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软骨手术中的浸润治疗。

Infiltration therapy in the context of cartilage surgery.

机构信息

Department of Orthopaedics, University Medicine, 18057, Rostock, Germany.

Orthopaedic-Neurosurgery Center, Roentgenstrasse 10, 45661, Recklinghausen, Germany.

出版信息

Arch Orthop Trauma Surg. 2024 Sep;144(9):3913-3923. doi: 10.1007/s00402-023-04964-1. Epub 2023 Jul 4.

DOI:10.1007/s00402-023-04964-1
PMID:37400671
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11564373/
Abstract

Guideline-based surgical cartilage therapy for focal cartilage damage offers highly effective possibilities to sustainably reduce patients' complaints and to prevent or at least delay the development of early osteoarthritis. In the knee joint, it has the potential to reduce almost a quarter of the arthroses requiring joint replacement caused by cartilage damage. Biologically effective injection therapies could further improve these results. Based on the currently available literature and preclinical studies, intra- and postoperative injectables may have a positive effect of platelet-rich plasma/fibrin (PRP/PRF) and hyaluronic acid (HA) on cartilage regeneration and, in the case of HA injections, also on the clinical outcome can be assumed. The role of a combination therapy with use of intra-articular corticosteroids is lacking in the absence of adequate study data and cannot be defined yet. With regard to adipose tissue-based cell therapy, the current scientific data do not yet justify any recommendation for its use. Further studies also regarding application intervals, timing and differences in different joints are required.

摘要

基于指南的手术软骨疗法为局灶性软骨损伤提供了高度有效的可能性,可持久减轻患者的不适,并预防或至少延迟早期骨关节炎的发展。在膝关节中,它有可能减少近四分之一因软骨损伤而需要关节置换的关节炎。生物有效注射疗法可以进一步改善这些结果。基于目前的文献和临床前研究,富血小板血浆/纤维蛋白(PRP/PRF)和透明质酸(HA)的关节内和术后注射剂可能对软骨再生有积极影响,在 HA 注射的情况下,对临床结果也有积极影响。在缺乏足够的研究数据的情况下,关节内皮质类固醇联合治疗的作用尚不清楚,目前还无法确定。关于脂肪组织来源的细胞疗法,目前的科学数据还不能证明其使用的任何建议。还需要进一步研究,包括应用间隔、时机和不同关节之间的差异。

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1
Infiltration therapy in the context of cartilage surgery.软骨手术中的浸润治疗。
Arch Orthop Trauma Surg. 2024 Sep;144(9):3913-3923. doi: 10.1007/s00402-023-04964-1. Epub 2023 Jul 4.
2
A placebo-controlled study comparing the efficacy of intra-articular injections of hyaluronic acid and a novel hyaluronic acid-platelet-rich plasma conjugate in a canine model of osteoarthritis.一项安慰剂对照研究比较了关节内注射透明质酸和新型透明质酸-富血小板血浆缀合物在犬骨关节炎模型中的疗效。
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Am J Sports Med. 2019 Feb;47(2):347-354. doi: 10.1177/0363546518814532. Epub 2018 Dec 13.
4
Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis.富血小板血浆关节内注射与透明质酸黏弹性补充治疗软骨病变:从早期退变到骨关节炎。
Arthroscopy. 2011 Nov;27(11):1490-501. doi: 10.1016/j.arthro.2011.05.011. Epub 2011 Aug 10.
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Biomaterials. 2014 Dec;35(36):9599-607. doi: 10.1016/j.biomaterials.2014.07.058. Epub 2014 Aug 28.
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本文引用的文献

1
Long-term outcomes after humeral head replacement and total shoulder replacement for osteonecrosis of the humeral head: a mean follow-up of 8 years.肱骨头坏死行肱骨头置换和全肩关节置换后的长期疗效:平均 8 年随访。
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Are leukocyte-poor or multiple injections of platelet-rich plasma more effective than hyaluronic acid for knee osteoarthritis? A systematic review and meta-analysis of randomized controlled trials.白细胞缺乏或多次注射富血小板血浆与透明质酸治疗膝骨关节炎相比哪个更有效?一项随机对照试验的系统评价和荟萃分析。
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Empfehlungen der AG Klinische Geweberegeneration zur Behandlung von Knorpelschäden am Kniegelenk.临床组织再生工作组关于治疗膝关节软骨损伤的建议。
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Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation.德国医疗体系中细胞基质移植的长期成本效益:离散事件模拟
Arch Orthop Trauma Surg. 2023 Mar;143(3):1417-1427. doi: 10.1007/s00402-021-04318-9. Epub 2022 Jan 22.
5
Platelet-Rich Plasma Versus Hyaluronic Acid for Hip Osteoarthritis Yields Similarly Beneficial Short-Term Clinical Outcomes: A Systematic Review and Meta-analysis of Level I and II Randomized Controlled Trials.富血小板血浆与透明质酸治疗髋骨关节炎短期临床疗效相当:I 级和 II 级随机对照试验的系统评价和荟萃分析。
Arthroscopy. 2022 Jun;38(6):2035-2046. doi: 10.1016/j.arthro.2021.11.005. Epub 2021 Nov 14.
6
Hyaluronic Acid as a Carrier Supports the Effects of Glucocorticoids and Diminishes the Cytotoxic Effects of Local Anesthetics in Human Articular Chondrocytes In Vitro.透明质酸作为载体支持糖皮质激素的作用,并减少局部麻醉剂对体外人关节软骨细胞的细胞毒性作用。
Int J Mol Sci. 2021 Oct 25;22(21):11503. doi: 10.3390/ijms222111503.
7
Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial.多次富血小板血浆注射优于单次 PRP 注射或膝关节骨关节炎生理盐水注射:一项随机、双盲、安慰剂对照的临床 2 年研究结果。
Arch Orthop Trauma Surg. 2022 Oct;142(10):2755-2768. doi: 10.1007/s00402-021-04230-2. Epub 2021 Oct 27.
8
Patients with stage II of the knee osteoarthritis most likely benefit from the intra-articular injections of autologous adipose tissue-from 2 years of follow-up studies.从为期 2 年的随访研究来看,膝关节骨性关节炎 II 期患者最有可能从关节内注射自体脂肪组织中获益。
Arch Orthop Trauma Surg. 2023 Jan;143(1):55-62. doi: 10.1007/s00402-021-03979-w. Epub 2021 Jun 11.
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Efficacy and safety of mesenchymal stem cell injections for patients with osteoarthritis: a meta-analysis and review of RCTs.间充质干细胞注射治疗骨关节炎患者的疗效和安全性:荟萃分析和 RCT 综述。
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Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis.富血小板血浆与透明质酸治疗膝骨关节炎的疗效比较:一项荟萃分析。
J Orthop Surg Res. 2020 Sep 11;15(1):403. doi: 10.1186/s13018-020-01919-9.