Simon Maciej J K, Aartsen Vivian E, Coghlan Jennifer A, Strahl André, Bell Simon N
Department of Orthopaedics, The University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Apr;91(4):673-679. doi: 10.1111/ans.16672. Epub 2021 Feb 20.
Currently, non-surgical treatments for glenohumeral osteoarthritis (GH-OA) mainly aim to reduce pain. Autologous conditioned serum (ACS), Orthokine, an interleukin-1 inhibitor from the patient's own blood has an anti-inflammatory effect. The objective was to determine whether intra-articular injections of this ACS improved symptoms in patients with GH-OA and delayed the need for a shoulder replacement.
A total of 36 consecutive patients, 40 shoulders, with OA received up to 6-weekly intra-articular injections of ACS were included. Imaging of GH-OA, range of motion, visual analogue scale (VAS) pain, Shoulder Pain And Disability Index (SPADI), American Shoulder and Elbow Surgeons and Constant scores were assessed pre-injection and post treatment at 3 months. At a minimum of 2 years, VAS and SPADI scores and whether anyone had progressed to a shoulder replacement were recorded.
Outcomes 3 months post-ACS injections demonstrated on average statistically significant improvement (P < 0.05) of all measurements: SPADI (54.3 ± 21.5 vs 43.7 ± 23.7), Constant score (50.5 ± 14.1 vs 57.1 ± 17.4), VAS pain (4.8 ± 2.2 vs 3.7 ± 2.4) and range of motion. Of these, 16 shoulders progressed to a shoulder replacement, nine cases quickly (0.6 ± 0.2 years) and seven cases were delayed by 3.1 ± 1.7 years. The other 18 cases had significant improvement in pain, SPADI (58.0 ± 19.6 to 31.8 ± 21.4; P < 0.01) scores and no progression to a shoulder replacement at 3.6 ± 1.0 years follow-up. There was no correlation of glenoid Walch score or joint space with clinical outcome parameters.
ACS injections in the shoulder joint for OA can reduce pain and disability, and postpone the need for a shoulder replacement.
目前，肩肱关节骨关节炎（GH-OA）的非手术治疗主要旨在减轻疼痛。自体条件血清（ACS），即Orthokine，一种从患者自身血液中提取的白细胞介素-1抑制剂，具有抗炎作用。目的是确定关节内注射这种ACS是否能改善GH-OA患者的症状，并延迟进行肩关节置换的需求。
纳入36例连续患者（40个肩部），这些OA患者接受了每周一次、共6周的关节内ACS注射。在注射前以及治疗后3个月评估GH-OA的影像学表现、活动范围、视觉模拟评分（VAS）疼痛、肩痛和功能障碍指数（SPADI）、美国肩肘外科医生评分和Constant评分。在至少2年的时间里，记录VAS和SPADI评分以及是否有患者进展到需要进行肩关节置换。
ACS注射后3个月的结果显示，所有测量指标平均有统计学意义的改善（P < 0.05）：SPADI（54.3±21.5对43.7±23.7）、Constant评分（50.5±14.1对57.1±17.4）、VAS疼痛（4.8±2.2对3.7±2.4）和活动范围。其中，16个肩部进展到需要进行肩关节置换，9例进展迅速（0.6±0.2年），7例延迟了3.1±1.7年。其他18例在3.6±1.0年的随访中疼痛、SPADI评分（58.0±19.6至31.8±21.4；P < 0.01）有显著改善，且未进展到需要进行肩关节置换。关节盂Walch评分或关节间隙与临床结果参数之间无相关性。
肩关节内注射ACS治疗OA可减轻疼痛和功能障碍，并推迟进行肩关节置换的需求。
