透明质酸在膝关节骨关节炎治疗中的应用  

Intra-articular hyaluronic acid injection for knee osteoarthritis

作　　者：王俏杰[1] 张先龙[1] Wang Qiaojie;Zhang Xianlong(Department of Orthopaedic Surgery, Shanghai Sixth People＇s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, Chin)

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华骨科杂志》2018年第11期690-697,共8页Chinese Journal of Orthopaedics

摘　　要：膝关节骨关节炎是一种常见的慢性退行性关节疾病，是导致老年人失能的主要病因之一。常用治疗方法包括物理治疗、口服非甾体抗炎药物、关节内注射类固醇激素以及黏弹性补充治疗和手术等。透明质酸是一类在关7组织中发挥重要生理作用的高分子聚合物，是关节滑液和软骨等组织的重要组成成分。关节内透明质酸注射是以恢复关节滑液黏弹性和生理稳态为基础的局部治疗。大量临床试验研究和临床实践证实透明质酸可有效缓解膝关节骨关节炎患者的疼痛症状，减少关节结构损伤。关节内注射透明质酸缓解疼痛的治疗效果与非甾体抗炎药、关节内注射类固醇激素以及物理治疗的疗效类似或更高。非甾体抗炎药可引起胃肠道出血且与患者死亡率升高相关，而关节内注射透明质酸不良事件发生率低、患者耐受性好。相关作用机制的研究证实，透明质酸可通过与多种细胞特异性受体（如CD44）或黏附分子（ICAM-1）结合，改善细胞功能。不同文献及指南中关于透明质酸是否可产生显著临床获益的争论仍然存在，不同透明质酸产品间的差异性、膝关节骨关节炎的严重程度、不同的治疗方案以及注射技术等因素均可影响关节内注射透明质酸对膝关节骨关节炎的治疗效果。As one of the major causes of disability in the elderly population, knee osteoarthritis is a common degenerative joint disease. The general treatment approaches for knee osteoarthritis include physical therapy, nonsteroidal anti-inflammatory drugs （NSAIDs）, iutra-articular injection of steroid hormones, viscosupplementation and surgery, etc. Hyaluronic acid （HA） is a kind of macromolecule which plays pivotal roles in the articular physiology as a key component of synovial fluid and cartilage. Intra -articular injection of hyaluronic acid （IA-HA） is established as a local therapy to restore the viscoelasticity of synovial fluid and achieve physiological stability. Numerous clinical trials have demonstrated that IA-HA is effective in relieving pain and reducing structural damage in patients with knee osteoarthritis. Generally, the pain-relieving activity of IA-HA is comparable to or higher than that of NSAIDs, intra-articular corticosteroids, and physical therapy. In addition, IA-HA treatment is tolerated and is associat- ed with less adverse events in comparison with NSAIDs, which elicits gastrointestinal bleedings and is associated with increased mortality. Studies in the mechanisms of action also revealed that HA could specifically bind to the membrane receptor （such as CD44） and adhesion molecules （ICAM-1） in cells. The connection may stimulate functional activities, including cell migration and proliferation. However, debates on whether hyaluronic acid produces significant clinical benefits still exist in the literature and dif- ferent clinical practice guidelines. The variability in pharmaceutical property of different HA products, the severity of knee osteoar- thritis, treatment protocol and injection technique can potentially have impacts on the outcomes of treatment of knee osteoarthritis with IA-HA.

关 键 词：膝关节骨关节炎 透明质酸 物理治疗 非甾体抗炎药物 黏弹性补充治疗 关节内注射 关节炎患者 退行性关节疾病 

分 类 号：R684.3[医药卫生—骨科学]