Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO, USA.
Cartilage. 2015 Apr;6(2):106-12. doi: 10.1177/1947603515571001.
Intra-articular injection of local anesthetic and/or corticosteroid is an adjunct treatment for arthritic and inflammatory orthopedic conditions. Despite potential benefits, there is growing concern that these medications may cause significant morbidity, including potential toxicity to intra-articular chondrocytes and synoviocytes.
Twenty dogs underwent intra-articular injection of the shoulder joint using ultrasound guidance, with the following injectates (n = 5 each): negative control (saline), methylprednisolone/1.0% lidocaine, triamcinolone/1.0% lidocaine, and triamcinolone/0.0625% bupivacaine. The dogs were euthanized 24 hours postinjection for reasons unrelated to this study. Synovium/cartilage explants were harvested under sterile conditions and assessed immediately or cultured for 7 days. Synoviocyte and chondrocyte viability was determined on day 1 and day 7 using Calcien AM and Sytox Blue live/dead fluorescent stains, and cell metabolism determined on day 2 using the alamar blue additive test. Results were compared statistically.
On day 1 synovium exposed to 1%L/M demonstrated a significant decrease in cell metabolism (P = 0.0107) and subjective synoviocyte viability scores (P = 0.013) compared with the negative control. Cartilage exposed to 1%L/M demonstrated decreased chondrocyte viability and cell metabolism versus all other groups, although not significantly. After 7 days of culture, cartilage viable cell density in the 1%L/M group was significantly (P ≤ 0.001) lower than the negative control. Subjective synoviocyte viability scores was significantly lower in the 1%L/M (P = 0.013), 1%L/T (P ≤ 0.001), and 0.0625%B/T groups (P = 0.006) compared with the negative control.
This study suggests potential negative effects of combination local anesthetic/corticosteroid on intra-articular cell viability and cell metabolism. Further study is needed before determining definitive clinical recommendations.
关节内注射局部麻醉药和/或皮质类固醇是治疗关节炎和炎症性骨科疾病的辅助治疗方法。尽管有潜在的益处，但人们越来越担心这些药物可能会引起显著的发病率，包括对关节内软骨细胞和滑膜细胞的潜在毒性。
20 只狗接受了超声引导下的肩关节关节内注射，以下列注射剂（每组 5 只）：阴性对照（生理盐水）、甲泼尼龙/1.0%利多卡因、曲安奈德/1.0%利多卡因和曲安奈德/0.0625%布比卡因。狗在注射后 24 小时因与本研究无关的原因被安乐死。在无菌条件下采集滑膜/软骨标本，并立即或培养 7 天进行评估。在第 1 天和第 7 天使用 Calcien AM 和 Sytox Blue 活/死荧光染色测定滑膜细胞和软骨细胞活力，在第 2 天使用 alamar blue 添加剂试验测定细胞代谢。结果进行统计学比较。
在第 1 天，与阴性对照组相比，暴露于 1%L/M 的滑膜显示细胞代谢显著降低（P = 0.0107）和主观滑膜细胞活力评分降低（P = 0.013）。暴露于 1%L/M 的软骨显示与所有其他组相比，软骨细胞活力和细胞代谢降低，尽管没有显著差异。培养 7 天后，1%L/M 组软骨活细胞密度显著低于阴性对照组（P ≤ 0.001）。1%L/M（P = 0.013）、1%L/T（P ≤ 0.001）和 0.0625%B/T 组的主观滑膜细胞活力评分均显著低于阴性对照组（P = 0.006）。
本研究提示联合局部麻醉药/皮质类固醇对关节内细胞活力和细胞代谢可能有潜在的不良影响。在确定明确的临床建议之前，需要进一步研究。
