Effect of sodium hyaluronate combined with rehabilitation training on knee joint injury caused by golf

BACKGROUND In high-intensity sports like golf,knee joints are prone to injury,leading to pain,limited mobility,and decreased quality of life.Traditional treatment methods typically involve rehabilitation exercises,but their effectiveness may be limited.In recent years,sodium hyaluronate has emerged as a widely used biomedical material in the treatment of joint diseases.AIM To explore the effect of sodium hyaluronate combined with rehabilitation training on pain degree,flexion range of motion and motor function of knee joint injured by golf.METHODS Eighty patients with knee joint injury caused by golf were randomly divided into control(group B)and observation group(group A).The group B was treated with rehabilitation training,and the group A was treated with sodium hyaluronate combined with rehabilitation training.The clinical efficacy,range of motion and function of knee joint,quality of life and inflammatory factors were compared.RESULTS The excellent and good rate of rehabilitation in the group A was raised than group B.At 6 weeks and 3 months after treatment,the range of motion of the two groups was raised than that before treatment,and that of the group A was raised than group B.After treatment,the scores of Lysholm and International Knee Documentation Committee(IKDC)in the group A were raised,and those in the group A were raised than group B.The VAS score of the two groups was reduced than that of the group B,and the SF-36 score of the group A was reduced than group B.The interleukin(IL)-1β,IL-8 and tumor necrosis factor-αin the two groups were reduced,and those in the group A were reduced than group B.CONCLUSION Sodium hyaluronate combined with rehabilitation training has a good clinical effect in the treatment of patients with knee joint injury caused by golf,which relieve pain,maintain knee joint function and improve patients'life quality.

Clinical effect of Rehabmtation Treating combined with Intra-Articular Injection of Sodium Hyaluronate for Exercise induced knee osteoarthritis

Objective: To study the clinical effect of rehabmtation treating combined with intra-articular injection of sodium hyaluronate for exercise induced knee osteoarthritis, and to research the function, biomechanics of knee joint, and inflammatory factor in articular cavity. Method:Selecting 120 patients with exercise induced knee osteoarthritis, then they were randomly divided into control group (n=60) and intervene group (n=60). The patients in the control group were given conventional rehabmtation treating, and the intervene group were given intra-articular injection of sodium hyaluronate on this basic, they were treated 4 weeks. Evaluating the function of knee joint;conduct isokinetic muscle strength test (determination of the angIllar velocity were 60°/S, 180°/S);test the ratio of muscle peak torque and four muscles centripetal centripetal peak torque and peak torque, work load of femoral knee joints after (simultaneous determination of the angular velocity were 60°/S);detect the inflammatory factor in the joint fluid. Results: After the treatment, clinical effect in intervene group was superior to that in control group,but had no statistical significance;after the treatment, the score of function of knee joint in the two groups were higher than before treatment, and had statistical significance, and the score of function of knee joint in the intervene group were higher than control group, and the difference had statistical significance;Angular velocity of 60°/S and 180°/S the two groups peak torque, work load and the H/Q values were significantly increased, the intervene group were higher than control group, and the difference had statistical significance;inflammatory factor in the two groups were significantly decreased, the intervene group were lower than control group, and the difference had statistical significance.Conclusions: On the basic of rehabmtation treating, the treatment of intra-articular injection of sodium hyaluronate can improve the function of knee joint through improving the knee muscle strength, the level of their participation in the activities of the biomechanics of knee joint, and the inflammatory factor in the joint fluid.

Effect of arthroscopic debridement combined with intra-articular sodium hyaluronate injection on the Wnt/β-catenin pathway in joint fluid of patients with knee osteoarthritis

Objective: To investigate the effect of arthroscopic debridement combined with intra-articular sodium hyaluronate injection on the Wnt/β-catenin pathway in joint fluid of patients with knee osteoarthritis. Methods: Patients undergoing arthroscopic debridement for knee osteoarthritis in the hospital between June 2014 and April 2017 were selected as the research subjects and randomly divided into the observation group who accepted arthroscopic debridement combined with intra-articular sodium hyaluronate injection and the control group who accepted arthroscopic debridement alone. The Wnt/β-catenin pathway molecules as well as downstream collagen metabolism molecules and bone metabolism molecules in the joint fluid were measured before surgery and 7 d after surgery. Results: 7 d after surgery, Wnt1, Wnt5a, Wnt7b, β-catenin, MMP1, MMP13, CTX-I, CTX-II, ADAMTS4, ADAMTS5, RANK, RANKL and TRACP5b mRNA expression in joint fluid of both groups of patients were higher than those before surgery whereas OPG and OC contents were lower than those before surgery, and Wnt1, Wnt5a, Wnt7b, β-catenin, MMP1, MMP13, CTX-I, CTX-II, ADAMTS4, ADAMTS5, RANK, RANKL and TRACP5b mRNA expression in joint fluid of observation group were significantly lower than those of control group whereas OPG and OC contents were significantly higher than those of control group. Conclusion: Arthroscopic debridement combined with intra-articular sodium hyaluronate injection can inhibit the collagen metabolism and bone metabolism disorder mediated by Wnt/β-catenin after surgery.

Meta-analysis of the traditional Chinese medicine fumigation combined with sodium hyaluronate in the treatment of knee osteoarthritis

Objective:To explore the meta-analysis of traditional Chinese medicine fumigation combined with sodium hyaluronate in the treatment of knee osteoarthritis.Methods: The database was originated from CNKI, Wanfang, Chongqing Weipu database, PubMed and so on. The deadline was April 2017. The database was searched with the keywords of'Chinese herbal fumigation','sodium hyaluronate' and'knee osteoarthritis'. Finally, 13 articles about the treatment of Chinese herbal fumigation combined with sodium hyaluronate were obtained. RCT literatures of knee osteoarthritis identified the outcome indicators as the effective rate and recovery rate. Lysholm's score was observed after treatment in both groups, and all the results were input into Review Manager 5.2 for analysis.Result: A total of 13 RCT literatures about the treatment of knee osteoarthritis with Chinese herbal fumigation and sodium hyaluronate were obtained. The control group was treated with sodium hyaluronate or anti-inflammatory drugs, totaling 619 cases. The study group was treated with sodium hyaluronate and Chinese herbal fumigation, totaling 649 cases. The combined effect of forest map OR=1.82, Z=5.00 (P<0.00001), 95% CI. (1.44, 2.30). Compared with sodium hyaluronate or anti-inflammatory drugs, fumigation with traditional Chinese medicine combined with sodium hyaluronate has obvious advantages in curing knee osteoarthritis. The combined effect of forest chart OR=5.55, Z=7.44 (P<0.00001), 95% CI (3.54, 8.73), indicating that compared with sodium hyaluronate or anti-inflammatory drugs, traditional Chinese medicine is used. Fumigation combined with sodium hyaluronate has obvious advantages in the treatment of knee osteoarthritis;forest map combined effect OR=12.11, Z=5.18 (P<0.00001), 95% CI (7.53, 16.68), indicating that compared with sodium hyaluronate or anti-inflammatory drugs, traditional Chinese medicine fumigation combined with sodium hyaluronate in the treatment of knee osteoarthritis can restore knee joint function. Advantages.Conclusion: Chinese herbal fumigation combined with sodium hyaluronate has obvious advantages in curing and effective rate of knee osteoarthritis, and can better restore knee joint function. Due to the lack of literature and low quality, the exact effect still needs to be confirmed by higher quality RCT literature.

Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis:a systematic review and Meta-analysis

OBJECTIVE:To assess the efficacy and safety of extracorporeal shockwave therapy(ESWT)combined with sodium hyaluronate(HA)for the treatment of knee osteoarthritis(KOA).METHODS:PubM ed,Embase,the Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang database,China Science and Technology Journal Database,and SinoMed were searched from inception to July 2020.The quality of the randomized controlled trials was evaluated independently by two reviewers according to the criteria in the Cochrane Collaboration for Systematic Reviews.The identified articles were then screened individually using EndnoteX9 for eligibility in this Meta-analysis.The heterogeneity among the articles was evaluated using I2.RESULTS:A total of 17 studies,comprising 2000 individuals,were included in this Meta-analysis.The results showed that a significant improvement was observed in knee pain and function based on the clinical efficacy of ESWT combined with HA.Statistical analysis of clinical efficacy showed that[relative risk(RR)=1.21,95%confidence interval(CI)(1.12,1.30),P<0.01].Statistical analysis of visual analog scale showed that[standardized mean difference(SMD)=-2.84,95%CI(-4.01,-1.66),P<0.01].Western Ontario and McMaster University osteoarthritis index statistical analysis showed that[SMD=-1.57,95%CI(-2.52,-0.61),P<0.01].Lysholm score statistical analysis showed that[SMD=1.71,95%CI(0.98,2.44),P<0.01].In addition,only minor side effects,such as redness and swelling of the skin,were observed.CONCLUSIONS:Medium to low quality evidence showed that ESWT combined with HA offers an inexpensive,welltolerated,safe,and effective method to improve pain and functionality in patients with KOA.However,tightly controlled,randomized,large multicenter trials are warranted to validate the current findings.

Intraarticular injections(corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis

Osteoarthritis(OA)is a complex"whole joint"disease pursued by inflammatory mediators,rather than purely a process of"wear and tear".Besides cartilage degradation,synovitis,subchondral bone remodeling,degeneration of ligaments and menisci,and hypertrophy of the joint capsule take parts in the pathogenesis.Pain is the hallmark symptom of OA,but the extent to which structural pathology in OA contributes to the pain experience is still not well known.For the knee OA,intraarticular(IA)injection(corticosteroids,viscosupplements,blood-derived products)is preferred as the last nonoperative modality,if the other conservative treatment modalities are ineffective.IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA.IA hyaluronic acid(HA)injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk.But for HA injections,the costeffectiveness is an important concern that patients must be informed about the efficacy of these preparations.Although more high-quality evidence is needed,recent studies indicate that IA platelet rich plasma injections are promising for relieving pain,improving knee function and quality of life,especially in younger patients,and in mild OA cases.The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction.But,there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.

Single-and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: A randomized controlled trial

BACKGROUND Platelet-rich plasma(PRP)and hyaluronic acid have been shown to be useful in the treatment of knee osteoarthritis.However,investigations comparing the efficacy of these two drugs together are insufficient.AIM To compare the outcomes of PRP vs hyaluronic acid injections in three groups of patients with bilateral knee osteoarthritis.METHODS This randomized controlled trial study involved 95 patients.Thirty-one subjects received a single injection of PRP(group PRP-1),33 subjects received two injections of PRP at an interval of 3 wk(group PRP-2)and 31 subjects received three injections of hyaluronic acid at 1-wk intervals(group hyaluronic acid).The patients were investigated prospectively at the enrollment and at 4-,8-and 12-wk follow-up with the Western Ontario and McMaster Universities Arthritis Index(WOMAC)and Visual Analogue Scale questionnaires.RESULTS Percentages of patients experiencing at least a 30%decrease in the total score for the WOMAC pain subscale from baseline to wk 12 of the intervention were 86%,100%and 0%in the groups PRP-1,PRP-2 and hyaluronic acid,respectively(P<0.001).The mean total WOMAC scores for groups PRP-1,PRP-2 and hyaluronic acid at baseline were 63.71,61.57 and 63.11,respectively.The WOMAC scores were significantly improved at final follow-up to 42.5,35.32 and 57.26,respectively.The highest efficacy of PRP was observed in both groups at wk 4 with about 50%decrease in the symptoms compared with about 25%decrease for hyaluronic acid.Group PRP-2 had higher efficacy than group PRP-1.No major adverse effects were found during the study.CONCLUSION PRP is a safe and efficient therapeutic option for treatment of knee osteoarthritis.It was demonstrated to be significantly better than hyaluronic acid.We also found that the efficacy of PRP increases after multiple injections.

Clinical effect of sodium hyaluronate joint cavity filling combined with exercise therapy on patients with post-traumatic knee arthritis

Objective:To research the sodium hyaluronate joint cavity filling combined with exercise therapy on the indicator of pain,motor function,and levels of inflammatory factors in joint fluid in patients with post-traumatic knee arthritis.Method Totally 100 patients(Department of Orthopaedics,The second Affiliated Hospital to Liaoning University of Chinese Medicine,2013.10-2018.8)with post-traumatic knee arthritis were selected,then they were divided into observation group(n=50)and control group(n=50).The control group was given glucosamine sulfate and sodium hyaluronate joint cavity filling,the observation group was given leg press with visual feedback,they were treated 4 weeks.Assessing the pain degree through visual analog scale(VAS),hospital for special surgery knee score(HSS)as the indicator of motor function,inflammatory factor(TNF-α,IL-6,and IL-8)in the joint fluid.Results The score of VAS were lower than pretherapy(P<0.05),the degree of VAS of observation group were lower than control group(P<0.05).The score of HSS were higher than pretherapy(P<0.05),the degree of VAS of observation group were higher than control group(P<0.05).The inflammatory factor(TNF-α,IL-6,and CRP)in the joint fluid were lower than pretherapy(P<0.05),and the observation group were lower than control group(P<0.05).Conclusions Giving sodium hyaluronate joint cavity filling combined with exercise therapy can improve the function of joint.

State-of-the-Art management of knee osteoarthritis

Osteoarthritis(OA) is the most common type of arthritis found in the United States' population and is also the most common disease of joints in adults throughout the world with the knee being the most frequently affected of all joints. As the United States' population ages along with the increasing trends in obesity prevalence in other parts of the world, it is expected that the burden of OA on the population, healthcare system, and overall economy will continue to increase in the future without making major improvements in managing knee OA. Numerous therapies aim to reduce symptoms of knee OA and continued research has helped to further understand the complex pathophysiology of its disease mechanism attempting to uncover new potential targets for the treatment of OA. This review article seeks to evaluate the current practices for managing knee OA and discusses emerging therapies on the horizon. These practices include non-pharmacological treatments such as providing patient education and self-management strategies, advising weight loss, strengthening programs, and addressing biomechanical issues with bracing or foot orthoses. Oral analgesics and anti-inflammatories are pharmacologicals that are commonly used and the literature overall supports that some of these medications can be helpful for managing knee OA in the short-term but are less effective for long-term management. Additionally, more prolonged use significantly increases the risk of serious associated side effects that are not too uncommon. Diseasemodifying osteoarthritis drugs are being researched as a treatment modality to potentially halt or slow disease progression but data at this time is limited and continued studies are being conducted to further investigate their effectiveness. Intra-articular injectables are also implemented to manage knee OA ranging from corticosteroids to hyaluronans to more recently plateletrich plasma and even stem cells while several other injection therapies are presently being studied. The goal of developing new treatment strategies for knee OA is to prolong the need for total knee arthroplasty which should be utilized only if other strategies have failed. High tibial osteotomy and unicompartmental knee arthroplasty are potential alternatives if only a single compartment is involved with more data supporting unicompartmental knee arthroplasty as a good treatment option in this scenario. Arthroscopy has been commonly used for many years to treat knee OA to address degenerative articular cartilage and menisci, however, several high-quality studies have shown that it is not a very effective treatment for the majority of cases and should generally not be considered when managing knee OA. Improving the management of knee OA requires a multi-faceted treatment approach along with continuing to broaden our understanding of this complex disease so that therapeutic advancements can continue to be developed with the goal of preventing further disease progression and even potentially reversing the degenerative process.

Acupotomy versus sodium hyaluronate for treatment of knee osteoarthritis in rabbits

OBJECTIVE: To investigate the possible advantages of acupotomy over sodium hyaluronate injection for the treatment of knee osteoarthritis(KOA).METHODS: Twenty rabbits were divided randomly into four groups(n = 5 in each): a control group,model group, acupotomy group, and sodium hyaluronate injection group. The model, acupotomy,and sodium hyaluronate groups underwent anterior cruciate ligament transection plus partial medial meniscectomy. Sodium hyaluronate injection and acupotomy were administered to the respective groups from weeks 5 to 8, and samples of the tibial plateau and medial condyle of the femur were collected in week 9. Vascular endothelial growth factor(VEGF) expression was assessed in cartilage and subchondral bone by immunohistochemical staining.RESULTS: Articular cartilage degeneration was less pronounced in the acupotomy compared with the model and sodium hyaluronate groups. VEGF expression levels in cartilage and subchondral bone were increased in the model group compared with the control group(P < 0.01), and acupotomy had a more pronounced therapeutic effect than sodium hyaluronate injection(P < 0.01).CONCLUSION: Acupotomy and sodium hyaluronate injection may both reduce degeneration in the cartilage and subchondral bone in KOA based on the results from a rabbit model, but acupotomy improved the histopathology and reduced the VEGF content more effectively than sodium hyaluronate injection, probably by reducing venous stasis and intraosseous pressure. Acupotomy may improve KOA by lowering VEGF.

In vitro effects of sodium hyaluronate on the proliferation and the apoptosis in chondrocytes from patients with Kashin-Beck disease and osteoarthritis

Objective：To identify the in vitro effects of sodium hyaluronate（HA） on the proliferation and the apoptosis of chondrocytes from patients with Kashin-Beck disease（KBD） and osteoarthritis（OA）. Methods：Samples of articular cartilages from KBD and OA patients, as well as healthy volunteers（6 subjects in each of the 3 groups） were dissected, digested with collagenase and the cells cultured in monolayers. Chondrocytes from each sample were assigned to an untreated group and two HA-treated groups： H0（no HA）, H100（HA, 0.1 g/L） and H500（HA, 0.5 g/L）. The first passage chondrocytes were used to observe proliferation using the MTT assay, and apoptosis by flow cytometry through Annexin V/PI staining. Results：HA promoted proliferation of chondrocytes in all the three groups, and.in KBD and OA groups, for cells cultured for 4 and 6 days, H500 significantly promoted the cell proliferation. The apoptotic rates of both KBD and OA group chondrocytes were in the order H500 〈 HA100 〈 H0. Conclusion：Sodium hyaluronate administration has a dosedependent in vitro effect to promote proliferation and inhibit apoptosis of chondrocytes from patients with KBD and OA.

Effect and safety of acupotomy in treatment of knee osteoarthritis:a systematic review and Meta-analysis

OBJECTIVE: To evaluate the clinical efficacy and safety of acupotomy in treatment of knee osteoarthritis(OA).METHODS: Extensive literature searches were carried out in PubMed, EMBASE, Cochrane Library(Issue 5, 2017), Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database and Wanfang Database. All databases were retrieved from their inception until May 31, 2017.Randomized controlled trials incorporating acupotomy versus intra-articular sodium hyaluronate for knee osteoarthritis were included. According to Cochrane Reviews’ Handbook(5.2), two reviewers screened each article and extracted data independently and were blinded to the findings of each reviewer. Meta-analysis was performed by the Cochrane Collaboration’s RevMan 5.3 software.RESULTS: We identified 12 studies involving 1150 patients aged between 40 and 78 years old. The pooled analysis indicated that acupotomy showed a significant improvement for short-term effect[cure rate: odds ratio(OR) = 2.04, 95% confidence interval(CI)(1.46, 2.85), P < 0.01;total effective rate:OR = 2.25, 95% CI(1.55, 3.28), P < 0.01;pain score:standard mean difference(SMD) =-1.02;95% CI(-1.72,-0.31);P = 0.005;Western Ontario and McMaster Universities Questionnaire(WOMAC) score:SMD =-0.74;95% CI(-1.11,-0.37);P < 0.01];and also for long-term effect [total effective rate:OR = 2.99, 95%CI(1.88, 4.76), Z = 4.64, P < 0.01;pain score: SMD =-1.68;95% CI(-2.14,-1.22);P <0.001;WOMAC score: SMD =-0.91;95% CI(-1.40,-0.41);P < 0.001]. In addition, there was no obvious difference between acupotomy group and control group in adverse events [OR = 2.13, 95% CI(0.14, 32.28), P = 0.58].CONCLUSION: Acupotomy is a safe and effective treatment for KOA. However, due to the methodological deficiency of the included studies, well-designed randomized controlled trials are required to further confirm the findings.

Effect of holistic stratification acupotomy on lower limb function,MMP1 and MMP13 in bursal fluid of patients with knee osteoarthritis:A randomized clinical trail

Objective:To observe the differences in clinical effect on knee osteoarthritis(KOA)between the holistic stratification acupotomy and the joint injection with sodium hyaluronate so as to provide a safe and effective treatment for KOA.Methods:A total of 100 KOA patients were randomly divided into an acupotomy group and a sodium hyaluronate group,50 patients in each one.In the acupotomy group,the holistic stratification acupotomy was adopted.In the sodium hyaluronate group,sodium hyaluronate injection was applied in the joints.The index of Western Ontario and McMaster University(WOMAC)and the expressions of MMP1 and MMP13 in bursal fluid of the patients were compared before and after treatment in the patients between two groups before and after treatment,and the clinical therapeutic effect was observed.Results:After treatment,WOMAC score of each dimension and the concentrations of MMP1 and MMP13 in bursal fluid of the patients of either group were all lower than those before treatment(all P<0.05).After treatment,WOMAC score of each dimension and the concentrations of MMP1 and MMP13 in bursal fluid in the acupotomy group were lower than the sodium hyaluronate group(all P<0.05).The total effective rate in the acupotomy group was higher than that of the sodium hyaluronate group(P<0.05).Conclusion:Both the holistic stratification acupotomy and the joint injection with sodium hyaluronate are effective on KOA in this trial.However,the therapeutic effect of holistic stratification acupotomy is remarkable,which is probably related to the improvements in inflammatory response.

人工虎骨粉与玻璃酸钠联合治疗肝肾亏虚型膝骨关节炎的效果分析

目的观察人工虎骨粉与玻璃酸钠联合治疗肝肾亏虚型膝骨关节炎的临床疗效。方法按随机数字表法将120例肝肾亏虚型膝骨关节炎患者分为对照组和治疗组,每组60例。对照组患者每周进行一次玻璃酸钠关节腔内注射治疗,治疗组患者在对照组基础上给予人工虎骨粉口服治疗。持续治疗5周后,比较两组治疗前后Lequesne评分、WOMAC评分、膝关节Lysholm评分、膝骨性关节炎症状分级量化表、中医证候评分,采用ELISA法检测两组治疗前后关节液中MMP-3、TIMP-1、IL-1β及TGF-β1水平。结果治疗组总有效率为86.67%,总满意度91.67%,高于对照组(P<0.05)。治疗后,两组Lequesne评分、WOMAC评分、膝骨性关节炎症状分级量化表评分、中医证候评分及MMP-3、IL-1β表达水平显著降低(P<0.05),且治疗组降低程度低于对照组(P<0.05);治疗后,两组膝关节Lysholm评分,关节液TIMP-1、TGF-β1水平较治疗前升高(P<0.05),且治疗组升高水平明显高于对照组(P<0.05)。结论人工虎骨粉与玻璃酸钠治疗肝肾亏虚型膝骨关节炎可明显改善膝关节活动功能,缓解膝骨关节炎的症状,其机制可能与降低关节液中MMP-3、IL-1β水平,升高TIMP-1、TGF-β1的水平相关。

独活寄生汤联合几丁糖对寒湿痹阻型膝骨关节炎的临床疗效

目的 观察独活寄生汤联合几丁糖治疗寒湿痹阻型膝骨关节炎的临床效果。方法 选取2023年1月至8月黑龙江中医药大学附属第一医院门诊的60例膝骨关节炎患者,采用随机数字表法将其分为观察组和对照组,各30例。观察组采用独活寄生汤(加水煎煮,200 ml/剂,1剂/d,早晚两次温服,连续服用3周)联合几丁糖注射液(2 ml/次,1次/周,共3周)治疗,对照组口服洛索洛芬钠片(120 mg/次,3次/d)联合几丁糖注射液(2 ml/次,1次/周,共3周)治疗。评价两组临床疗效。比较两组治疗前后中医症状评分、西安大略和麦克马斯特大学骨关节炎指数评分(WOMAC评分)、视觉模拟评分法(VAS)评分,血清白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)的水平和血清环氧合酶(COX-2)和前列腺素(PGE2)的改善情况,并对两组患者于治疗后六周进行电话追踪和随访观察复发率。结果 观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。治疗后,两组VAS评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组WOMAC评分较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组IL-1、TNF-α水平较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后两组血清COX-2、PGE2降低,且观察组低于对照组,差异有统计学意义(P<0.05)。两组复发率比较,差异无统计学意义(P>0.05)。结论 独活寄生汤联合几丁糖对寒湿痹阻型膝骨关节炎有显著疗效,并且能恢复膝关节功能,提高生活质量。

Therapeutic effect of an injectable sustained-release sinomenine hydrochloride and sodium hyaluronate compound in a rabbit model of osteoarthritis

Background While intra-articular injection of sinomenine hydrochloride has a therapeutic effect on osteoarthritis, it has a short half-life, and is thermolabile and photolabile. The aim of this research was to evaluate the sustained-release of sinomenine hydrochloride from an injectable sinomenine hydrochloride and sodium hyaluronate compound （CSSSI） and its therapeutic effect in a rabbit model of osteoarthritis following intra-articular injection. Methods An injectable compound consisting of 1% sodium hyaluronate and 2.5% sinomenine hydrochloride was prepared and kept as the experiment group, and 2.5% sinomenine hydrochloride was prepared and kept as the control group. The cumulative mass release was measured at different time points in each group in vitro. Sixty-five male Zelanian rabbits were randomly divided into five groups： 15 （30 knees） each for the control, sodium hyaluronate, sinomenine hydrochloride, and CSSSI groups respectively, and five （10 knees） for the modeling group. Papain was injected into both knees of each rabbit for model establishment. Subsequently, 0.2 ml of the corresponding drugs was injected into the articular cavities of the remaining experiment groups, while the control group was treated with 0.2 ml normal saline. All groups were treated once a week for 4 weeks. Seven days after the last treatment, knees were anatomized to perl^orm pathological observations and Mankin＇s evaluation of the synovium. Four groups were compared using the SPSS 13.0 software package. Results In the in vitro sustained-release experiments, 90% of the drug was released in the experiment group 360 minutes following the injection. Comparison of the Mankin＇s evaluations of the four groups illustrated statistical discrepancies （P 〈0.05）. In further paired comparisons of the CSSSI group vs. modeling control/sodium hyaluronate/sinomenine hydrochloride groups, statistical significance was uniformly obtained. Moreover, sodium hyaluronate and sinomenine hydrochloride treatments showed significant improvement over the modeling control （P 〈0.05）, whereas sodium hyaluronate vs. sinomenine hydrochloride comparison failed to reach significance （P 〉0.05）. Conclusions CSSSI has a sustained-release effect on sinomenine hydrochloride. Intra-articular injection of CSSSI was significantly better than the sole sodium hyaluronate or sinomenine hydrochloride for the treatment of osteoarthritis in a rabbit model.

The effects of sodium hyaluronate on mRNA expressions of matrix metalloproteinase-1,-3 and tissue inhibitor of metalloproteinase-1 in cartilage and synovium of traumatic osteoarthritis model

Objective: To observe the influence of intra-articular injection of sodium hyaluronate (HA) on the mRNA expressions of matrix metalloproteinase-1,-3 (MMP-1,-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in cartilage and synovium of traumatic osteoarthritis (OA).Methods: Sixteen white rabbits underwent unilateral anterior cruciate ligament transection (ACLT) were divided into 2 groups randomly 5 weeks after transection. The experimental group rabbits received 0.3 ml of 1% HA by intra-articular injection once a week. Animals in the control group were treated under the same conditions using physiological saline. Ten weeks following surgery, cartilage and synovium were harvested. The mRNA expressions of MMP-1, MMP-3 and TIMP-1 were analyzed using reverse transcription-polymerase chain reaction (RT-PCR).Results: In synovium, the mRNA expression of MMP-3 was suppressed in the HA injection group. HA treatment had no effect on the MMP-3 expression in cartilage. No significant difference of MMP-1 and TIMP-1 expressions in cartilage and synovium was found between the HA injection group and the control group.Conclusions: One of the mechanisms of the therapeutic effect of HA may be the inhibition of expression of MMP-3 in synovium during early stage of traumatic OA.

膝骨关节炎患者SFRP与玻璃酸钠治疗效果的关系

目的探讨膝骨关节炎(knee osteoarthritis,KOA)患者分泌型卷曲相关蛋白(secretory curl related protein,SFRP)水平与玻璃酸钠治疗效果的关系。方法选取2021年5月至2023年6月温州市中医院收治的KOA患者89例纳入观察组,所有患者均采用玻璃酸钠治疗,根据治疗效果分为显效/好转组和效果差组;同期选取67名健康体检者纳入对照组。采用酶联免疫吸附试验测定各组纳入者的SFRP1、SFRP2和SFRP5水平,并对KOA患者玻璃酸钠治疗效果进行多因素Logistic回归分析;绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线),分析SFRP水平在KOA患者治疗效果中的评价效能。结果观察组患者的SFRP1、SFRP2及SFRP5水平低于对照组(P<0.05);89例KOA患者经玻璃酸钠治疗后,67例治疗效果良好(75.28%),显效/好转组患者的SFRP1、SFRP2及SFRP5水平高于效果差组(P<0.05);多因素分析结果表明,SFRP1、SFRP2、SFRP5水平及西安大略和麦克马斯特大学骨关节炎指数均为KOA患者治疗效果的影响因素(P<0.05);ROC曲线结果表明,SFRP1、SFRP2联合SFRP5对KOA患者治疗效果评价的敏感度和特异性高于单一指标(P<0.05)。结论SFRP1、SFRP2和SFRP5在KOA患者中呈低表达,其表达水平与患者玻璃酸钠治疗效果存在紧密联系,不同指标联合测定可提高预测的敏感度和特异性。

经皮神经电刺激联合通络祛痹膏外敷对膝骨性关节炎疗效及关节滑液免疫细胞的影响

目的:探究经皮神经电刺激(transcutaneous electrical nerve stimulation,TENS)联合通络祛痹膏外敷治疗膝骨性关节炎(knee osteoarthritis,KOA)疗效及对关节滑液免疫细胞和膝关节功能的影响。方法:将KOA患者60例按随机数字表法分为对照组A、对照组B及观察组各20例。对照组A予TENS治疗,对照组B予通络祛痹膏外敷+扶他林治疗,观察组予通络祛痹膏外敷+TENS治疗,各组均治疗6周。比较3组患者治疗前后关节滑液中白细胞介素1(interleukin-1,IL-1)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、干扰素γ(interferon-γ,IFN-v)、一氧化氮(nitric oxide,NO)、超氧化物歧化酶(superoxide dismutase,SOD)和丙二醛(malondialdehyde,MDA)的表达水平,并采用疼痛视觉模拟量表(visual analogue score,VAS)评分和膝关节康复量表(lysholm knee score scale,LKSS)评分评估膝关节恢复情况。结果:治疗后观察组VAS评分低于对照组A及对照组B(P<0.05),LKSS评分高于对照组A及对照组B(P<0.05);治疗后观察组IL-1、IL-6、TNF-α、IFN-γ表达水平均降低,与对照组A及对照组B比较,差异有统计学意义(P<0.05);治疗后观察组NO、MDA表达水平降低,SOD表达水平升高,与对照组A及对照组B比较,差异有统计学意义(P<0.05)。结论:TENS联合通络祛痹膏治疗KOA疗效明显,止痛效果显著,能有效减轻患者关节炎症及氧化应激反应。

透明质酸钠联合关节镜微创手术对老年膝骨关节炎患者膝关节功能及炎性因子水平的影响

目的探讨透明质酸钠联合关节镜微创手术对老年膝骨关节炎(KOA)患者膝关节功能及炎性因子水平的影响。方法选取2019年1月至2021年1月我院收治的158例老年KOA患者作为研究对象,采用随机数字表法将其分为对照组和观察组,各79例。对照组给予关节镜微创手术治疗,观察组在对照组基础上给予透明质酸钠治疗。比较两组的治疗效果。结果观察组的治疗总有效率为96.20%,显著高于对照组的84.81%(P<0.05)。治疗1、3、6个月,观察组的膝关节Lysholm评分高于对照组(P<0.05)。治疗后,观察组的白细胞介素-8(IL-8)、白细胞介素-17(IL-17)、环氧合酶-2(COX-2)水平低于对照组(P<0.05)。治疗后,观察组的总Ⅰ型胶原氨基端延长肽(TPⅠNP)、骨钙素(BGP)、骨保护素(OPG)水平高于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。结论透明质酸钠联合关节镜微创手术治疗老年KOA患者的效果显著,可改善膝关节功能、骨代谢情况,降低炎性因子水平及并发症发生率。