection and even joint replacement. Continuous irrigation should be considered a feasible treatment option for pyogenic arthritis.     

Treatment of adhesive capsulitis with intra-articular hyaluronate: A systematic review

Sodium hyaluronate injection into the glenohumeral joint is a treatment option in the management of adhesive capsulitis of the shoulder. We hypothesized that a systematic review would demonstrate that intra-articular sodium hyaluronate injections would result in significant improvements in passive range-of-motion, shoulder and general clinical outcome measures, and pain scales at short- and mid-term follow-up. Multiple medical databases were searched for levels I-IV evidence with a priori defined specific inclusion and exclusion study criteria. Clinical outcome measures used included Constant score, VAS pain scores, Cho functional scores, JOA scores, and range-of-motion measurements. Seven studies were included (four Level I and three Level IV; 292 subjects, 297 shoulders). Mean subject age was 59.1 years and mean pre-treatment duration of symptoms was 7.3 months. 140 subjects underwent one or multiple hyaluronate injections (120 glenohumeral joint; 20 subacromial bursa). Clinical follow-up was mean 9.0 weeks. Sodium hyaluronate injection into the glenohumeral joint has significantly improved shoulder range-of-motion, constant scores, and pain at short-term follow-up following treatment of adhesive capsulitis. Isolated intra-articular hyaluronate injection has significantly better constant scores than control. Isolated intra-articular hyaluronate injection has equivalent clinical outcomes and range-of-motion compared to intra-articular corticosteroid injection. Intra-articular hyaluronate injection was safe, with no reported complications within the studies in this review. Sodium hyaluronate injection into the glenohumeral joint is a safe, effective treatment in the management of adhesive capsulitis of the shoulder. Short-term evidence indicates that clinical outcomes are better than control and equivalent to intra-articular corticosteroid injection.     

Granulomatous inflammation after Hylan G-F 20 viscosupplementation of the knee : a report of six cases

BACKGROUND: Recently, intra-articular viscosupplementation with hyaluronate-derived products has gained popularity as a palliative modality for the treatment of osteoarthritis of the knee. Mild pain or swelling at the site of injection may occur in up to 20% of patients, although severe local inflammation, warmth, and joint effusion are rare. We present a series of six cases in which granulomatous inflammation of the synovium was observed after hyaluronate viscosupplementation of the knee. METHODS: Six knees (five patients) treated with intra-articular Hylan G-F 20 viscosupplementation underwent a surgical procedure because of persistent symptoms. Routine histopathological evaluation, supplemented by alcian-blue staining and hyaluronidase digestion, was performed in each case. RESULTS: Chronically inflamed synovium with areas of histiocytic and foreign-body giant-cell reaction was observed surrounding acellular, amorphous material. The material stained with alcian blue, a stain for hyaluronate, which disappeared after hyaluronidase digestion. CONCLUSIONS: We believe that the injected hyaluronate (Hylan G-F 20) may have been responsible for the synovitis in our patients and thus may be a pathological cause of recalcitrant symptoms after such injection. It is not known whether the responsible pathological agent was the hyaluronate derivative, a contaminant of the purification process, or a component of the carrier substance. Importantly, it appears that the findings in these patients most likely represent a previously unreported pathological response to a viscosupplementation product. This report should raise clinical awareness about this potential complication.     

Successful nonoperative management of chronic osteoarthritis pain of the knee: safety and efficacy of retreatment with intra-articular hyaluronans

CONTEXT: Although there are many nonsurgical therapies available for the treatment of pain associated with osteoarthritis (OA), their long-term use and safety have not been systematically followed. Intra-articular hyaluronan therapy has been used in the treatment of symptoms associated with OA of the knee with a very favorable safety profile. Five intra-articular hyaluronan products are approved in the US. No systematic review of the safety and efficacy of their chronic use has been reported. OBJECTIVE: To evaluate the literature on the efficacy and safety of repeat courses of hyaluronan therapy in patients with OA of the knee. DATA SOURCES: MEDLINE, EMBASE, searched through October 2004. STUDY SELECTION: Databases were searched using the terms hyaluronan, sodium hyaluronate, hyaluronic acid, hylan, hylan G-F 20, osteoarthritis, adverse events, repeat treatment, and multiple courses. DATA SYNTHESIS: There are some data that support the benefit and safety of repeat treatment for all products. Data also indicate that one formulation of sodium hyaluronate (molecular weight [MW] 500-730 kDa) is well tolerated and as effective after multiple courses of treatment as it is after a single course. There is also clinical evidence that prolonged use of sodium hyaluronate (MW 500-730 kDa) may significantly decrease the rate of deterioration of joint structure. Localized severe acute inflammatory reactions reported with repeated treatment in some patients are not a class effect but may be linked to physicochemical characteristics of hylan-based treatment. CONCLUSIONS: Repeat courses of the hyaluronans are safe and effective in the treatment of pain associated with OA of the knee.     

Biomechanical study of gait using an intelligent brace

We have developed a new long leg brace fitted with a computer-controlled knee joint that allows the user to go up and down a slope and stairs. Using this new brace, we analyzed gait under various conditions in ten normal men in terms of dynamic electromyography. Walking up a slope with normal step produced discharges in the leg muscles other than the gastrocnemius lateral head before and after the heel-strike on the ground, which indicated the absorption of the impact of landing. Going down a slope with controlled step resulted in lower activities of the tibialis anterior and the gastrocnemius lateral head than doing so with non-locked step or locked step. In subjects walking up stairs with tandem gait, the large discharges of the gastrocnemius lateral head that were observed in the late stance phase with normal step disappeared when the brace was applied. These results indicated that the muscle activity levels decreased during controlled walking with this new brace, and that the new brace can compensate for reduced muscle strength of the lower leg during walking. Kinematic analysis of walking revealed no significant difference between normal walking and controlled walking under any walking conditions. Received: June 8, 1999 / Accepted December 22, 1999     

膝关节手术后注射透明质酸钠效果观察

目的　探讨膝关节术后关节腔内注射透明质酸钠的效果。方法　 1998年 1月～ 2 0 0 1年 2月 ,对关节镜手术 134例于手术结束时 ,以及膝关节开放手术 91例于术后 2 4小时拔引流管时 ,分别在关节腔内注射透明质酸钠 4ml(用药组 ) ;术后第 5天抽出关节积液 ,再注入透明质酸钠注射液 2 ml;每周 1次 ,连续 5周为一个疗程 ,根据病情注射 1～ 2个疗程 ,观察各时间点疼痛 VAS评分和达到最大无痛活动度的时间。与同期手术未用药的 85例进行比较。结果　用药组术后各时间点的疼痛程度评分均低于未用药组 ,关节镜手术用药组术后达最大无痛活动度所需的时间为 3天 ,未用药组为 5天 ;膝关节开放手术用药组达最大无痛活动度的时间为 6天 ,未用药组为 9天。结论　膝关节手术后关节腔内注射透明质酸钠能有效止痛 ,并有助于关节功能恢复