Turajane Thana, Amphansap Tanawat, Labpiboonpong Viroj, Maungsiri Samart
Department of Orthopedic Surgery, Police General Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2009 Dec;92 Suppl 6:S63-8.
Treatment with repeated cycles of Intra-Articular Sodium Hyaluronate (IA-HA), from previous study, can improve symptoms and delay surgical interventions in knee osteoarthritis patients who failed conservative treatment within minimum 2-years follow-up. This is a continued study to follow-up responded patients in the mentioned study whether continuing treatment with IA-HA could prolong time to surgery until the end of follow-up.
To evaluate the incidence of total knee replacement (TKR) in patients receiving repeated cycles of IA-HA during a 54-month follow-up period.
This was a prospective cohort study with 54-month follow-up period. All patients received at least a single course of 3-weekly injections of IA-HA (500-730 Kilodalton, Hyalgan). Patients who well responded to the treatment were recommended to repeat the administration of a 3-weekly injections every 6-12 months based on their symptoms. The incidence of TKR and time was recorded. Time to event analysis using Kaplan-Meier survival analysis was performed.
183 patients were recruited during March 2001 and March 2004 and followed-up until October 2008. Patients were classified into three groups according to Ahlback radiological grading system. 46 patients were in group 1 (Ahlback grade I-II), 70 patients were in group 2 (Ahlback grade III-IV) and 67 patients were in group 3 (Ahlback grade V). The incidence of TKR was 28.4% with a mean time to TKR of 15.4 months (0.7-51.7 months). For the rest of patients who had no TKR during study period (80.4%, 64.3% and 73.1% for group 1, 2, and 3 respectively), their mean follow-up time was 45.6 months (19.0-53.1 months). Mean survival time was 42.1 months (95% CI = 39.4-44.9 months).
The repeated cycles of intra-articular sodium hyaluronate treatment in delay time to TKR in patients with knee osteoarthritis which failed conservative treatment was found efficacious during a 54-month follow-up period.
根据先前的研究，对于保守治疗失败的膝骨关节炎患者，采用重复疗程的关节腔内注射透明质酸钠（IA-HA）治疗，在至少2年的随访期内可改善症状并推迟手术干预。这是一项持续性研究，旨在随访上述研究中有反应的患者，观察继续IA-HA治疗是否能将手术时间延长至随访结束。
评估在54个月的随访期内接受重复疗程IA-HA治疗的患者中全膝关节置换术（TKR）的发生率。
这是一项前瞻性队列研究，随访期为54个月。所有患者均接受至少一个疗程的IA-HA（500 - 730千道尔顿，海乐妙），每3周注射一次。对治疗反应良好的患者根据症状建议每6 - 12个月重复一次每3周注射一次的治疗。记录TKR的发生率和时间。采用Kaplan-Meier生存分析进行事件发生时间分析。
2001年3月至2004年3月招募了183例患者，并随访至2008年10月。根据阿尔贝克放射学分级系统将患者分为三组。第1组（阿尔贝克I-II级）有46例患者，第2组（阿尔贝克III-IV级）有70例患者，第3组（阿尔贝克V级）有67例患者。TKR的发生率为28.4%，TKR的平均时间为15.4个月（0.7 - 51.7个月）。对于研究期间未进行TKR的其余患者（第1、2、3组分别为80.4%、64.
