玻璃酸钠注射液治疗膝骨关节炎疗效观察

骨关节炎是以关节软骨退变为主要病理特征的临床综合征 ,是多发于中年以后的慢性变性关节疾病。随着我国社会人口老龄化的进程 ,该病发生率将逐年增多。由于其确切病因未定 ,目前治疗方法虽多 ,但效果不理想。我院自 1999年至今应用玻璃酸钠 (简称ＳＨ)注射液膝关节腔内注射治疗膝骨关节炎 (简称ＯＡ) 10 2例、178个关节 ,经 1年以上随访效果满意 ,现报告如下。1　资料与方法1.1　一般资料　 (1)本组共 10 2例、178膝 ,其中男 4 3例 ,76膝 ;女 5 9例 ,10 2膝。双膝病变约占 74 .5 %。年龄 4 2～ 78岁 ,平均 6 8岁。出现症状时间最短 1个月 ,…     

玻璃酸钠治疗膝骨关节炎100例临床观察

目的探讨玻璃酸钠对骨关节炎的疗效。方法对100例膝骨关炎患者行玻璃酸钠关节腔内注射，每周1次连续5周为一疗程。全部病例参照Kellgren和Lawrence的放射学标准分为Ⅴ级。随访时间最长4年，最短半年。结果优4例占36．3％，良40例占36．3％，中20例占18．1％，差10例占9％，总有效率90．9％，优良率72．7％。结论玻璃酸钠对Ⅰ、Ⅱ、Ⅲ级骨关节炎效果较好，Ⅳ级患者疗效较差。     

玻璃酸钠治疗膝骨关节炎的早期应用

膝骨关节炎(OA)是中老年人的常见病、多发病。伴随年龄老化出现的退行性改变，给患者带来巨大的痛苦，成为中老年人工作、生活、娱乐的障碍。对其进行早期的治疗及控制对提高生活质量有一定的意义。自1999年至今用施沛特(SH)进行关节腔内注射治疗OA 160例取，得显著疗效。报告如下：     

玻璃酸钠治疗膝骨关节炎的疗效观察

膝骨关节炎（osteoarthritis,OA）是引起成人膝关节疼痛的常见原因,起病缓慢,无症状,呈良性发展过程[1]。病变晚期常表现为：关节疼痛、腿无力、摩擦声、关节活动度减少和僵硬等。疼痛通常与活动相关,负重活动后关节疼痛加重,休息后缓解,屈膝用力时、休息后突然站起时加重。     

玻璃酸钠治疗膝骨关节炎的疗效观察

膝骨关节炎(osteoarthritis,OA)是引起成人膝关节疼痛的常见原因,起病缓慢,无症状,呈良性发展过程[1].病变晚期常表现为:关节疼痛、腿无力、摩擦声、关节活动度减少和僵硬等.疼痛通常与活动相关,负重活动后关节疼痛加重,休息后缓解,屈膝用力时、休息后突然站起时加重.我院采用玻璃酸钠治疗OA取得良好疗效,现报道如下.     

玻璃酸钠治疗膝关节骨关节炎85例观察

我科应用玻璃酸钠(sodium hyaluronate，SH)(山东正大福瑞达制药有限公司生产)进行膝关节腔注射治疗膝关节骨关节炎(OA)116例，其中85例得到半年随访，取得了较好的疗效，现报告如下。     

倍他米松联合玻璃酸钠治疗膝骨关节炎83例观察

目的：观察复方倍他米松联合玻璃酸钠治疗伴有膝关节肿胀或急性疼痛的骨关节炎的临床疗效。方法：采用复方倍他米松联合玻璃酸钠行关节腔内注射治疗膝骨关节炎83例127膝。玻璃酸钠每周注射1次,连续5周;复方倍他米松在第1周和第5周与玻璃酸钠联合注射。治疗后对疼痛和关节功能改善情况进行评估。结果：随访半年的优良率为55.7%,有效率为93.2%。结论：复方倍他米松联合玻璃酸钠治疗伴有膝关节肿胀或急性疼痛的骨关节炎患者临床疗效满意,但应注意合理用药。     

关节腔注射玻璃酸钠治疗膝骨关节炎362例分析

目的：总结关节腔注射玻璃酸钠治疗膝关节骨关节炎的经验。方法：本组362例,均采用膝关节腔内玻璃酸钠注射,每次2ml,每周1次,共5次。结果：优良率为87.3%,取得了良好疗效。结论：关节腔注射玻璃酸钠治疗膝关节1～2级骨关节炎有确切疗效,能有效缓解疼痛及延缓病程发展。     

玻璃酸钠治疗膝骨关节炎临床分析

目的观察玻璃酸钠关节腔内注射治疗骨关节炎的疗效。方法 190例骨关节炎患者每周1次关节内注射玻璃酸钠注射液,连续5次为1个疗程。结果随访2.5～20个月,190例骨关节炎治疗效果:临床缓解54例(28%),有效110例(58%),无效26例(14%),总有效率86%。结论玻璃酸钠治疗骨关节炎临床效果明显,特别对轻、中度患者疗效更好。     

玻璃酸钠替代性治疗膝骨关节炎临床研究

目的观察玻璃酸钠治疗膝骨关节炎的临床疗效。方法对 63例膝骨关节炎患者行关节腔内注射玻璃酸钠疗法 ,观察患者的症状及体征在用药前后的变化 ,并根据改善程度评估疗效。结果治疗总有效率为85 .7% ,轻度、中度组有效率明显高于重度组。所有病例未发现毒副作用。结论膝关节腔内注射玻璃酸钠治疗膝骨关节炎简便、有效 ,具有广阔的临床应用前景     

Treating knee osteoarthritis with intra-articular hyaluronans

ABSTRACT

Objective: Intra-articular hyaluronan (HA) or hylan is approved for the treatment of osteoarthritis (OA) knee pain. The authors review here published evidence of efficacy and safety of intra-articular HA for the treatment of knee pain. Since the systemic safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase (COX-2) inhibitors for OA knee treatment are a current concern, the authors also offer recommendations for repositioning HA in the OA treatment paradigm.

Methods: Relevant HA literature was identified by searching MEDLINE and EMBASE from their inception to April 2008 using the search words hyaluronan, hyaluronic acid, sodium hyaluronate, and hylan G-F 20, with knee and OA. Data from randomized, placebo-controlled trials were reviewed and summarized in this article. While not a systematic review, this article reviews the best available evidence for the use of HA to treat knee OA.

Results: For the most part, patients in the reviewed studies were adults over the age of 40 with mild to severe symptomatic OA of the knee. Reviewed studies demonstrated significant improvements in pain and physical function with HA or sodium hyaluronate and hylan G-F 20. HA or hylan products were most effective between 5 and 13 weeks after injection with improvements also observed at 14–26 weeks or sometimes longer, and were well tolerated with a low incidence of adverse events. HA also provides beneficial treatment effects when administered in conjunction with other therapies.

Conclusions: Intra-articular HA or hylan has proven to be an effective, safe, and tolerable treatment for symptomatic knee OA. In an effort to limit cardiovascular, gastrointestinal, and renal safety concerns with COX-2 selective and nonselective NSAIDs and maximize HA efficacy, the authors proposed using HA earlier in the treatment paradigm for knee OA and also as part of a comprehensive treatment strategy.     

参麦注射液对兔关节炎模型关节液透明质酸水平的影响

目的 从透明质酸（HA）方面研究参麦注射液关节腔注射治疗膝骨关节炎的机理.方法 清洁级新西兰白兔30只,随机分为治疗组、对照组及空白组,每组各10只.将对照组和治疗组采用改良Hulth法造模,空白组及对照组予生理盐水1 ml右后腿膝关节腔注射,治疗组用参麦注射液0.8 ml＋0.2ml 2%利多卡因关节腔注射,1次/周,连续4周.于第1、4周抽取关节液,Elisa检测关节液中HA含量.结果 治疗组与对照组治疗前HA含量均比空白组低（P〈0.01）,差异有显著性.治疗后,治疗组HA含量较前有所增高,对照组升高不明显,治疗组与对照组相比,治疗组HA含量增高显著（P〈0.01）.结论 参麦注射液关节腔注射治疗可能通过提高HA含量来治疗膝骨关节炎.     

Comments on the discordant recommendations for the use of symptomatic slow-acting drugs in knee osteoarthritis

Despite the near concurrent publication by influential scientific organizations, there are important differences in interpretation of the evidence base and the conclusions derived from the recent Osteoarthritis Research Society International (OARSI) guidelines for the management of knee osteoarthritis, the American College of Rheumatology (ACR) guidelines (concerning also hip and hand osteoarthritis) and the algorithm recommendations by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). This is particularly evident for the drug class of symptomatic slow-acting drugs in osteoarthritis. In this paper, we highlight these differences and try to understand where they derive from, proposing an evidence-based interpretation.     

自拟熏洗方联合关节腔内透明质酸钠注射治疗膝关节骨性关节炎的疗效观察

目的：观察自拟熏洗方联合关节腔内透明质酸钠注射治疗膝关节骨性关节炎的临床疗效及对关节液内炎症因子水平的影响。方法将2012年1月～2013年6月收治的80例膝关节骨性关节炎患者随机分为2组,每组各40例,对照组单纯关节腔内注射透明质酸钠治疗,观察组在对照组基础上再给予自拟熏洗方治疗,连用6周,治疗前后进行VAS评分、Lequesne评分,检测关节液中TNF-a及IL-6水平,评价两组临床疗效。结果观察组和对照组治疗后Lequesne评分、VAS评分、TNF-a、IL-6均较治疗前明显降低（P均＜0.05）,观察组治疗后Lequesne评分、VAS评分、TNF-a、IL-6明显低于对照组（P均＜0.05）;观察组和对照组临床总有效率分别为95%和75%,观察组总有效率显著高于对照组（χ2＝10.278,P＜0.05）。结论中药熏洗联合关节腔内透明质酸钠注射能够直接针对患处协同起效,增强疼痛缓解与关节功能恢复效果,是治疗膝关节骨性关节炎的理想方法,其作用机制可能与其调节关节液中炎症介质水平,抑制炎性反应有关。     

透明质酸膝骨关节腔内注射治疗膝骨关节炎

目的：研究透明质酸膝骨关节腔内注射治疗膝骨关节炎的疗效。方法：９０例膝骨关节炎病人，男性３８例，女性５２例，年龄６５±ｓ８ａ，随机分为Ａ，Ｂ，Ｃ３组，每组３０例，分别采用透明质酸关节腔内注射，２．５ｍＬ，ｑｗ×３ｗｋ；双氯芬酸５０ｍｇ，ｐｏ，ｂｉｄ×３ｗｋ；关节腔内注射曲安奈德注射液２０ｍｇ＋０．５％布比卡因注射液５ｍＬ＋０．９％氯化钠注射液至２０ｍＬ，ｑｗ×３ｗｋ。结果：Ａ，Ｂ，Ｃ３组有效率分别为９７％，８７％和９０％。Ｂ，Ｃ２组与Ａ组比较，差别有显著意义（Ｐ＜０．０５）。３组副作用均轻微。结论：透明质酸关节腔内注射是治疗膝骨关节炎较为有效的方法。     

针刀联合关节腔内注射治疗膝骨性关节炎临床研究

目的：探讨针刀联合关节腔内注射治疗膝骨性关节炎临床疗效。方法256例膝骨性关节炎患者随机分成两组：A组予膝关节腔内注射治疗;B组予针刀联合膝关节腔内注射治疗。观察记录治疗前与治疗后两组VAS、HSS、主动关节活动度（AROM）变化。结果治疗后两组VAS评分均下降（P＜0.05）, B组下降更明显;两组HSS评分和AROM度数均高于治疗前（P＜0.05）, B组明显高于A组。结论针刀联合关节腔内注射治疗膝骨性关节炎疗效显著。     

膝关节液透明质酸含量与滑膜炎程度的关系

目的探讨膝关节液透明质酸含量与滑膜炎程度之间的关系。方法酶联免疫吸附试验(ELISA)检测膝关节疾病(OA)患者102例共104膝的关节液透明质酸含量,并在关节镜下应用Ayral滑膜炎评分法和Outerbridge关节软骨损伤评分法评价膝滑膜炎和关节软骨损伤程度。采用t'检验、Spearman相关分析和多元线性回归分析进行统计分析。结果Ayral滑膜炎评分≥60分组的关节液透明质酸含量比Ayral滑膜炎评分<60分组高(P<0.001)。104膝关节液透明质酸含量与Ayral滑膜炎评分呈正相关(茁'A=0.497,P<0.001),与Outerbridge软骨损伤累计评分呈负相关(茁'o=-0.364,P<0.001),且Ayral滑膜炎评分的影响较大。关节液透明质酸含量与Ayral滑膜炎评分在Ayral滑膜炎评分≥60分组呈正相关(r=0.306,P<0.05),在Ayral滑膜炎评分<60分组无相关性(r=-0.144,P>0.05)。与非OA组相比,OA组的关节液透明质酸含量较低(P<0.05),而Ayral滑膜炎评分较高(P<0.01)。结论膝关节液透明质酸可作为生物标记物反映滑膜炎的程度,关节液透明质酸含量的增高提示滑膜炎较重。     

A型肉毒毒素联合透明质酸注射治疗面部老化临床疗效观察

目的：探讨A型肉毒毒素、透明质酸注射联合治疗面部皮肤老化疗效及安全性。方法：对45例患者面部老化问题,采用A型肉毒毒素联合透明质酸注射治疗,观察治疗效果。结果：患者面部老化问题得到不同程度的改善,治疗有效率83.11%,术后不良反应轻且都是暂时性,恢复良好。结论：A型肉毒毒素联合透明质酸注射治疗面部皮肤老化疗效好,患者满意度高,安全有效。     

Overall tolerability and analgesic activity of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis

ABSTRACT

Objective: Viscosupplementation with intra-articular hyaluronic acid (HA) is an alternative to the treatment of symptomatic knee osteoarthritis (OA) with pain relieving drugs. Sinovial, is a sterile, non-pyrogenic 0.8% solution of highly purified sodium hyaluronate for intra-articular application. The aim of the present study was to investigate the safety and tolerability profile of this preparation in patients with symptomatic knee OA over 24 weeks.

Research design and methods: This was a single group, open-label study, including outpatients of both sexes, aged between 18 and 85 years, with symptomatic knee OA. All patients underwent weekly intra-articular injections of HA for 5 consecutive weeks and were followed-up for 19 additional weeks. The safety and tolerability profile (primary endpoint) was assessed by adverse event (AE) reporting. The secondary endpoint was efficacy evaluated by changes in the Western Ontario and McMaster Universities (WOMAC) score vs. baseline. Patient and physician satisfaction were also recorded.

Results: Intra-articular HA was generally well tolerated. The most frequent AE was pain at the injection site (5.8% of the injections); no serious treatment-related AE was reported. The WOMAC score was significantly reduced within the first 2 weeks of treatment (from 4.02 ± 1.90 to 3.55 ± 2.04, p = 0.0011), further decreased by the end of the injection series (week 6: 2.59 ± 1.90; p < 0.0001) and maintained during the follow-up (week 24: 2.44 ± 1.88; p < 0.0001). The WOMAC subscores were also significantly reduced from week 4 for ‘pain’ and from week 6 for ‘stiffness’ and ‘physical function’.

Conclusions: In the present study, intra-articular HA was well tolerated and safe in patients with symptomatic knee OA. Based on the sustained improvements in WOMAC score and subscores, a carry-over effect lasting for at least 19 weeks after the last injection may be proposed. These results further confirm the evidence of efficacy and safety of intra-articular HA in the management of knee OA.