透明质酸钠预防关节粘连及强直的实验研究

背景：透明质酸钠（sodium hyaluronate,SH）是目前治疗骨关节炎的常用药物之一,在缓解关节疼痛,保护软骨方面有积极作用,同时研究还发现应用SH4～5周可以缓解关节腔内粘连,起到预防关节强直的作用。临床石膏等外固定常需8周甚至更长时间,延长使用至8周是否可以减轻关节粘连和强直,增加关节活动度尚未见文献报道。目的：比较家兔膝关节腔内注射SH4周和8周的关节粘连及强直情况。方法：新西兰大白兔36只,随机分成3组：A组为8周用药实验组（12只）,右膝关节腔内注射SH（阿尔治,昆明贝克诺顿制药有限公司提供）0.3ml,每周1次,共8周;B组为4周用药实验组（12只）,用药及用量同A组,前4周用药,后4周未用药;C组为对照组,右膝关节腔内注射等量生理盐水0.3ml,每周1次;共8周。3组术后均石膏外固定8周,8周后观察膝关节粘连程度、关节活动以及关节滑膜的胶原含量。结果：膝关节活动度,A组平均为70.28°±11.04°,B组平均61.34o±9.89o;C组平均为54.58°±11.23°,A、B两组和B、C组比较均有显著性差异（P〈0.05）。骨关节囊粘连视觉评分,A组平均为（2.17±0.94）分,B组平均为（2.54±0.77）分;C组平均为（3.08±0.67）分,A、B两组和B、C组比较有显著性差异（P〈0.05）。膝关节滑膜中平均胶原含量,A组平均为（39.04±4.18）μg/mg,B组（34.01±3.55）μg/mg;C组平均为（32.37±4.66）μg/mg,A、B两组和B、C组比较有显著性差异（P〈0.05）。结论：兔膝关节石膏外固定后,关节腔内应用SH治疗4周和8周均可减轻兔膝关节粘连及强直,增加关节活动度。且8周效果明显优于4周。

Experimental study on hyaluronate sodium intra-articular injection in prevention of joint adhesion and stiffness

Background： Sodium hyaluronate （SH） is one of the most popular medicine used for protecting chondrocyte and relieving the pain of osteoarthfitis. Simultaneously, it is found that SH could alleviate joint adhesion and prevent joint stiffiaess after administration for 4-5 weeks. External fixation normally delay to 8 weeks in clinical practice and the joint were inclined to stiffness. Could SH do some positive effect in external fixation joint if delaying the administration of SH to 8 weeks？ We try to find out an alternative method to alleviate joint adhesion and stiffness in the basical research. Objective： The purpose of the study is to compare the joint adhesion and stiffness after SH intra-articular injection in rabbit knee for 4 weeks versus 8 weeks. Methods： Totally 36 New Zealand rabbits were randomly divided into three groups （n=12） animals each （group A, treated; group B and group C, control）, 0.3mL SH were injected in the right articular cavity of rabbits in group A and group B, and an identical volume of normal saline was applied in group C. The right knees external immobilization were used in all ani- mals for 8 weeks. The rabbits in groups A and C received weekly （8 weeks） intra-articular SH or saline at the right knee, but group B received weekly intra-articular SH only for the first 4 weeks. Joint adhesions, range of motion and collagen content in synovium were evaluated 8 weeks later. Results： The average range of motion in groups A, B and C were 70.28°±11.04°, 61.340°±9.89° and 54.58°± 11.23°, respectively. There were significant differences between group A and B, between group B and C （P〈0.05）. VAS scoring for intracapsular adhesion were 2.17±0.94, 2.54±0.77 and 3.08±0.67 in groups A, B and C, respectively. There were significant differences between group A and B, between group B and C （P〈0.05）. The mean collagen content in group A （39.04±4.18μg/mg） was significantly higher than that in group B （34.01±3.55 μg/mg） and group C （32.37±4.66 μg/mg） （P〈0.05）. Conclusions： Hyaluronic acid may be considered a promising biochemical agent to control the knee adhesion and stiffness after 8 weeks of external fixation. The application of hyaluronic acid for 8 weeks is superior to 4-week use.