Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing City, China.
Department of Rheumatology and Immunology, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing City, China.
Medicine (Baltimore). 2024 Oct 4;103(40):e39924. doi: 10.1097/MD.0000000000039924.
This study explores the clinical efficacy of intra-articular injection of chitosan combined with low-dose glucocorticoid for the treatment of knee osteoarthritis in early and middle stages. The visual analog scale (VAS) score, Lysholm score, Hospital for Special Surgery (HSS) score, and changes in the levels of inflammatory cytokines IL-1, IL-6, and TNF-α in the joint fluid before and after treatment in the 3 groups were compared, and the clinical efficacy was evaluated. All cases were followed up, with a follow-up time of 7 to 12 months, and no lost cases. The horizontal comparison showed that the VAS score, Lysholm score, HSS score, and levels of inflammatory cytokines IL-1, IL-6, and TNF-α in the joint fluid after treatment in each group were better than before treatment, and the difference was statistically significant (P < .05). The longitudinal comparison showed that there was no significant difference in VAS score, Lysholm score, HSS score and levels of inflammatory cytokines IL-1, IL-6, and TNF-α in synovial fluid among the 3 groups before treatment (P > .05); However, after treatment, there were significant differences among the 3 groups (P < .05), group C was better than group A and group B, group B was better than group A, and the differences were statistically significant (P < .05). The difference in clinical efficacy among the 3 groups was statistically significant (P < .05). The clinical efficacy of chitosan combined with low-dose glucocorticoid intra-articular injection in the treatment of knee osteoarthritis in early and middle stages is significant, with the characteristics of small trauma, rapid onset, and lasting efficacy, and it avoids the adverse reactions of topical or oral nonsteroidal anti-inflammatory drugs. As a first-line treatment option, it is recommended for promotion and use in clinical practice.
本研究探讨了壳聚糖联合小剂量糖皮质激素关节腔内注射治疗早中期膝骨关节炎的临床疗效。比较三组治疗前后视觉模拟评分（VAS）、Lysholm 评分、美国特种外科医院（HSS）评分及关节液中炎症细胞因子 IL-1、IL-6、TNF-α 水平的变化，并评价临床疗效。所有病例均获得随访，随访时间 7～12 个月，无失访病例。水平比较显示，三组治疗后 VAS 评分、Lysholm 评分、HSS 评分及关节液中炎症细胞因子 IL-1、IL-6、TNF-α 水平均优于治疗前，差异有统计学意义（P < .05）。纵向比较显示，三组治疗前 VAS 评分、Lysholm 评分、HSS 评分及关节液中炎症细胞因子 IL-1、IL-6、TNF-α 水平比较差异无统计学意义（P > .05）；治疗后三组间比较差异有统计学意义（P < .05），C 组优于 A 组和 B 组，B 组优于 A 组，差异均有统计学意义（P < .05）。三组临床疗效比较差异有统计学意义（P < .05）。结论：壳聚糖联合小剂量糖皮质激素关节腔内注射治疗早中期膝骨关节炎疗效显著，具有创伤小、起效快、疗效持久等特点，且避免了局部或口服非甾体类抗炎药的不良反应。作为一线治疗方案，推荐在临床实践中推广应用。
