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膝关节关节镜下部分半月板切除术后关节腔内注射透明质酸。

Intra-articular injection of hyaluronic acid following arthroscopic partial meniscectomy of the knee.

作者信息

Thein Rafael, Haviv Barak, Kidron Amos, Bronak Shlomo

机构信息

Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Petach-Tikva, Israel.

出版信息

Orthopedics. 2010 Oct 11;33(10):724. doi: 10.3928/01477447-20100826-11.

DOI:10.3928/01477447-20100826-11
PMID:20954664
Abstract

The short-term recovery period post-arthroscopic meniscectomy is characterized by pain and impaired function most likely related to the irrigation of synovial fluid from the knee intraoperatively. Consequently, along with removal of harmful debris, the irrigation fluid dilutes the hyaluronic acid layer covering the joint tissues. Hyaluronic acid contributes to the homeostasis of the joint environment and is an important component of synovial fluid and cartilage matrix. Hence, the instillation of hyaluronic acid after the procedure may relieve symptoms. This prospective, single-blind, randomized, controlled study evaluated clinical outcome after hyaluronic acid injection to patients who underwent arthroscopic meniscectomy of the knee. Patients with ligamentous injuries or severe chondral damage were excluded. Fifty-six patients with a mean age of 34 years (range, 17-44 years) were injected with Viscoseal (TRB Chemedica International S.A., Geneva, Switzerland) or normal saline immediately post-arthroscopy and divided into the Viscoseal group or control group, respectively. Patients were evaluated for pain, swelling, and function at 1, 4, and 12 weeks postoperatively. Patients in the control group reported more pain at week 1, with a mean visual analog score (VAS) of 43, than did patients in the Viscoseal group, with a mean VAS of 28 (P=.006). At 4 weeks postoperatively, none of the Viscoseal patients had consumed analgesics, where 9 (of 28) in the control group reported acetaminophen intake (P=.039). No significant difference in knee function was found between groups. Intra-articular injection of Viscoseal after arthroscopic meniscectomy reduced pain in the short-term recovery period.

摘要

关节镜下半月板切除术后的短期恢复期以疼痛和功能受损为特征,这很可能与术中膝关节滑膜液的冲洗有关。因此,在清除有害碎屑的同时,冲洗液会稀释覆盖关节组织的透明质酸层。透明质酸有助于维持关节环境的稳态,是滑液和软骨基质的重要组成部分。因此,术后注入透明质酸可能会缓解症状。这项前瞻性、单盲、随机对照研究评估了膝关节镜下半月板切除术后患者注射透明质酸后的临床疗效。排除有韧带损伤或严重软骨损伤的患者。56例平均年龄34岁(范围17 - 44岁)的患者在关节镜检查后立即注射了Viscoseal(TRB Chemedica International S.A.,瑞士日内瓦)或生理盐水,分别分为Viscoseal组或对照组。在术后1周、4周和12周对患者的疼痛、肿胀和功能进行评估。对照组患者在第1周报告的疼痛更多,平均视觉模拟评分(VAS)为43分,而Viscoseal组患者的平均VAS为28分(P = 0.006)。术后4周,Viscoseal组患者均未服用镇痛药,而对照组28例中有9例报告服用了对乙酰氨基酚(P = 0.039)。两组之间膝关节功能无显著差异。关节镜下半月板切除术后关节内注射Viscoseal可减轻短期恢复期的疼痛。

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