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.
OBJECTIVE: 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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.
目的: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。
设计: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。
结果: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)。
结论: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。
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