高分子量透明质酸治疗髋骨关节炎的黏弹性补充治疗：随机对照试验的疗效、疼痛、功能障碍和不良事件发生的系统评价和荟萃分析。
Viscosupplementation with High Molecular Weight Hyaluronic Acid for Hip Osteoarthritis: a Systematic Review and Meta-Analysis of Randomised Control Trials of the Efficacy on Pain, Functional Disability, and the Occurrence of Adverse Events.
机构信息
Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom.
Department of Trauma and Orthopaedics, The Princess Royal Hospital, Telford, United Kingdom.
出版信息
Acta Chir Orthop Traumatol Cech. 2024;91(2):109-119. doi: 10.55095/ACHOT2024/009.
PURPOSE OF THE STUDY
Hip osteoarthritis (OA) has a prevalence of around 6.4% and is the second most commonly affected joint. This review aims to assess the clinical outcomes of intra-articular high molecular weight hyaluronic acid (HMWHA) in the management of hip osteoarthritis.
MATERIAL AND METHODS
We conducted a comprehensive search across PubMed, Google Scholar, and the Cochrane Library for randomised trials investigating the effectiveness of high molecular weight hyaluronic acid (HMWHA) in the treatment of hip osteoarthritis. Quality and risk of bias assessments were performed using the Cochrane RoB2 tool. To synthesise the data, we utilised the Standardised Mean Difference (SMD) for assessing pain relief through the Visual Analogue Scale (VAS) and the Lequesne index (LI) for evaluating functional outcomes. Risk Ratio (RR) was calculated to assess the occurrence of complications.
RESULTS
A total of four studies involving HMWHA and control groups were included. The standardised mean difference (SMD) for the Visual Analogue Scale (VAS) (SMD -0.056; 95% CI; -0.351, 0.239; p = 0.709) and the Lequesne index (SMD -0.114; 95% CI; -0.524, 0.296; p = 0.585) were not statistically significant. Analysis for complications demonstrated an overall relative risk ratio (RR) of 0.879 (95% CI; 0.527, 1.466; p = 0.622), and was not statistically significant.
DISCUSSION AND CONCLUSIONS
Intra-articular HMWHA in hip OA can significantly reduce pain and improve functional recovery when compared with the condition before treatment. However, there is no significant difference between HMWHA, or saline, or other therapeutic treatments. Currently, available evidence indicates that intra-articular HMWHA in hip OA would not increase the risk of adverse events.
KEY WORDS
hip osteoarthritis, hyaluronic acid, intra-articular, molecular weight, viscosupplementation.
研究目的
髋骨关节炎（OA）的患病率约为 6.4%，是第二大常见的受影响关节。本综述旨在评估关节内高分子量透明质酸（HMWHA）在髋骨关节炎管理中的临床疗效。
材料与方法
我们在 PubMed、Google Scholar 和 Cochrane 图书馆中进行了全面检索，以查找关于高分子量透明质酸（HMWHA）治疗髋骨关节炎疗效的随机试验。使用 Cochrane RoB2 工具进行质量和偏倚风险评估。为了综合数据，我们使用视觉模拟量表（VAS）评估疼痛缓解的标准化均数差（SMD）和 Lequesne 指数（LI）评估功能结果。计算风险比（RR）评估并发症的发生。
结果
共纳入 4 项 HMWHA 与对照组的研究。视觉模拟量表（VAS）的标准化均数差（SMD）（SMD-0.056；95%CI；-0.351，0.239；p=0.709）和 Lequesne 指数（SMD-0.114；95%CI；-0.524，0.296；p=0.585）差异无统计学意义。并发症分析显示，总体相对风险比（RR）为 0.879（95%CI；0.527，1.466；p=0.622），差异无统计学意义。
讨论与结论
与治疗前相比，关节内 HMWHA 可显著减轻髋 OA 患者的疼痛并改善功能恢复。然而，HMWHA 与盐水或其他治疗方法之间并无显著差异。目前的证据表明，关节内 HMWHA 不会增加髋 OA 的不良事件风险。
关键词
髋骨关节炎，透明质酸，关节内，分子量，黏弹性补充。
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