Boutefnouchet Tarek, Puranik Guru, Holmes Esther, Bell Karl M
Department of Trauma Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
Department of Trauma Orthopaedics, Alexandra Hospital, Redditch, UK.
Knee Surg Relat Res. 2017 Jun 1;29(2):129-136. doi: 10.5792/ksrr.16.061.
Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis.
A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results.
Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint.
This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.
透明质酸产品的选择及患者的挑选仍存在争议。开展了一项研究，以报告高分子量透明质制剂海兰 GF - 20（施沛特 - 优）关节腔内注射对有症状的膝关节骨关节炎患者的长期疗效。
对单一治疗系列进行回顾性观察分析。以关节成形术及任何其他外科干预作为终点结果来确定治疗效果的持久性。
连续 77 例患者（82 个膝关节）接受了为期五年的随访。在一年的随访中，71 个膝关节（87%）对治疗有反应，仅有 8 个膝关节（10%）因症状持续而接受了关节成形术。在五年的随访中，41 个膝关节（50%）仍被视为有反应。在研究期间，9 个膝关节（11%）接受了重复注射。26 个膝关节（31%）需要进行关节成形术（全膝关节置换或单髁置换）。以关节成形术为终点的治疗效果的 Kaplan - Meier 生存分析显示，5 年生存率为 67%；以所有二次干预为终点时，5 年生存率为 58%。
本研究表明海兰 GF - 20 注射的临床益处持续时间显著更长。目前的结果可能提示了一种针对尚未准备好接受关节成形术患者的理想延迟治疗策略。需要进一步的研究来帮助明确这些患者亚组的特征。
