Hulsopple Chad
Uniformed Services University Department of Family Medicine, 4301 Jones Bridge Road A1038, Bethesda, Maryland 20814-4799.
FP Essent. 2018 Jul;470:21-26.
Injections often are used in the management of common musculoskeletal conditions. Physicians should understand the disease pathophysiology and evidence supporting available injections when determining appropriate therapy. These therapies include corticosteroid injections (CSIs), hyaluronic acid (HA) injections, hypertonic dextrose prolotherapy, platelet-rich plasma (PRP) injections, mesenchymal stem cell (MSC) injections, and trigger point injections (TPIs). CSIs are recommended conditionally by the American College of Rheumatology for osteoarthritis (OA) management. CSIs are associated with short-term improvement in pain and function in patients with OA, although cartilage volume loss can occur with repetitive, frequent use. CSIs show no long-term benefit in the management of lateral epicondyle pain. For knee OA, HA injection shows prolonged improvement of pain and function compared with CSI. Studies of HA injection for other joints show the injection to be no more effective than placebo. Evidence for prolotherapy and PRP injection shows long-term improvement of pain and function in knee OA and tendinopathies. There is low-quality evidence showing MSC injections improve pain and function in OA and tendinopathies. It is unclear whether TPIs are effective because of a lack of high-quality evidence. Ultrasonography guidance has been shown to improve accuracy of delivery and clinical outcomes in injection therapies.
注射疗法常用于常见肌肉骨骼疾病的治疗。医生在确定合适的治疗方案时，应了解疾病的病理生理学以及支持现有注射疗法的证据。这些疗法包括皮质类固醇注射（CSI）、透明质酸（HA）注射、高渗葡萄糖促愈疗法、富血小板血浆（PRP）注射、间充质干细胞（MSC）注射和触发点注射（TPI）。美国风湿病学会有条件地推荐CSI用于骨关节炎（OA）的治疗。CSI与OA患者疼痛和功能的短期改善相关，尽管反复、频繁使用可能会导致软骨体积减少。CSI在治疗外侧上髁疼痛方面没有长期益处。对于膝关节OA，与CSI相比，HA注射显示疼痛和功能改善的时间更长。对其他关节进行HA注射的研究表明，该注射疗法并不比安慰剂更有效。促愈疗法和PRP注射的证据表明，它们可使膝关节OA和肌腱病的疼痛和功能得到长期改善。有低质量证据表明，MSC注射可改善OA和肌腱病的疼痛和功能。由于缺乏高质量证据，尚不清楚TPI是否有效。超声引导已被证明可提高注射疗法的给药准确性和临床疗效。
