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 remodeli...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.展开更多
目的:系统评价针刀联合关节腔内注射药物治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Web of Science和Cochrane Library中关...目的:系统评价针刀联合关节腔内注射药物治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Web of Science和Cochrane Library中关于针刀联合关节腔内注射药物治疗KOA的对比研究文献,检索时限均为建库至2022年10月31日。试验组采用传统针刀联合关节腔内注射药物治疗,对照组仅采用关节腔内注射药物治疗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Revman5.4软件进行Meta分析。结果:共检索到367篇文献,最终纳入11篇文献,共涉及1601例患者,其中试验组800例,对照组801例。Meta分析结果显示,试验组有效率、Lysholm膝关节评分高于对照组[RR=1.21,95%CI(1.16,1.25),P=0.000;MD=6.01,95%CI(3.82,8.20),P=0.000],膝关节疼痛视觉模拟量表评分、西安大略和麦克马斯特大学骨关节炎指数评分低于对照组[MD=-1.17,95%CI(-1.24,-1.09),P=0.000;MD=-6.94,95%CI(-8.31,-5.56),P=0.000]。结论:针刀联合关节腔内注射药物治疗KOA的临床疗效优于单纯关节腔内注射药物。展开更多
目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,...目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,随机分为CFNB组(n=50)和CFNB联合PLIA组(简称PLIA组,n=50),以视觉模拟评分(visual analogue score,VAS)评价患者疼痛程度,在术后各时点记录静息及被动运动时患侧膝关节前、后部VAS评分。记录术后患者被动屈膝90°时间、主动直腿抬高时间,记录患者术前及术后72 h美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)。结果:术后静息时膝关节前部VAS评分在各时点两组间差异均无统计学意义(P>0.05),但膝关节后部VAS评分在术后4、8、12、24 h时PLIA组明显低于CFNB组(P<0.05)。被动运动时PLIA组膝关节前部VAS评分在术后24 h明显低于CFNB组(P<0.05),膝关节后部VAS评分在术后12、24 h明显低于CFNB组(P<0.05)。两组术前及术后72 h HSS评分差异无统计学意义(P>0.05)。与CFNB组比较,PLIA组被动屈膝90°时间和主动直腿抬高时间均明显缩短(P<0.05)。结论:CFNB联合PLIA镇痛可以降低术后膝关节后部疼痛评分,减少被动运动疼痛,缩短被动屈膝90°时间,改善患者术后早期康复效果。展开更多
文摘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.
文摘目的:系统评价针刀联合关节腔内注射药物治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Web of Science和Cochrane Library中关于针刀联合关节腔内注射药物治疗KOA的对比研究文献,检索时限均为建库至2022年10月31日。试验组采用传统针刀联合关节腔内注射药物治疗,对照组仅采用关节腔内注射药物治疗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Revman5.4软件进行Meta分析。结果:共检索到367篇文献,最终纳入11篇文献,共涉及1601例患者,其中试验组800例,对照组801例。Meta分析结果显示,试验组有效率、Lysholm膝关节评分高于对照组[RR=1.21,95%CI(1.16,1.25),P=0.000;MD=6.01,95%CI(3.82,8.20),P=0.000],膝关节疼痛视觉模拟量表评分、西安大略和麦克马斯特大学骨关节炎指数评分低于对照组[MD=-1.17,95%CI(-1.24,-1.09),P=0.000;MD=-6.94,95%CI(-8.31,-5.56),P=0.000]。结论:针刀联合关节腔内注射药物治疗KOA的临床疗效优于单纯关节腔内注射药物。
文摘目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,随机分为CFNB组(n=50)和CFNB联合PLIA组(简称PLIA组,n=50),以视觉模拟评分(visual analogue score,VAS)评价患者疼痛程度,在术后各时点记录静息及被动运动时患侧膝关节前、后部VAS评分。记录术后患者被动屈膝90°时间、主动直腿抬高时间,记录患者术前及术后72 h美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)。结果:术后静息时膝关节前部VAS评分在各时点两组间差异均无统计学意义(P>0.05),但膝关节后部VAS评分在术后4、8、12、24 h时PLIA组明显低于CFNB组(P<0.05)。被动运动时PLIA组膝关节前部VAS评分在术后24 h明显低于CFNB组(P<0.05),膝关节后部VAS评分在术后12、24 h明显低于CFNB组(P<0.05)。两组术前及术后72 h HSS评分差异无统计学意义(P>0.05)。与CFNB组比较,PLIA组被动屈膝90°时间和主动直腿抬高时间均明显缩短(P<0.05)。结论:CFNB联合PLIA镇痛可以降低术后膝关节后部疼痛评分,减少被动运动疼痛,缩短被动屈膝90°时间,改善患者术后早期康复效果。
