Younger Alastair S E, Penner Murray, Wing Kevin, Veljkovic Andrea, Nacht Jeff, Wang Zhe, Wester Tawana, Harrison Andrew
Professor, Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
Clinical Professor, Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
J Foot Ankle Surg. 2019 May;58(3):514-518. doi: 10.1053/j.jfas.2018.10.003. Epub 2019 Mar 23.
Ankle osteoarthritis (OA) can cause disabling symptoms, and some patients prefer to be treated with minimally invasive procedures. Nonanimal hyaluronic acid (NASHA) is a cross-linked hyaluronic acid product that has a prolonged intra-articular residence time. The authors report the first study of NASHA for the treatment of ankle OA. Thirty-seven patients with Kellgren-Lawrence grade II or III ankle OA received an intra-articular injection of NASHA (1 mL). Outcomes included visual analogue scale (VAS) scores for pain and disability. At baseline, the mean VAS pain score was 50.1 ± 14.5mm. During the 26-week follow-up period, the least squares (LS) mean change from baseline in the ankle OA VAS pain score was -20.5mm (95% confidence interval [CI] -25.5 to -15.6 mm), an LS mean percentage reduction of 40.0% (95% CI 30.2% to 49.9%). The LS mean change from baseline in the VAS disability score during 26 weeks was -19.2mm (95% CI -24.8 to -13.6 mm), a percentage reduction of 34% (95% CI 22.3% to 45.7%). Five participants experienced a total of 7 adverse events considered to be related to study treatment (injection site pain, n = 3; injection site joint pain, n = 3; plantar fasciitis, n = 1). This study shows promise for viscosupplementation with NASHA in the treatment of ankle OA. A single injection was associated with clinically meaningful reductions in pain and disability during a 26-week period and, in general, was well tolerated.
踝关节骨关节炎（OA）可导致致残症状，一些患者更倾向于接受微创手术治疗。非动物源性透明质酸（NASHA）是一种交联透明质酸产品，其关节内停留时间延长。作者报告了首例关于NASHA治疗踝关节OA的研究。37例Kellgren-Lawrence II级或III级踝关节OA患者接受了关节内注射NASHA（1毫升）。观察指标包括疼痛和功能障碍的视觉模拟量表（VAS）评分。基线时，VAS疼痛评分的平均值为50.1±14.5毫米。在26周的随访期内，踝关节OA的VAS疼痛评分相对于基线的最小二乘（LS）平均变化为-20.5毫米（95%置信区间[CI]-25.5至-15.6毫米），LS平均降低百分比为40.0%（95%CI 30.2%至49.9%）。26周内VAS功能障碍评分相对于基线的LS平均变化为-19.2毫米（95%CI-24.8至-13.6毫米），降低百分比为34%（95%CI 22.3%至45.7%）。5名参与者共经历了7起被认为与研究治疗相关的不良事件（注射部位疼痛，n = 3；注射部位关节疼痛，n = 3；足底筋膜炎，n = 1）。这项研究表明，NASHA关节腔注射补充疗法在治疗踝关节OA方面具有前景。单次注射在26周内可使疼痛和功能障碍得到具有临床意义的减轻，总体耐受性良好。
