利美达松关节腔内注射治疗无菌性关节炎50例分析

作者报告应用利美达松和确炎舒松－Ａ对５０例无菌性关节炎行关节腔内注射的疗效。结果显示利美达注射后四周显效率为３３．３％，总有效率为８６．６％，认为利美达松在消肿、止痛和增加关节活动度方面均明显优确炎舒松－Ａ，总体疗效提高２１．６％。利美达松注射二周后药效仍明显存在。各种类型关节滑膜炎中，以类风湿关节炎为其最佳适应证。     

利美达松封闭注射治疗四肢疼痛的疗效观察

目的：观察利美达松封闭注射治疗四肢疼痛的疗效。方法：对43例门诊四肢慢性疼痛患者采用利美达松封闭注射治疗,1年随访后进行疗效统计分析。结果：利美达松对于适应症明确四肢疼痛封闭注射疗效满意。结论：利美达松作为氟美松的一种缓释型制剂封闭注射具有临床优点。     

注射性坐骨神经损伤的手术治疗

目的：提高注射性坐骨神经损伤的疗效。方法：对56例注射性坐骨神经损伤的患儿采用神经卡压松解。神经外膜内注射醋酸确炎舒松-A,神经束膜松解,坐骨神经周围放置醋酸确炎舒松-A,术中对坐骨神经直接电刺激,术后随访2年。结果：神经损伤症状完全恢复18例,部分恢复27例,无明显恢复11例,有效率80.4%。结果：注射性坐骨神经损伤的症状体征,应立即手术,及早的神经外膜松解、生理盐水冲洗及术中对丛骨神经直接电刺激有助于坐骨神经损伤的恢复。醋酸确炎舒松-A的应用能减轻粘连并有效地防止坐骨神经术后的再次疤痕卡压。     

确炎舒松-A穴位封闭联合中药熏洗治疗肛周瘙痒症疗效观察

目的探索肛周瘙痒症治疗方法。方法将100例肛门瘙痒患者随机分成观察组与对照组,观察组采用确炎舒松-A加利多卡因穴位封闭联合中药熏洗,对照组采用维生素B1加维生素B12于局部注射。结果观察组治疗效果明显优于对照组（P〈0．001）。结论确炎舒松-A穴位封闭加中药熏洗法治疗肛周瘙痒症疗效确切。     

手术切除与注射确炎舒松A治疗瘢痕疙瘩

目的：探讨瘢痕疙瘩的治疗方法及疗效。方法：采用手术切除与局部注射确炎舒松A治疗瘢痕疙瘩87例,其中随访62例。结果：参照朱兆明疗效分类方法,随访62例中优52例（83.87%),良9例（14.52%）,差1例（1.61%）。其中1例注射4例后局部皮肤萎缩。结论：手术切除与注射确炎舒松A是目前治疗瘢痕疙瘩较理想的方法。     

利美达松复合液硬膜外注射治疗腰腿痛

利美达松复合液硬膜外注射治疗腰腿痛吕艳霞刘爱香段秀芬梁丽革作者单位：０５００５１河北医科大学附属第三医院麻醉科（吕艳霞刘爱香）；药剂科（段秀芬梁丽革）利美达松（Ｌｉｍｅｔｈａｓｏｎ），又名氟美松棕榈酸酯，为糖皮质激素氟美松的一种新型缓释剂，具有抗炎作...     

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.     

注射性坐骨神经损伤的手术治疗

目的 提高注射性坐骨神经损伤的疗效。方法 对56例注射性坐骨神经损伤的患儿采用神经卡压松解、神经外膜内注射醋酸确炎舒松－A,神经束膜松解,坐骨神经周期放置醋酸确炎舒松－A,术中对坐骨神经直接电刺激等。结果 术后随访2年,神经损伤症状完全恢复18例,部分恢复27例,无明显恢复11例,有效率80．4％。结论注射性坐骨神经损伤一旦有损伤的症状体征,应立即手术,及早神经外膜松解、生理盐水冲洗及术中对坐骨神经直接电刺激有助于坐骨神经损伤的恢复。醋酸确炎舒松－A的应用能减轻粘连并有效地防止坐骨神经术后的再次疤痕卡压。     

5-氟尿嘧啶联合利多卡因及确炎舒松治疗900例瘢痕疙瘩的注射及护理效果分析

目的总结5-FU联合利多卡因及确炎舒松治疗900例瘢痕疙瘩的注射及护理体会,分析注射治疗过程中的注意要点。方法自2002年以来,选择900例瘢痕疙瘩患者,在瘢痕处注射5-FU+利多卡因+确炎舒松,并记录注射前后病灶变化以观察疗效。结果本组中,2例患者因出现药物不良反应而中止治疗,30例患者效果不佳,其余868例患者疗效满意,随访1年均未见复发。结论 5-氟尿嘧啶联合利多卡因及确炎舒松注射治疗瘢痕疙瘩,操作简单,疗效确切,且加强注射前后的护理,有利于提高临床治疗效果。     

用得宝松（Diprospan）局封的临床观察

用得宝松（Ｄｉｐｒｏｓｐａｎ）局封的临床观察陈德松近半年，我们用Ｄｉｐｒｏｓｐａｎ作为局封药物，对曾用过醋酸确炎舒松一Ａ局封治疗，目前还需要用该药继续治疗的患者进行治疗，比较两药的解痛效果和解痛时间，发现Ｄｉｐｒｏｓｐａｎ的临床疗效以及注射后的局部反...     

Changes in MMP‐2 and ‐9 Activity and MMP‐8 Reactivity After Amphotericin B Induced Synovitis and Treatment with Bufexamac

The objective here was to evaluate the acute effects of induced arthritis on synovial fluid (SF) levels of matrix metalloproteinases (MMP) ‐2, ‐8 and ‐9 in horses. To evaluate MMP‐2 and ‐9 activities and the effect of non‐steroidal anti‐inflammatory drug (NSAID) bufexamac during remission from acute arthritis. Aseptic arthritis was induced in 24 Standardbred horses using 20 mg of amphotericin B as a single intra‐articular (IA) injection in the right intercarpal joint. After 1 week and 2 weeks, horses were treated intra‐articularly with 10, 20, or 40 mg of bufexamac suspension or with sterile saline solution as control. SF was sampled prior to induction and at weekly intervals for 5 weeks. Fluids were evaluated for MMP‐2 and MMP‐9 activity by gelatin zymography or for MMP‐8 immunoreactivity by Western Blotting. IA injection of amphotericin B consistently resulted in significant increase in the immunoreactivity of MMP‐8 and activity of both the latent and the active forms of MMP‐2 and ‐9, among which the active form of MMP‐2 increased the most. MMP‐9 levels declined to pre‐induction levels within 2 weeks, whereas levels of MMP‐2 remained still high after 5 weeks. Treatment with bufexamac did not significantly affect levels of gelatinolytic MMP. Results suggest that after acute arthritis of horses, elevated MMP activity is present in the joint, for several weeks, to a degree that could promote cartilage degradation, and treatment with the NSAID bufexamac is not likely to affect that. Furthermore, analysing levels of MMP‐9 activity and especially levels of active forms of MMP‐2 activity may be valuable to predict the time of occurrence of arthritis in horses.     

Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting

PURPOSE: There have been few prospective studies evaluating the results of nonsurgical treatment of a well-defined patient cohort with symptomatic basal joint osteoarthritis of the thumb. This prospective study uses a validated outcome instrument to examine the effectiveness of a single steroid injection and 3 weeks of splinting in patients with osteoarthritis in Eaton stages 1 to 4 with a minimum of 18 months of follow-up evaluation. METHODS: Thirty consecutive patients (30 thumbs) were studied prospectively to evaluate the efficacy of a single injection of corticosteroid into the trapeziometacarpal joint, followed by immobilization in a thumb spica splint for 3 weeks. All patients answered an outcome-based questionnaire (Disabilities of the Arm, Shoulder, and Hand) and were examined before injection, 6 weeks after injection, and at final follow-up examination (minimum, 18 months). Eaton radiographic stage was recorded by 3 independent observers. RESULTS: At 6 weeks 13 patients had improvement in pain intensity and 17 patients reported no symptomatic improvement. Twelve of those with relief at 6 weeks continued to have relief at long term follow-up evaluation (mean, 25 months). Of patients with long-term relief average grip strength of the affected thumb was 95% of contralateral side, whereas those without relief had grip strength values that were 60% of contralateral side. For those patients without relief at 6 weeks there was no improvement seen at later follow-up evaluation. Five patients with Eaton stage 1 disease had an average of 23 months of relief with nonsurgical treatment. In stage 2 and stage 3 disease 7 thumbs improved at 6 weeks after injection and 6 thumbs had long-term relief. In stage 4 disease, 6 thumbs had neither short-term nor long-term relief with the injection. Disease side, handedness, and smoking did not affect outcomes. At final follow-up evaluation 12 thumbs had had surgical treatment. CONCLUSIONS: Steroid injection with splinting for the treatment of basal joint arthritis of the thumb provided reliable long-term relief in thumbs with Eaton stage 1 disease but provided long-term relief in only 7 of 17 thumbs with Eaton stage 2 and stage 3 basal joint arthritis.     

Renal side effects of high and low cyclosporin A doses in patients with rheumatoid arthritis

Thirty-nine patients with classical or definite rheumatoid arthritis (RA) entered a randomized double-blind placebo controlled study with low dose cyclosporin A (CyA) (mean whole blood CyA level after 26 weeks 282 +/- 33 micrograms/l) or placebo treatment for 48 weeks. The placebo treatment had to be withdrawn before 48 weeks in 9 out of 19 patients because of a deterioration of their arthritis symptoms. All 20 patients in the CyA group completed 26 weeks of treatment. Fourteen of them were followed up for 48 weeks of treatment on CyA and then 12 weeks after CyA treatment was withdrawn. The side effects in the CyA group were compared with the results from another study with high CyA doses (mean whole blood CyA level 419 +/- 71 micrograms/l) for 26 weeks in 11 other patients with RA. Serum creatinine increased 19.7% (p less than 0.01) in the low CyA dose group after 26 weeks as compared with 59.5% in the high CyA dose group. Creatinine clearance was reduced by 17.9% (low dose) (p less than 0.01) and 26.2% (high dose), respectively. Twelve weeks after withdrawal of the low dose CyA treatment, serum creatinine values were still higher than before treatment (p less than 0.05), but creatinine clearance had normalized. Eight of the 20 patients treated with low CyA doses also started with nonsteroidal anti-inflammatory drugs (NSAIDs) after 20-36 weeks of CyA treatment. Serum creatinine was 16.6% above baseline 4 weeks before NSAIDs compared with an increase of 40.4% (p less than 0.05) 4 weeks after start of NSAID treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of ovariectomy and estrogen replacement therapy on arthritis and bone mineral density in rats with collagen-induced arthritis

We investigated the effects of ovariectomy (ovx) and estrogen replacement therapy (ERT) on bone mineral density (BMD) and arthritis severity in rats with collagen-induced arthritis (CIA). Seven-month-old female Sprague-Dawley rats were separated into a sham group (n = 8), CIA group (n = 14), ovx group (n = 10), CIA + ovx group (n = 11), and CIA + ovx + ERT group (n = 14). In these groups, ovx was performed at 7 days, and ERT (17β-estradiol at 20 μg/kg three times per week) was initiated 8 days after sensitization. Every 2 weeks, until 8 weeks after sensitization, arthritis score and hind paw thickness were evaluated, and BMD of the trabecular and cortical bones in the metaphysis and diaphysis of the tibia were measured by peripheral quantitative computed tomography. The arthritis score was highest in the CIA + ovx group at all timepoints after sensitization. The hind paw thickness was significantly higher in the CIA + ovx group than in the CIA group at 8 weeks after sensitization (p < 0.05). Both the arthritis score and hind paw thickness were lower in the CIA + ovx + ERT group than in the CIA + ovx group. BMD in the metaphysis was significantly decreased in both the trabecular and cortical bones in the CIA + ovx group compared with those in the CIA group at 4, 6, and 8 weeks after sensitization. In the CIA + ovx group, trabecular BMD was changed by −34 ± 11%, and cortical BMD changed by −14 ± 7% in the metaphysis at 8 weeks compared with those at 0 week. In the CIA group, changes of BMD in the metaphysis were −7 ± 11% in trabecular bone and 0 ± 7% in cortical bone. These differences of trabecular and cortical bone loss in the metaphysis were significant (both p < 0.01). BMD reduction was significantly less in the CIA + ovx + ERT group than in the CIA + ovx group at 6 and 8 weeks after sensitization. Although BMD in the diaphysis was also reduced in the groups with CIA, the degree of reduction was smaller than in the metaphysis. We conclude that ovx in CIA rats could enhance the severity of arthritis and bone loss, and that ERT could suppress arthritis and bone loss.     

关节内注射复方倍他米松对兔佐剂性关节炎的效果

目的评价关节内注射复方倍他米松对兔佐剂性关节炎的效果。方法日本大耳白兔，雌雄各半，体重2～3kg，6～8月龄。采用皮内注射卵清蛋白＋非完全弗氏佐剂的方法制备佐剂性关节炎模型。佐剂性关节炎模型制备成功的48只免随机分为2组（n=24），C组双膝关节内各注射生理盐水1ml；D组注射复方倍他米松0．5mg／kg。每组各随机取6只兔，持续观察膝关节外观，分别于治疗前、治疗后2周测量髌骨上缘处双膝周径，并测定膝关节灌洗液中一氧化氮（NO）浓度，治疗后2周处死兔，打开膝关节，观察关节腔内改变，取髌上囊处滑膜，光镜下观察病理学改变。2组分别于治疗后1、2、3d各随机处死6只兔，取髌上囊滑膜，观察细胞凋亡情况。结果与c组比较，治疗后D组关节滑膜炎性反应较轻，NO浓度降低（P〈0．01）；治疗后2、3d滑膜细胞凋亡率升高（P〈0．05或0．01）。结论膝关节内注射复方倍他米松0．5mg／kg对免佐剂性关节炎有抗炎作用，可能与抑制NO的合成及促进滑膜细胞凋亡有关。     

Septic knee arthritis after intra-articular hyaluronate injection. Two case reports

Intraarticular sodium hyaluronate injection to treat osteoarthritis is associated with minor side effects. Infections seem uncommon. We report two cases of septic knee arthritis. One patient was an 80-year-old woman who was admitted for Staphylococcus aureus knee arthritis after several intraarticular injections of sodium hyaluronate and corticosteroids. In the other patient, a 78-year-old woman, Neisseria mucosa knee arthritis occurred after a single sodium hyaluronate injection. Faultless aseptic technique is essential when administering hyaluronate viscosupplementation. Patients should be informed of the risk of septic arthritis.     

Gait change after local anesthetic of chronically arthritic knee

Gait alterations of chronic knee arthritis before and after injection of local anesthesia was measured in the orthopedist's office area. A portable gait analyzer was used to evaluate gait characteristics before and after injection of local anesthesia in the chronically arthritic knee. Gait was analyzed during a 400-meter walk. Overall velocity and cadence increased 3.3% (p = 0.016) and 2.8% (p = 0.005). In-stance phase single and double support time (SLS and DLS) reduced 1.3% (p = 0.003) and 3.8% (p = 0.028). The ratio of SLS/DLS increased confirming a relatively increased duration in SLS as a percentage of the overall gait cycle. In swing phase the pulling power (initial swing), swing power (terminal swing) and ground impact increased 10.3% (p < 0.001), 6.8% (p = 0.003), and 4.2% (p = 0.003). Patients demonstrated fatigability at the end of walking measured as diminished velocity. Fatigability decreased after injection of the arthritic knee. The study demonstrates the specific gait phase changes afforded by injection of local anesthesia into the chronically arthritic knee. This study may serve as a benchmark for the measure of possible improvements afforded by different therapy for the patient suffering from chronic knee arthritis.     

鹿瓜多肽注射液治疗类风湿性关节炎临床疗效

目的探讨鹿瓜多肽注射液在类风湿性关节炎患者中的临床应用效果及安全性。方法将41例类风湿关节炎患者随机分为鹿瓜多肽组（21例）和对照组（20例）,治疗后观察5周。鹿瓜多肽组静脉滴注,2周为1疗程,间隔1周后继续应用1疗程;对照组应用非甾体类抗炎药。结果鹿瓜多肽组治疗后2、5周的血沉、血清类风湿因子、C反应蛋白水平均有明显好转（P〈0.05）,服药5周后,两组患者的关节痛例数、关节压痛指数、关节肿胀指数、晨僵和握力等各项指标均有改善（P〈0.05）,鹿瓜多肽组副作用发生率明显低于对照组。结论鹿瓜多肽注射液治疗类风湿性关节炎有一定临床效果,安全性高。     

Safety of intra-articular injection of etanercept in small-joint arthritis: an uncontrolled, pilot-study with independent imaging assessment

This study was conducted to test the safety of intra-articular tumor necrosis factor alpha (TNF-alpha) antagonists in small joints with arthritis. A dose of 2-8 mg etanercept was given intra-articularly guided by ultrasonography (US) in 26 patients with a flare of arthritis in a particular joint (16 wrists, two elbows, two ankles, six finger joints). Primary end points were imaging analyses by independent investigators: US-Doppler measurements were performed in all patients before and after the injection and MRI before and after were obtained in nine patients. The only adverse event was a case of swelling of the hand lasting 2 days after a wrist injection. Two patients had a supplementary glucocorticoid injection and were excluded from efficacy analysis after 4 days and 3 weeks, respectively. VAS for pain decreased after 1 week in 23 of 25 patients (median 0.62), and after 1 month in 14 of 24 patients (median 0.60). No significant changes were seen in erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). On MRI, all nine cases tested had a reduction in synovial thickness (P=0.008) and US Doppler signals diminished after treatment (resistance index (RI) P=0.02, pixels P=0.09). In conclusion, intra-articular injection of etanercept gave no noticeable adverse events.     

Clinical effects of a 3-month formulation LH-RH agonist,TAP-144-SR (3M) in prostate cancer patients

TAP-144-SR (3M) is a 3-month sustained releasing injection of a super-active agonist of luteinizing hormone releasing hormone (LH-RH), leuprorelin acetate. At the Department of Urology of Gunma University Hospital, TAP-144-SR (3M) was injected once subcutaneously into 10 prostatic cancer patients who had had no treatment in the past to investigate safety, serum testosterone levels, drug concentrations and efficacy. In safety, no problematic adverse reactions occurred, and the drug was well tolerated. Serum testosterone levels elevated temporarily up to 2 days after injection and then were reduced rapidly. The levels were reduced below the castration level (100 ng/dl) after 3 weeks and then remained reduced up to 12 weeks. Serum TAP-144 levels including metabolite M-I, elevated to maximal plasma concentration up to 3 hours after injection and then were maintained at about 0.2 ng/ml between 1 week and 12 weeks after injection. With respect to the anti-tumor effects, the response rate according to "criteria of prostate cancer" at 12 weeks after injection was 100% (stable response cases) and the ratio of PSA normalization at 12 weeks was 90%. These results showed that an injection of TAP-144-SR (3M) was well tolerated in prostate cancer patients having no prior treatment and inhibited serum testosterone persisting for at least 12 weeks so that TAP-144-SR (3M) was concluded to be safe and clinically effective for prostate cancer patients.