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...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.展开更多
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: P...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.展开更多
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 kn...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.展开更多
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, Chong...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.展开更多
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-traumati...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.展开更多
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 a...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.展开更多
BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis(KOA).Due to the differences in the research subjects,methods,and efficacy evaluation indexes,there are great differences in the surgica...BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis(KOA).Due to the differences in the research subjects,methods,and efficacy evaluation indexes,there are great differences in the surgical efficacy reported in the literature.AIM To compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODS Patients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group,and those who refused surgical treatment were included in a conservative treatment group.Gender,age,body mass index(BMI),side of KOA,American hospital for special surgery knee score(HSS score)before treatment,visual analogue scale(VAS)score during walking and rest before treatment,conservative treatment content,and surgical procedure were recorded.Outpatient visits were conducted at the 1st,3rd,6th,12th,and 24th mo after treatment in the two groups.The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed,and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTS In the conservative treatment group,there were 80 patients with complete followup data,including 20 males and 60 females,aged 58.75±14.66 years old.And in the knee arthroscopic debridement group,there were 98 patients with complete follow-up data,including 24 males and 74 females,aged 59.27±14.48 years old.There was no statistically significant difference in the general data(gender,age,BMI,side of KOA,Kellgren-Lawrence grade distribution,HSS score,and VAS score)between the two groups before treatment.The HSS scores of the conservative treatment group at the 1st,3rd,6th,12th,and 24th mo after treatment were significantly higher than that before treatment(P<0.05).There was no statistical difference in HSS score of the conservative treatment group among the 1st,3rd,6th,12th,and 24th mo(P>0.05).The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery(P<0.05).HSS scores of the knee arthroscopic debridement group at the 3rd,6th,12th,and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery(P<0.05).There were no statistically significant differences in HSS scores at the 3rd,6th,12th,and 24th mo after surgery(P>0.05).HSS scores at the 3rd,6th,12th,and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group(P<0.05).There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up(P>0.05).VAS scores during walking and rest were significantly decreased in both groups,and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group,but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSION Compared with conservative treatment,arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.展开更多
目的评价中药熏洗结合玻璃酸钠关节腔内注射治疗膝骨关节炎(knee osteoarthritis,KOA)的有效性与安全性。方法检索万方数据库(Wanfang Data)、中国知网(CNKI)、维普网(VIP)、Cochrane Library、Embase以及Pub Med 6个数据库中公开发表...目的评价中药熏洗结合玻璃酸钠关节腔内注射治疗膝骨关节炎(knee osteoarthritis,KOA)的有效性与安全性。方法检索万方数据库(Wanfang Data)、中国知网(CNKI)、维普网(VIP)、Cochrane Library、Embase以及Pub Med 6个数据库中公开发表的关于中药熏洗联合玻璃酸钠关节腔内注射治疗膝骨关节炎的随机对照试验,检索时限为建库至2022年12月31日,采用Cochrane干预系统评价手册对纳入文献进行质量评价,运用Rev Man 5.3软件对纳入文献进行Meta分析。结果本研究共纳入16篇文献,总计1388例患者。Meta分析结果显示,与单纯使用玻璃酸钠关节腔内注射相比,联合中药熏洗治疗膝骨关节炎的有效率更高(RR=1.16,95%CI 1.11~1.21,P<0.00001),患者疼痛视觉模拟量表(VAS)评分更低(WMD=-0.64,95%CI-0.74~-0.53,P<0.00001),西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分(WMD=-6.81,95%CI-8.03~-5.59,P<0.00001)及Lysholm评分更高(WMD=4.71,95%CI 3.66~5.75,P<0.00001)。结论相比单独使用玻璃酸钠关节腔内注射治疗膝骨关节炎,联合中药熏洗可以提升疗效。展开更多
基金2022 project of the Training and Research Center for Ideological and Political Workers in Colleges and Universities of the Ministry of Education(Southwest Jiaotong University)titled"Research on the Sociocultural and Psychological Mechanism of Casting the Consciousness of the Chinese Nation Community",No.SWJTUKF22-06.
文摘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.
文摘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.
基金National Natural Science Foundation Youth Project:81501857.
文摘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.
基金Projects Funded by the National Natural Science Foundation of China.Project No:81870364.
文摘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.
文摘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.
文摘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.
基金Shanghai Jing'an District Health Research Project,China,No.2018MS09.
文摘BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis(KOA).Due to the differences in the research subjects,methods,and efficacy evaluation indexes,there are great differences in the surgical efficacy reported in the literature.AIM To compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODS Patients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group,and those who refused surgical treatment were included in a conservative treatment group.Gender,age,body mass index(BMI),side of KOA,American hospital for special surgery knee score(HSS score)before treatment,visual analogue scale(VAS)score during walking and rest before treatment,conservative treatment content,and surgical procedure were recorded.Outpatient visits were conducted at the 1st,3rd,6th,12th,and 24th mo after treatment in the two groups.The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed,and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTS In the conservative treatment group,there were 80 patients with complete followup data,including 20 males and 60 females,aged 58.75±14.66 years old.And in the knee arthroscopic debridement group,there were 98 patients with complete follow-up data,including 24 males and 74 females,aged 59.27±14.48 years old.There was no statistically significant difference in the general data(gender,age,BMI,side of KOA,Kellgren-Lawrence grade distribution,HSS score,and VAS score)between the two groups before treatment.The HSS scores of the conservative treatment group at the 1st,3rd,6th,12th,and 24th mo after treatment were significantly higher than that before treatment(P<0.05).There was no statistical difference in HSS score of the conservative treatment group among the 1st,3rd,6th,12th,and 24th mo(P>0.05).The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery(P<0.05).HSS scores of the knee arthroscopic debridement group at the 3rd,6th,12th,and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery(P<0.05).There were no statistically significant differences in HSS scores at the 3rd,6th,12th,and 24th mo after surgery(P>0.05).HSS scores at the 3rd,6th,12th,and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group(P<0.05).There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up(P>0.05).VAS scores during walking and rest were significantly decreased in both groups,and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group,but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSION Compared with conservative treatment,arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.
文摘目的评价中药熏洗结合玻璃酸钠关节腔内注射治疗膝骨关节炎(knee osteoarthritis,KOA)的有效性与安全性。方法检索万方数据库(Wanfang Data)、中国知网(CNKI)、维普网(VIP)、Cochrane Library、Embase以及Pub Med 6个数据库中公开发表的关于中药熏洗联合玻璃酸钠关节腔内注射治疗膝骨关节炎的随机对照试验,检索时限为建库至2022年12月31日,采用Cochrane干预系统评价手册对纳入文献进行质量评价,运用Rev Man 5.3软件对纳入文献进行Meta分析。结果本研究共纳入16篇文献,总计1388例患者。Meta分析结果显示,与单纯使用玻璃酸钠关节腔内注射相比,联合中药熏洗治疗膝骨关节炎的有效率更高(RR=1.16,95%CI 1.11~1.21,P<0.00001),患者疼痛视觉模拟量表(VAS)评分更低(WMD=-0.64,95%CI-0.74~-0.53,P<0.00001),西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分(WMD=-6.81,95%CI-8.03~-5.59,P<0.00001)及Lysholm评分更高(WMD=4.71,95%CI 3.66~5.75,P<0.00001)。结论相比单独使用玻璃酸钠关节腔内注射治疗膝骨关节炎,联合中药熏洗可以提升疗效。
