玻璃酸钠治疗膝骨关节炎的临床观察

目的: 探讨玻璃酸钠治疗膝骨关节炎的疗效。方法: 回顾性分析膝骨关节炎 179例, A组应用玻璃酸钠关节内注射, B组单纯进行膝关节镜手术, C组进行膝关节镜手术, 术后关节腔内注射玻璃酸钠。观察治疗前后病人的疼痛、膝关节活动情况。治疗后头半年每月随访 1次, 以后每半年随访 1次。结果: 116例患者获得随访, 随访时间 9~37个月, 平均 13. 3个月。采用林志雄评分标准评价疗效: 术后与术前相比, 差异有显著性。C组优 36例, 良 6例, 可 1例; A组优 18例, 良15例, 可 3例, 差 2例; B组优 14例, 良 14例, 可 6例, 差 1例; C组与A组、B组相比效果显著。治疗和随访过程中未发现玻璃酸钠明显的毒副作用。结论: 玻璃酸钠注射治疗膝骨关节炎疗效确切, 膝关节镜手术后关节腔内注射玻璃酸钠是治疗膝骨关节炎的理想方法。     

风湿液联合玻璃酸钠治疗老年膝骨关节炎临床观察

目的:观察风湿液联合玻璃酸钠治疗老年膝骨关节炎的临床疗效。方法:将90例老年膝骨关节炎患者随机分为治疗组和对照组,每组45例。对照组给予玻璃酸钠膝关节腔内注射,每次20 mg,每周1次。治疗组在对照组治疗基础上加服风湿液,每次10 m L,每日3次。两组均以5周为1个疗程。观察两组治疗前后视觉模拟评分法(VAS)评分、Lequesne指数及实验室指标。结果:治疗后,两组患者VAS评分、Lequesne指数、红细胞沉降率和C-反应蛋白较治疗前均有改善(P0.05),且治疗组优于对照组(P0.05)。结论:风湿液联合玻璃酸钠治疗老年膝骨关节炎能够有效地缓解关节疼痛、改善关节功能,值得临床推广应用。     

洛索洛芬钠片联合玻璃酸钠注射液治疗膝骨性关节炎25例

目的:探讨洛索洛芬钠片联合玻璃酸钠注射液治疗膝骨关节炎的疗效.方法: 将膝骨关节炎患者50例,随机分为治疗组和对照组各25例.治疗组于膝骨关节腔内注射玻璃酸注射液25 mg,每周1次,连续5周,洛索洛芬钠片60mg,每日二次,连续服用二周;对照组于关节腔内注射玻璃酸钠25mg,每周1次,连续5周.观察两组疗效.结果:治疗后两组患者关节疼痛、关节肿胀均明显下降,关节活动度评分提高.治疗组总有效率(96.0%)明显高于对照组(84.0%)(P<0. 05).结论:玻璃酸钠注射液联合洛索洛芬钠片治疗膝骨关节炎疗效较好,不良反应少,值得临床推广.     

玻璃酸钠关节腔注射联合超激光治疗膝骨关节炎

目的：观察玻璃酸钠关节腔注射联合痛点超激光照射治疗膝骨关节炎的疗效。方法150例膝骨关节炎患者关节腔内注射玻璃酸钠,每周1次,5周为1疗程。超激光疼痛治疗仪B型探头痛点照射,每点照射时间5-10分钟,每天1次,每周6次。结果治疗5周后．88．7％的患者膝关节疼痛、肿胀及功能障碍较治疗前明显改善。结论玻璃酸钠关节腔注射联合痛点超激光照射治疗膝骨关节炎疗效确切。尤其对早中期患者效果更佳。     

中药内服外用联合玻璃酸钠治疗中重度膝骨关节炎临床观察

目的:观察中药内服外用联合玻璃酸钠治疗中重度膝骨关节炎的临床疗效。方法:将60例中重度膝骨关节炎患者随机分为对照组和治疗组,每组30例。治疗组辨证给予口服独活寄生汤加减,外敷双黄散,关节腔内注射玻璃酸钠;对照组给予口服双醋瑞因胶囊,外用吡罗昔康贴片,关节腔内注射玻璃酸钠。3周为1个疗程。观察两组患者临床疗效,治疗前后膝关节视觉模拟评分法(VAS)评分及西安大略和麦克马斯特大学骨关节炎调查表(WOMAC)评分。结果:治疗组临床治愈3例,显效8例,有效15例,无效4例,总有效率为86.67%;对照组临床治愈3例,显效7例,有效14例,无效6例,总有效率为80.00%。两组比较,差异无统计学意义(P0.05)。治疗后,两组膝关节VAS评分、WOMAC评分较治疗前均有显著改善(P0.05),且治疗组优于对照组(P0.05)。结论:中药内服外用联合玻璃酸钠治疗中重度膝骨关节炎,在改善患者临床症状、减轻关节疼痛、改善关节功能方面疗效确切,值得临床推广。     

玻璃酸钠治疗膝关节骨性关节炎疗效观察

目的：观察玻璃酸钠注射液治疗膝关节骨性关节炎（0A）的临床疗效。方法：2012年4月-2013年12月对388例504膝骨性关节炎患者关节腔内注射玻璃酸钠注射液,每周1支,5周为1个疗程,治疗期间均未用其他相关药物,嘱患者在治疗期间注意休息,减少活动。结果：388例（504膝）随访6-12个月,疗效为优328膝,良125膝,可32膝,差19膝,优良率89．88％,未见明显不良反应。结论：玻璃酸钠对轻、中度膝骨关节炎具有良好的疗效;是一种安全、有效的理想药物。     

综合治疗及护理膝骨关节炎疗效观察

目的:观察关节腔冲洗、低浓度臭氧联合玻璃酸钠关节腔注射治疗膝骨关节炎临床疗效及不良反应.方法:215例病人随机分两组,治疗组(A组):112例,每个膝关节腔冲洗后注射30μg/l的低浓度臭氧10ml,2-3次,玻璃酸钠2.5ml,共5次;对照组(B组):103人,关节腔注射曲安奈德20mg,玻璃酸钠2.5ml,共 5次.结果:治疗组:总有效率88.39%.对照组:总有效率86.41%.结论:关节腔冲洗、低浓度臭氧联合玻璃酸钠膝关节腔注射治疗膝骨关节炎疗效肯定,且不良反应发生率低.     

玻璃酸钠注射联合关节松动术治疗膝关节骨关节炎46例临床分析

目的 探讨玻璃酸钠注射联合关节松动术治疗膝关节骨关节炎46例的临床疗效.方法 对96例住院和门诊膝关节骨关节炎患者随机分为治疗组46例,采用玻璃酸钠注射联合关节松动术治疗 对照组50例患者采用药物治疗和理疗.1个疗程后观察两组治疗前和治疗后Lysholm膝量表计分.结果治疗组和对照组各组间治疗前后比较均有效（P＜0.01）.治疗组Lysholm膝量表计分治疗后评分明显改善,评分高于对照组,与对照组比较,差异具有统计学意义（t=5.971,P＜0.01）.结论 玻璃酸钠注射联合关节松动术治疗膝关节骨关节炎优于药物和物理因子治疗.     

医用臭氧对膝骨关节炎患者疼痛程度、关节功能及血清NO、SOD、MDA的影响

目的:探讨医用臭氧关节腔注射对膝骨关节炎患者疼痛程度、关节功能及血清一氧化氮(NO)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平的影响.方法:将80例膝骨关节炎患者随机分为治疗组和对照组,每组40例.治疗组采用医用臭氧关节腔内注射治疗,对照组采用玻璃酸钠关节腔内注射治疗.2组均每周治疗1次,5次为1个疗程.比较2组...     

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。     

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     

Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo

OBJECTIVE: To investigate the efficacy and tolerability of a 3-month duration, twice a-year, intermittent treatment with oral chondroitin sulfate (CS) in knee osteoarthritis (OA) patients. DESIGN: A total of 120 patients with symptomatic knee OA were randomized into two groups receiving either 800mg CS or placebo (PBO) per day for two periods of 3 months during 1 year. Primary efficacy outcome was Lequesne's algo-functional index (AFI); secondary outcome parameters included VAS, walking time, global judgment, and paracetamol consumption. Radiological progression was assessed by automatic measurement of medial femoro-tibial joint space width on weight-bearing X-rays of both knees. Clinical and biological tolerability was assessed. RESULTS: One hundred and ten of 120 patients were included in the ITT analysis. AFI decreased significantly by 36% in the CS group after 1 year as compared to 23% in the PBO group. Similar results were found for the secondary outcomes parameters. Radiological progression at month 12 showed significantly decreased joint space width in the PBO group with no change in the CS group. Tolerability was good with only minor adverse events identically observed in both groups. CONCLUSION: This study provides evidences that oral CS decreased pain and improved knee function. The 3-month intermittent administration of 800mg/day of oral CS twice a year does support the prolonged effect known with symptom-modifying agents for OA. The inhibitory effect of CS on the radiological progression of the medial femoro-tibial joint space narrowing could suggest further evidence of its structure-modifying properties in knee OA.     

Factors affecting the prevalence of osteoarthritis in healthy middle-aged women: data from the longitudinal Melbourne Women's Midlife Health Project

The prevalence of osteoarthritis (OA) is greater in women then men. Weight, a factor strongly associated with osteoarthritis, is significantly increased over the menopausal transition. Despite the high prevalence of osteoarthritis, a disabling disease with limited treatment options, there is a paucity of studies in women. The longitudinal phase of the Melbourne Women's Midlife Health Project, is a population-based prospective study of 438 Australian born women who have been followed annually over 11 years. 257 (59%) of these women remained in longitudinal assessment at 11th year of follow-up and 224 of these women agreed to undergo X-rays of their knees and hands. In this study, X-rays were scored for evidence of osteoarthritis using a validated scale, by two investigators who were blinded to questionnaire results. Information on hormone therapy use, physical activity, smoking, BMI and age were obtained by both self-administered and face-to-face questionnaires. Results showed that one hundred and twenty-eight women (56%) had evidence of radiological OA. Forty-nine (21.6%) had evidence of radiological knee OA. One hundred and one (44.5%) had evidence of radiological hand OA. Compared to baseline, at 11th year of follow-up participants had put on weight (4 kg range -14 to 25 kg) and a larger proportion (25% vs. 40%) reported exercising frequently (P = 0.005). Physical activity and BMI were associated with higher prevalence of osteoarthritis in the final year of follow-up. Smoking was associated with a lower prevalence of radiological knee OA. The prevalence was 61% among never smokers compared to only 39% among those who smoked (P < 0.05). Total OA was associated with never having used hormone therapy (odds ratio 2.7; CI 1.1-6.9). There was a trend for increasing level of physical activity at ages 20-29 to be associated with an increased risk of knee OA (P value 0.03 for trend). In conclusion increasing age, BMI and history of more frequent physical activity in younger years were risk factors for radiological knee OA. In contrast, smoking appeared to be associated with less knee OA. Never having used hormone therapy was a risk factor for radiological hand and knee OA. Further work will be needed to determine whether modification of these factors can prevent the development of OA.     

A 5-year randomized controlled, double-blind study of glycosaminoglycan polysulphuric acid complex (Rumalon) as a structure modifying therapy in osteoarthritis of the hip and knee

OBJECTIVE: To determine the structure (disease) modifying effect of a glycosaminoglycan polypeptide association complex (GP-C; Rumalon) in patients with knee and hip osteoarthritis (OA). METHODS: Double-blind, randomized, placebo-controlled five-year study. Primary assessment criterion was change in radiographic joint space width between baseline and follow-up at 5 years. Secondary outcome criteria included Lequesne algofunctional index (LAI), pain on passive motion and consumption of non-steroidal antiinflammatory drugs (NSAIDs). The patients received 10 courses of injections of placebo or GP-C 2 ml intramuscularly in 5 years (two courses each year). Each course included 15 injections administered twice weekly. RESULTS: There were 277 patients with knee OA and 117 patients with hip OA. Control and GP-C treated groups were comparable as to sex, age, duration of disease, body weight, X-ray stage and value of LAI at the baseline. Knee joint space at 5 years decreased 0.37+/-0.08 (mean+/-standard deviation) mm for GP-C and 0.42+/-0.08 mm for placebo groups (P=0.68). Hip joint space at 5 years decreased 0.21+/-0.08 mm for GP-C and 0.22+/-0.08 mm for placebo groups (P=0.53). In a subset of patients with hip OA, Kellgren-Lawrence> or =2 and JSW> or =1 mm, there was a trend in favor of GPC for lower joint space narrowing in 5 years (P=0.11). In addition, there were no statistical differences between the treatment groups in LAI, pain on passive motion and consumption of NSAIDs. Side-effects after GP-C (14.5%) were rare, mild and not more frequent than in the placebo group (15%). CONCLUSION: We were not able to demonstrate a structure modifying effect of GP-C in OA of the hip or knee. Radiographic progression of OA in both knee and hip OA was lower than expected in both study groups.     

Long-term effect of sodium hyaluronate (Hyalgan) on osteoarthritis progression in a rabbit model

BACKGROUND: Intra-articular (IA) hyaluronan (HA) injections are approved for the treatment of knee osteoarthritis (OA) pain. One of the currently available products is approved for repeat treatment courses. While HA is classed as a symptom-modifying agent, there is substantial evidence that this therapeutic modality also possesses disease-modifying activity. OBJECTIVE: A rabbit model of OA, anterior cruciate ligament transection (ACLT), was used to investigate the long-term effects of single and sequential courses of HA therapy on OA progression. DESIGN: One or two courses of five weekly IA injections of sodium hyaluronate (Hyalgan) average molecular weight, MW, of 500-730 kDa, or vehicle were administered to rabbits (N=10 per group), initiated 4 and 13 weeks (for groups that received a second course) after ACLT. Gross morphological and histomorphometric evaluations were performed on harvested knee joints following sacrifice at 26 weeks after surgery. RESULTS: All the rabbits exhibited the characteristic pathologic changes of OA. Rabbits that received one or two courses of HA injections showed less disease progression than rabbits treated with ACLT alone or with 10 vehicle injections. However, rabbits that received five vehicle injections also showed improved morphology compared with those given no injections. Rabbits that received 10 HA injections showed significantly less surface roughness of the femoral cartilage compared with rabbits treated with ACLT, 5 HA injections, or 10 vehicle injections, and showed significantly less surface roughness of the tibial plateau compared with all other treatment groups (P<0.05). CONCLUSIONS: Repeat courses of HA injections reduced the degree of articular degeneration in a rabbit ACLT model of OA. Sequential courses of HA therapy may be advantageous in the long-term management of OA.     

Risk factors for the incidence and progression of radiographic osteoarthritis of the knee among Japanese

This longitudinal study aimed to identify risk factors for the incidence and progression of radiographic knee osteoarthritis (OA). We examined the inhabitants of Miyagawa village aged ≥65 years every two years between 1997 and 2007. Anteroposterior radiographs of both knees were graded for OA using the Kellgren-Lawrence (K/L) grading system. Knee OA was defined as grade ≥2. We recorded the incidence of knee OA among participants in whom both knees changed from K/L grades 0 or 1 to ≥2 over a four-year follow-up period. We also recorded the progression of knee OA using this threshold among patients in whom one or both knees changed from K/L grades 2 or 3 to any higher grade over the follow-up period. Baseline data obtained from standard questionnaires, physical findings and X-rays included age, gender, body mass index (BMI), osteoporosis, Heberden’s nodes, knee range of motion (ROM), knee pain and cigarette smoking. The rates of incidence and progression of knee OA among 360 participants (241 women, 119 men) who fulfilled the study criteria were 4.0 and 6.0% per year, respectively. Female gender (odds ratio [OR] 2.849, 95% confidence interval [CI] 1.170–6.944) and high BMI (OR 1.243, 95% CI 1.095–1.411) were significantly associated with the incidence of knee OA, and restricted knee ROM (OR 0.941, 95% CI 0.892–0.992) was significantly associated with knee OA progression. Patients with a low knee ROM relative to grade of radiographic knee OA require more careful follow-up than those with a higher ROM.     

透明质酸钠治疗退行性膝骨关节炎的临床观察

目的　观察透明质酸钠注射液对退行性膝骨关节炎 (DOA)的治疗作用。方法　 10 0例 116膝DOA患者关节腔内注入透明质酸钠注射液 2 ml和 1%利多卡因注射液 0 .5 m l,每周给药 1次 ,共 3次。观察治疗前、后关节疼痛、肿胀及积液等症状的缓解 ,以及关节活动度、步行能力、上下楼梯、下蹲和跑步等关节功能的改善情况。结果　 96例 10 8膝获得 1～ 6个月随访 ,显效 39例 (占 40 .6 % ) ;有效 32例 (占 33.3% ) ,进步 16例 (占16 .7% ) ,无效 9例 (占 9.4% )。总有效率为 74.0 %。未见明显毒副作用。结论　透明质酸钠注射液关节腔内注射治疗膝 DOA,具有缓解临床症状、改善关节功能的作用     

Hyaluronate improves pain, physical function and balance in the geriatric osteoarthritic knee: a 6-month follow-up study using clinical tests

OBJECTIVE: To investigate the effects of intraarticular hyaluronic acid (HA) (Artzal, Seikagaku Corp., Japan) in geriatric participants with unilateral knee osteoarthritis (OA). METHOD: This was a prospective, observer-blind study with 6 months follow-up done in the setting of an outpatient rehabilitation department in a university-affiliated tertiary care medical center. Sixty-eight patients, aged 65 years or above, with symptoms and radiographic evidence of unilateral knee OA for at least 6 months were recruited. Patients received five weekly intraarticular injections of Artzal into symptomatic knees. Fifty-six participants completed the study. Fifty age-, body mass- and gender-matched healthy individuals were selected as control. Visual analog scale (VAS), Lequesne index and four balance tests including single-leg stance test (SLS), function reach test (FRT), timed "Up-and-Go" test (TUG) and Berg balance scale (BBS) were assessed before injection and at each follow-up visit in the OA group. Four balance tests were obtained on healthy participants for data comparison. RESULTS: Before Artzal injections, the OA group showed significantly worse VAS, Lequesne index and four balance tests scores than did the control group (P < 0.001). Significant improvement in all outcome measures were noted at 1 week, 1, 3 and 6 months post the fifth injection compared with baseline before injection. Local adverse events were reported in four patients (7.1%). CONCLUSION: Significant improvement in pain, physical function and balance tests was demonstrated after five weekly Artzal injections in geriatric patients with knee OA. The effect had rapid onset at 1 week and may last for 6 months.     

Impact of patellofemoral osteoarthritis on long-term outcome of high tibial osteotomy and effects of ventralization of tibial tubercle

BACKGROUND: Medial compartment osteoarthritis (OA) of the knee frequently accompanies patellofemoral osteoarthritis (PF-OA). No consensus has been reached whether it is better to include treatment for the PF joint at the time of high tibial osteotomy (HTO), or if treatment of the PF joint is unnecessary. The purpose of this comparative retrospective study on medial compartment OA of the knee accompanying PF-OA was to examine the effects of PF-OA on the long-term outcome of HTO and to evaluate the significance of ventralization of the tibial tubercle when combined with HTO. METHODS: We studied the impact of PF-OA on the long-term outcome of HTO and the effects of ventralization of the tibial tubercle, which was performed in conjunction with HTO for medial and PF compartment OA more than 10 years previously. The 42 subjects included 14 men (15 knees) and 26 women (27 knees). Their mean age at the time of surgery was 60.7 years, and the follow-up period was 10-15 years (average 12 years). Ventralization of the tibial tubercle was performed on 18 knees. RESULTS: A significant relation was observed between improvement of the clinical knee score and preoperative radiological PF-OA stage in the HTO patients (P < 0.05). Radiologically, no correlation was observed between the shift in radiological PF-OA stage and the presence or absence of ventralization of the tibial tubercle. Among the preoperative radiological moderate and severe PF-OA cases, no significant relation was found between the presence or absence of ventralization of the tibial tubercle performed with HTO and improvement of the knee joint function score. CONCLUSION: In cases of severe PF-OA in which HTO was performed, ventralization of the tibial tubercle as combined surgery did not prove effective at the long-term follow-up.