玻璃酸钠治疗膝骨关节炎8年观察

Treatment of Knee Osteoarthritis with Sodium Hyaluronate: A 8 Years Observation

目的:探讨玻璃酸钠对膝骨关节炎的疗效和安全性。方法:对153例膝骨关节炎病人行玻璃酸钠关节内注射,每周1次。连续3次为1个疗程。参照Lequesne骨关节炎严重性和活动性评估法制定观察表,记录每次治疗前、后临床和实验室检查情况。治疗后头半年每月随访1次,以后每半年随访1次。结果:168个关节完成1个或1个以上疗程的治疗。其中54个关节(32％)2个疗程,36个关节(21％)3个疗程,12个关节(7％)4个疗程,4个关节(2.4％)8个疗程。治疗及随访过程中未发现明显的毒副反应。在168个关节中,治疗1个疗程结束时的有效率为92.9％;半年和1年时的有效率分别为78％和39.2％。有效率有随时间下降的趋势,但重新用药有效。关节指数、体块指数及X线分级积分较低者,疗效较好。结论:玻璃酸钠是治疗膝骨关节炎的安全、有效的药物,尤其适用于关节指数、体块指数及X线分级较低者。有效率有随着时间的延长而递减的趋势,但重复用药后仍可取得疗效。

Objective To evaluate the therapeutic efficacy and safety of sodium hyaluronate(SH) intraar-ticular injection in the treatment of knee osteoarthritis(OA). Methods 153 cases of knee OA were treated with intraarticular injection of SH weekly for three consecutive weeks (one course of treatment). Lequesne's protocol for the evaluation of OA severity and activity was used. Clinical data and laboratory parameters were recorded before and after each injection. Follow-up was carried out monthly during the first half year and then per half year. Results 168 knees received one course, 54 knees(32%) received 2 courses,36 knees(21%)3 courses, 12 knees(7%)4 courses, and 4 knees (2. 4%)received 8 courses of injections. No serious toxic or side effect was observed during the period of treatment and follow up. The efficacy rate of the first course of treatment was 92. 9%,and of the half year and 1 year,78. 2% and 39. 2% respectively. The therapeutic efficacy seemed decreasing with time. However, therapeutic response remained with re-treatment. Better response was appeared a-mong those patients with lower joint index, lower body mass index, and lower radiological grade. Conclusions Intraarticular SH injection is one of the safety and effective treatment for knee OA, especially for those with lower joint index, body mass index, and radiological grade. Although the efficacy might be decreasing with time, a fresh treatment was effective for the relapse.