Xu Jianda, Qu Yuxing, Li Huan, Zhu Aixiang, Jiang Tao, Chong Zheng, Wang Bin, Shen Pengfei, Xie Zikang
Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, Changzhou, China.
Department of Arthroplasty, First People's Hospital of Changzhou, Changzhou, China.
Orthop J Sports Med. 2020 Apr 10;8(4):2325967120911126. doi: 10.1177/2325967120911126. eCollection 2020 Apr.
Intra-articular corticosteroid injections have been widely used and are considered a mainstay in the nonoperative treatment of symptomatic knee osteoarthritis (OA). However, their increased use can have negative implications, including chondral toxicity and a high risk of infections. As a result, nonsteroidal anti-inflammatory drugs have been considered as an alternative.
To determine the pain relief and safety of ketorolac versus a corticosteroid to supplement an intra-articular sodium hyaluronate injection for the treatment of symptomatic knee OA.
Cohort study; Level of evidence, 3.
A total of 84 patients with unilateral symptomatic knee OA receiving 5 weekly injections were enrolled in this retrospective study. Group A (n = 42) received 3 weekly intra-articular corticosteroid injections (0.5% lidocaine, 25 mg of triamcinolone acetonide, and 25 mg of sodium hyaluronate, followed by 2 weekly injections of 0.5% lidocaine and 25 mg of sodium hyaluronate), while group B (n = 42) received 5 weekly ketorolac injections (0.5% lidocaine, 10 mg of ketorolac, and 25 mg of sodium hyaluronate). The following parameters were used to evaluate pain relief and safety: visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and side effects before the injection and at 1, 2, and 5 weeks after treatment commencement as well as 3 months after the last injection.
Patients from both groups had a significant improvement in VAS and WOMAC scores from the first injection to final follow-up at 3 months. In the first week, the VAS score was lower in group A ( = .041), but no significant between-group differences were found for either the VAS or the WOMAC score at the other time points. Of the 42 patients in group A, 34 (81.0%) and 25 (59.5%) achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. In group B, 32 (76.2%) and 24 (57.1%) patients achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. At final follow-up, no significant difference was found in the successful treatment rate between the groups ( = .825).
The current study demonstrated that intra-articular ketorolac and corticosteroid injections produce the same pain relief and functional improvement.
关节内注射皮质类固醇已被广泛应用，被认为是有症状的膝关节骨关节炎（OA）非手术治疗的主要手段。然而，其使用增加可能会产生负面影响，包括软骨毒性和高感染风险。因此，非甾体抗炎药被视为一种替代药物。
确定酮咯酸与皮质类固醇补充关节内注射透明质酸钠治疗有症状的膝关节OA的止痛效果和安全性。
队列研究；证据等级，3级。
本回顾性研究共纳入84例单侧有症状的膝关节OA患者，每周接受5次注射。A组（n = 42）每周接受3次关节内注射皮质类固醇（0.5%利多卡因、25 mg曲安奈德和25 mg透明质酸钠，随后每周注射2次0.5%利多卡因和25 mg透明质酸钠），而B组（n = 42）每周接受5次酮咯酸注射（0.5%利多卡因、10 mg酮咯酸和25 mg透明质酸钠）。采用以下参数评估止痛效果和安全性：疼痛视觉模拟量表（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC），以及注射前、治疗开始后1周、2周、5周以及最后一次注射后3个月的副作用。
两组患者从首次注射到3个月的最终随访时，VAS和WOMAC评分均有显著改善。在第1周，A组的VAS评分较低（P = .041），但在其他时间点，两组的VAS或WOMAC评分均未发现显著差异。A组的42例患者中，分别有34例（81.0%）和25例（59.5%）在治疗开始后5周和最后一次注射后3个月取得成功结果。B组分别有32例（76.2%）和24例（57.1%）患者在治疗开始后5周和最后一次注射后3个月取得成功结果。在最终随访时，两组之间的成功治疗率无显著差异（P = .825）。
本研究表明，关节内注射酮咯酸和皮质类固醇产生相同的止痛效果和功能改善。
