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Objective:To observe the clinical effect of arthrocentesis combined with liquid phase con-centrated growth factor(CGF)injection in the treatment of unilateral temporomandibular joint osteoarthri-tis(TMJOA),in order to provide a new treatment option for TMJOA patients.Methods:In this non-randomized controlled study,patients diagnosed with unilateral TMJOA who visited the center for tem-poromandibular joint disorder and orofacial pain of Peking University School and Hospital of Stomatology from June 2021 to January 2023 were selected as research objects.The patients were divided into experi-mental group and control group,which were selected by patients themselves.The experimental group re-ceived arthrocentesis combined with liquid phase CGF injection and the control group received arthrocen-tesis combined with HA injection.Both groups were treated 3 times,once every two weeks.The clinical effect was evaluated by the maximum mouth opening,pain value and the degree of mandibular function limitation 6 months after treatment.The change of condylar bone was evaluated by cone beam CT(CBCT)image fusion technology before and after treatment.Results:A total of 20 patients were included in the experimental group,including 3 males and 17 females,with an average age of(34.40± 8.41)years.A total of 15 patients were included in the control group,including 1 male and 14 females,with an average age of(32.20±12.00)years.There was no statistical difference in general information between the two groups(P＞0.05).There were no statistical differences in the mouth opening,pain value and the degree of jaw function limitation between the two groups before treatment(P＞0.05),and all of them improved 6 months after treatment compared with before treatment(P＜0.05).However,the mouth opening of experimental group was significantly higher than that of control group 6 months after treatment(P＜0.05),and the degree of jaw function limitation was significantly lower than that of con-trol group(P＜0.05).CBCT 2D images showed that the condylar bone of both groups was smoother after treatment than before treatment,and image fusion results showed that 10 patients(50.0％)in the experimental group and 5 patients(33.3％)in the control group had reparative remodeling area of con-dylar bone,and there was no statistical difference between them(P＞0.05).Except for one CGF pa-tient,the other patients in both groups had some absorption areas of condylar bone.Conclusion:The ar-throcentesis combined with liquid phase CGF injection can improve the clinical symptoms and signs of unilateral TMJOA patients in short term,and is better than HA in increasing mouth opening and impro-ving jaw function.CBCT fusion images of both patient groups show some cases of condylar bone repara-tive remodeling and its relevance to treatment plans still requires further study.
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BACKGROUND:Intra-articular injection played an important role in the treatment of osteoarthritis and has more options with the development of novel drug delivery systems.The cartilage targeting function is aimed at the adhesion or retention of drugs in the cartilage layer to form a drug bank to achieve slow release and precise drug delivery. OBJECTIVE:To review various cartilage targeting biomaterials and their characteristics in the treatment of osteoarthritis by articular injection. METHODS:Using the term"osteoarthritis,drug carrier,drug delivery,cartilage targeting,penetrate"as key words,relevant articles were searched in CNKI,WanFang and PubMed databases.According to inclusion and exclusion criteria,67 articles were finally selected for further review. RESULTS AND CONCLUSION:The research on cartilage-targeting biomaterials is mainly divided into two directions.One is the combination of electrostatic interaction,such as the combination of positively charged biomaterials and negatively charged polysaccharides in cartilage.This kind of scheme is operable and easy to modify,but limited by the shortcomings of electrostatic interaction itself,it performs badly in advanced osteoarthritis.Another one is the specific binding of various components in cartilage which is strong and reliable,and related biomaterials have excellent performance in advanced osteoarthritis,which is an important direction for future cartilage-targeted therapy.
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BACKGROUND:In recent years,tranexamic acid has been extensively used to mitigate the substantial blood loss associated with total knee arthroplasty.However,the optimal method of topical application has not yet been established. OBJECTIVE:To evaluate the effectiveness and safety of intraoperative topical application of tranexamic acid combined with physical compression dressing in reducing perioperative blood loss in total knee arthroplasty. METHODS:A retrospective analysis was conducted on 90 patients who underwent total knee arthroplasty at the Honghui Hospital in Xi'an from January 2021 to December 2022.Based on the different topical use methods of tranexamic acid during surgery,patients were divided into three groups,with 30 cases in each group.In the compression dressing group,2 g of tranexamic acid was placed in the articular cavity,and after packing the wound with gauze and cotton pads,a bandage was used to compress the wound.In the periarticular injection group,2 g of tranexamic acid was injected into the surrounding tissue of the articular cavity.In the intra-articular injection group,2 g of tranexamic acid was injected into the articular cavity.The blood loss,operation time,coagulation indicators,inflammatory indicators,and postoperative complications of the three groups were statistically analyzed. RESULTS AND CONCLUSION:(1)In terms of total blood loss,hidden blood loss,and maximum hemoglobin drop,the periarticular injection group had the least amount,and there was no statistically significant difference between the compression dressing group and periarticular injection group(P>0.05).In terms of intraoperative blood loss,the compression dressing group had the least amount,and there were statistically significant differences compared with the periarticular injection group and intra-articular injection group(P<0.05).There was no statistically significant difference in operation time among the three groups(P>0.05).(2)There were no statistically significant differences in coagulation indicators(D-dimer and fibrinogen degradation products)and inflammation indicators(C-reactive protein and erythrocyte sedimentation rate)among the three groups preoperatively and on the first and third days after operation(P>0.05).(3)There was no statistically significant difference observed among the three groups in terms of slow blood flow in the affected limb,intramuscular venous thrombosis,soft tissue swelling,and incidence of wound complications(P>0.05).Additionally,no cases of deep vein thrombosis or pulmonary embolism were detected in any of the groups.(4)The topical application of tranexamic acid combined with compression dressing achieves the same effect as a periarticular injection in terms of simplicity of operation and reduced perioperative blood loss.This method also avoids the trauma caused by repeated punctures and does not increase the incidence of postoperative complications,making it a worthwhile option for clinical promotion.
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BACKGROUND:For early knee osteoarthritis in which total knee arthroplasty fails to achieve satisfactory results,high tibial osteotomy that has been found to promote regeneration of damaged cartilage and alleviate symptoms in patients is considered a classic knee-preserving procedure. OBJECTIVE:To review and discuss the effectiveness,mechanism,and application prospects of high tibial osteotomy in stimulating cartilage regeneration in knee osteoarthritis and to provide a theoretical basis for the use of high tibial osteotomy in the treatment of knee osteoarthritis. METHODS:A computerized search was conducted in PubMed,Web of Science,CNKI and WanFang databases for relevant literature published from 2013 to 2023.The search terms used were"knee osteoarthritis,high tibial osteotomy,limb alignment,chondrocytes,biomechanics,intra-articular"in both English and Chinese.Finally,75 articles were included for review. RESULTS AND CONCLUSION:High tibial osteotomy correcting the lower limb alignment has been found to be effective in alleviating symptoms and potentially delaying or preventing the need for total knee arthroplasty.This is an important aspect of orthopedic step-down treatment in knee osteoarthritis.Maintaining a normal mechanical microenvironment is crucial for the proper functioning and maintenance of chondrocyte phenotype.Abnormal mechanical signals can be converted into intracellular chemical signals through mechanosensors like primary cilia,integrins,cytoskeleton and nucleoskeleton,resulting in disruptions to the balance of matrix metabolism and regulation of inflammatory responses.Chondrocytes after abnormal stress action still have the potential to revert to a normal phenotype under appropriate stress;correction of the mechanical microenvironment by high tibial osteotomy leads to spontaneous cartilage repair and remission of synovial inflammation.The combination of high tibial osteotomy and cartilage regeneration strategy holds promising prospects for patients with early knee osteoarthritis who are not candidates for total knee arthroplasty.
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Background: Adhesive capsulitis is a debilitating disease in an otherwise healthy individual. Intra-articular corticosteroid injections offer a cost-effective, non-operative treatment option. However, it is currently unclear whether an ultrasound-guided injection relieves the symptoms of shoulder pain more effectively than if the injection was delivered landmark-guided. Methods: Eighty patients with adhesive capsulitis were randomized to two intervention groups - landmark guided and ultrasound (USG) guided. The functional status of the patients was documented prior to the intervention. Following allocation, the intra-articular steroid was administered either under USG guidance or following identification of the site of injection using landmarks. Follow-up was done on day 5, 3 weeks, 6 weeks, and 12 weeks post procedure to document the functional status. Results: The difference in visual analogue score (VAS) between the two arms was found to be statistically significant in favour of the ultrasound guided technique only on day 5 and day 21. On the other hand, the difference in disability of arm, shoulder, and hand (DASH) score between the 2 arms was found to be statistically significant in favour of the ultrasound guided technique on day 5, 21, 42 and 84. Finally, in our study, both shoulder flexion and abduction on day 84 achieved a statistically significant improvement, favouring the ultrasound guided arm. Conclusions: Ultrasound guided corticosteroid injections may offer modestly better short-term functional outcome and symptom relief when compared with landmark guided corticosteroids.
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Objective:To observe the clinical efficacy of intra-articular injection with Triamcinolone acetonide on the treatment of juvenile idiopathic arthritis (JIA).Methods:The clinical data of 26 children diagnosed with JIA undergoing the intra-articular injection of Triamcinolone acetonide for the joints with obvious swelling and pain at the Children′s Hospital Affiliated to Capital Institute of Pediatrics from October 2018 to December 2019 who were retrospectively analyzed.Erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) were tested before and after the application of Triamcinolone acetonide.Detailed clinical manifestations were recorded.The nonparametric Kruskal- Wallis test was used to compare the differences in clinical evaluation indicators and changes in laboratory tests at diffe-rent treatment times. Results:Among the 26 children, 8 were boys and 18 were girls.After the intra-articular injection of Triamcinolone acetonide, 9 cases (34.62%) achieved complete remission, 15 cases(57.69%) achieved partial remission, and 2 cases (7.69%) were not responsive to the intra-articular injection.The overall therapeutic efficacy was 92.31%.Compared with pre-treatment period, from 4 weeks after treatment, assessment of disease activity by the physicians and parents of the children was significantly improved after 4-week treatment, and the number of active joints, ESR and CRP and the Juvenile Arthritis Disease Activity Score with 27 joints (JADAS 27) gradually decreased, and the differences were statistically significant (all P<0.05). No adverse drug reactions were seen during the treatment and follow-up period. Conclusions:Intra-articular injection of Triamcinolone acetonide is effective in contro-lling joint symptoms of JIA with less adverse events.
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Knee osteoarthritis (KOA) is one of the most common musculoskeletal diseases. Platelet-rich plasma (PRP) has been widely used in the treatment of KOA. However, the effectiveness of KOA treatment has been affected due to the large differences in PRP preparation technology, storage method, and intra-articular injection treatment plan. Based on a comprehensive and systematic literature review and clinical practice experience, experts in blood transfusion medicine, orthopedics and rehabilitation medicine and other disciplines (departments) from a number of domestic large-scale tertiary hospitals with experience in the treatment of KOA with apheresis PRP formed this expert consensus by in-depth study. The consensus includes four aspects: the background of the formation of the consensus, the advantages of preparing PRP from autologous platelets apheresis for KOA treatment, the theoretical basis and the frozen storage method of apheresis PRP, and the clinical application scheme of apheresis PRP intraarticular injection for the treatment of KOA. Recommendations are as follows: autologous PRP prepared by platelets apheresis is used to treat KOA by intra-articular injection; the platelet concentration(Plt) in PRP prefers (1 000~1 800)×109/L, the red blood cells(RBC) contamination should be ≤3.2×1010/L, and the leukocytes(WBC) contamination should be ≤2.0×109/ L; PRP is suitable to be stored at -80℃, within 6-months storage; a course of treatment prefers 3 to 4 occasions of injection, with an interval of 1 to 2 weeks; the injection volume of one knee joint could be (4~8)mL/person; the joint effusion should be removed before injection without mixing with anesthetics or corticosteroids; restriction of strenuous exercise for 48 hours after injection is necessary. This consensus is intended to promote the standardized application of autologous apheresis PRP in the treatment of KOA, improve the effectiveness of clinical treatment of KOA and the scientificity of its evaluation, so as to lay a preliminary foundation for formulating standardized guidelines or (and) standards for the treatment of KOA with autologous apheresis PRP in the future.
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Abstract Objective: to evaluate the effectiveness of triamcinolone Hexacetonide (TH) Intra-Articular Injection (IAI) in hand Interphalangeal Joints (IP) of Osteoarthritis (OA) patients to improve pain and joint swelling; improve function, goniometry, and grasping force, and assess IAI influence on radiographic evolution over 1-year. Methods: A randomized, double-blind study. 60 patients who underwent IAI at the most symptomatic IP joint were randomly assigned to receive TH+Lidocaine (LD) (TH/LD group) or just LD (LD group). Patients were assessed blindly for 1-year, at baseline and 1, 4, 8, 12, and 48 weeks. The following variables were assessed: articular pain and swelling, AUSCAN and COCHIN functional questionnaires, grip and pinch strength, goniometry, perception of improvement, acetaminophen consumption, and simple radiography. Repeated-measures ANOVA test was used to analyze the intervention response. Results: Sixty patients completed the follow-up. There were nine missed assessments. 97% were women; mean age of 61-years (SD = 8.2), and approximately 5-years of disease (SD = 3.6). Half of the patients present radiographic classification Kellgren and Lawrence (KL) grades I and II, and the other half grades III and IV. The two groups evolved similarly at 48-weeks. TH/LD group had a better evaluation in joint swelling and acetaminophen consumption (p = 0.04 and p < 0.001, respectively) at 48-weeks. Radiographically there was no statistical difference between groups (KL, p = 0.564; erosive OA, p = 0.999; worsening, p = 0.573). Conclusion: The IAI IP hands OA is effective for the improvement of joint swelling and decrease of analgesic consumption and does not influence the radiographic evolution of the injected joint.
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@#This study sought to assess the therapeutic effect of celecoxib (CEL)-loaded polylactic acid-glycolic acid copolymer (PLGA) microspheres on rheumatoid arthritis in rats after intra-articular injection.The celecoxib-loaded microspheres (CEL-MS) were prepared by the O/W solvent volatilization method with PLGA as carrier.In order to investigate the therapeutic effect of CEL-MS on rheumatoid arthritis in rats after intra-articular injection, a rat model of adjuvant arthritis (AA) was constructed by complete Freund''s adjuvant, and the evaluation indicators of the therapeutic effect were rat paw swelling, arthritis index,spleen index and joint synovial histopathological examination. The results showed that the microspheres had a smooth spherical morphology with a particle size of (2.1 ± 0.3) μm and a drug loading efficiency of (20.8 ± 0.6)%.The results of the in vivo efficacy test showed that intra-articular injection of CEL-MS compared to the CEL suspension oral and the celecoxib suspension intra-articular injection in adjuvant arthritis rat model can significantly reduce joint swelling and arthritis index, thus effectively inhibiting synovial inflammation.The above results indicate that intra-articular injection of CEL-MS has a good therapeutic effect on rheumatoid arthritis in rats.
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Introduction: Prolotherapy is a minimally invasive techniqueused in the treatment of temporomandibular disorders.Prolotherapy agent induces an inflammatory process in thejoint, stimulates fibroblast proliferation, hence facilitatesthe healing process and strengthens the joint and associatedligaments and tendons. The main aim of this article wasto study the effect of 25% dextrose prolotherapy ontemporomandibular joint pain, clicking and maximum mouthopening by using different injection sites.Material and methods: Sixty patients with establisheddiagnosis of unilateral disc displacement with reduction whocomplained of unilateral symptoms (pain and clicking) wereincluded in the study. They were randomly allocated to threegroups (Group A, Group B and Group C) of 20 patients each.Group A patients received intra-articular injections into thesuperior joint space, Group B patients received injections intothe inferior joint space where as Group C patients were giveninjections into the retrodiscal tissues. Each group receivedsubsequent injections at first, second and third weeks at therespective sites. Pain, clicking and maximum mouth opening(MMO) was recorded pre-operatively, post-operatively at 3weeks and 2 months.Results: Group B and Group C patients showed a significantdecrease in the pain score at 3 weeks and 2 months postoperatively while as no significant pain relief was observed inGroup A. Maximum mouth opening improved significantly inGroup B and Group C patients at 3 weeks and 2 months andwas highest in Group C. Reduction in clicking was best seenin Group C.Conclusion: Prolotherapy is more effective when injectionsite is selected as per the type of symptoms of the patientswith temporomandibular disorders.
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BACKGROUND: Bone marrow mesenchymal stem cells have been extensively applied in animal experiments and clinical studies. The cell concentration, treatment times and results in each study are different, and there is no standard for optimal cell concentration. OBJECTIVE: To investigate the optimal concentration of bone mesenchymal stem cells injected into articular cavity in the treatment of rabbit cartilage defects. METHODS: Thirty 6-month-old New Zealand white rabbits were selected and randomly divided into control, 1×108, 1×109, 1×1010, and 1×1011/L groups. Cartilage defect models with diameter of 3 mm and depth of 2 mm were established in femoral trochlea in each group. One week after modeling, 1 mL of normal saline was injected into the rabbit’s knee of the control group. The other groups were injected with bone marrow mesenchymal stem cells at corresponding concentrations. After 6 and 12 weeks, gross observation, hematoxylin-eosin staining, Safranin-O-fast green-staining, type I and II collagen staining were performed to assess the cartilage regeneration. RESULTS AND CONCLUSION: In the control group, the defect area was obvious with no cartilage regeneration. The 1×108, 1×109, and 1×1010/L groups showed cartilage regeneration. The repairing effect was increased with the cell concentration increasing. The effect of cartilage repair in the 1×1011/L group was similar to that in the 1×1010/L group (P > 0.05). Therefore, 1×1010/L is the optimal concentration for intra-articular injection of bone marrow mesenchymal stem cells for treating cartilage defects, and higher concentration cannot enhance the repairing effect.
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OBJECTIVES@#To evaluate the efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty (TKA).@*METHODS@#A total of 50 patients with knee osteoarthritis treated by TKA from July to September 2018 were randomly divided into two groups (=25). The Group 1 underwent anterior intra-articular injection before prosthesis implanted while the Group 2 underwent posterior intra-articular injection before prosthesis implanted. Visual Analogue Scale (VAS) of all patients for pain during activity and at rest, maximal flexion degree of the knee at the 48th h and the 72th h after surgery, the time of raise leg, usage rate of patient-controlled analgesia (PCA), and complications were evaluated and analyzed.@*RESULTS@#VAS for pain at rest of patients in the Group 1 was significantly less than that in the Group 2 at the 6th, 12th, and 24th h after surgery (all <0.05). Maximal flexion degree of the knee at the 48th h and the 72th h after surgery in the Group 1 was better than that in the Group 2 (both <0.05). The Group 1 costed less time than the Group 2 on the ability to perform an active straight leg raise (=0.027).@*CONCLUSIONS@#The anterior intra-articular cocktail analgesic mixture injection can strongly relieve the pain early after TKA, which can improve knee function and achieve painless rehabilitation in most patients, with safety.
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Humans , Analgesics , Arthroplasty, Replacement, Knee , Injections, Intra-Articular , Osteoarthritis, Knee , General Surgery , Pain Measurement , Pain, PostoperativeABSTRACT
El dolor sacroilíaco es una causa generalmente subdiagnosticada de dolor lumbar, que afecta del 15% a 30% de los pacientes con dolor lumbar bajo crónico no radicular. La articulación sacroilíaca (ASI) recibe continuo stress durante la bipedestación y marcha, siendo estabilizada por estructuras ligamentarias, capsulares y miofasciales fuertes, que reciben una abundante inervación. Destaca la dificultad en el diagnóstico del dolor sacroilíaco; debido a su naturaleza heterogénea. Éste se debe sospechar en todo paciente con síndrome de dolor lumbar no radicular, unilateral y no central. El examen físico debería descartar patología de cadera y columna lumbar. La realización de maniobras de provocación del dolor sacroilíaco aporta en el diagnóstico, teniendo la combinación de 3 o más maniobras positivas una sensibilidad de 85% y especificidad de 79%. Se ha recurrido a inyecciones diagnósticas con anestésicos locales, tanto intraarticulares como de ligamentos circundantes. El tratamiento del dolor sacroilíaco es multimodal e individualizado para cada paciente. El tratamiento conservadorbasado en terapia física y antiinflamatorios no esteroidales es la terapia de primera línea. Las infiltraciones esteroidales tanto intra como extraarticulares pueden proveer alivio en un grupo de pacientes con inflamación activa. La denervación de los ramos dorsales laterales con radiofrecuencia ha mostrado ser un tratamiento exitoso en pacientes con dolor sacroilíaco, logrando 6 meses a 1 año de alivio del dolor. En pacientes con dolor refractario, la fusión de la articulación sacroilíaca es una opción, prefiriéndose la técnica mínimamente invasiva de fijación trans-sacroilíaca.
Sacroiliac pain is an frecuent underdiagnosed source of low back pain, affecting 15% to 30% of individuals with chronic, non-radicular pain. The sacroiliac joint (SIJ) is subject to continuous stress during standing position and gait, being stabilized by strong ligament, capsular and myofascial structures with rich innervation. Due to its heterogeneous nature, SIJ pain is difficult to diagnose, and it should be suspected in all patients with non-radicular unilateral and non-central low back pain syndrome. Physical examination should rule out hip and lumbar spine pathology. SIJ provocation maneuvers are used for diagnosis, with the combination of 3 or more positive maneuvers resulting in a sensitivity of 85% and a specificity of 79%. Diagnostic injections of local anesthetics, both intra-articular and in the surrounding ligaments have been used. treatment of SIJ pain is multimodal and individualized for each patient. Conservative treatment, based on physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs) is the first line therapy. Both intra- and extra-articular steroid infiltrations can provide relief in a group of patients with active inflammation. Radiofrequency denervation of lateral dorsal branches has proven to be a successful treatment in SIJ pain patients, achieving 6 to 12 months of pain relief. In patients with refractory pain, SIJ fusion is an option, with minimally invasive trans-sacroiliac fixation being the preferred technique.
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Humans , Sacroiliac Joint/pathology , Low Back Pain/diagnosis , Low Back Pain/therapy , Low Back Pain/etiology , Low Back Pain/physiopathology , Diagnosis, DifferentialABSTRACT
OBJECTIVE: To examine (1) the degree of reduction of passive range of motion (PROM) on the affected side compared to that on the unaffected side and (2) the degree of increase in PROM following intra-articular corticosteroid injection (IACI) in patients with frozen shoulder.METHOD: The medical records of 120 patients with frozen shoulder were retrospectively reviewed. PROM of the unaffected and affected shoulder (flexion, extension, abduction, internal rotation, external rotation) was compared, and changes in PROM of the affected shoulder after a single IACI (triamcinolone 20 mg) were evaluated after 12 weeks.RESULTS: At the time of diagnosis, PROM of the affected shoulder was most limited in external rotation, followed by internal rotation, abduction, extension, and flexion, compared to that of the unaffected shoulder. Compared to before IACI, PROM of external rotation demonstrated the greatest increase compared to all the other movements after IACI.CONCLUSION: Limitation in PROM of the frozen shoulder at the time of diagnosis was greatest for external rotation. Moreover, external rotation experienced the greatest improvement after IACI. Our findings should help to further clarify the clinical characteristics of frozen shoulder, aid in its diagnosis, and allow the prediction of the effects of IACI.
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Humans , Adrenal Cortex Hormones , Bursitis , Diagnosis , Follow-Up Studies , Injections, Intra-Articular , Medical Records , Methods , Range of Motion, Articular , Retrospective Studies , ShoulderABSTRACT
OBJECTIVE： To observe the efficacy and safety of fluorouracil combined with paracetamol in the treatment of knee osteoarthritis and its effects on related indexes. METHODS： Totally 115 patients with knee osteoarthritis admitted to our hospital from March 2015 to March 2018 were divided into control group （57 cases） and observation group （58 cases） according to medication plan. Control group was given Paracetamol tablets 0.3 g orally， 3 times a day， for consecutive 8 weeks. Observation group was additionally given intra-articular injection of Fluorouracil injection 0.075 g on the basis of control group， once a week， 4 times as a treatment course， for 2 courses in total. Clinical efficacies， VAS scores， Lysholm knee scores， Fugl-Meyer Assessment （FMA） scores， Barthel indexes， WHO QOL-BREF scores before and after treatment and the occurrence of ADR of 2 groups were observed. RESULTS： The total response rate of observation group was 94.83％， which was significantly higher than 78.95％ of control group （P＜0.05）. Before treatment， there was no statistical significance in VAS score， Lysholm knee scores， FMA scores， Barthel index or QOL-BREF scores between 2 groups （P＞0.05）. After treatment， VAS scores of 2 groups were significantly lower than before treatment， and the observation group was lower than the control group； Lysholm knee scores， FMA scores， Barthel indexes and QOL-BREF scores were significantly higher than the same group before treatment， and observation group was significantly higher than control group （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups （P＞0.05）. No severe ADR was found in 2 groups during treatment. CONCLUSIONS： Fluorouracil combined with paracetamol can significantly improve therapeutic efficacy of patients with knee osteoarthritis， and can significantly improve knee function， motor function， self-care ability and quality of life without increasing the occurrence of ADR.
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OBJECTIVE@#To observe and evaluate the clinical effect of intra-articular injection of parecoxib in patients with early knee osteoarthritis.@*METHODS@#From September 2016 to August 2017, 107 patients with early knee osteoarthritis were treated, including 50 males and 57 females, aged 45 to 64 (51.9±4.2) years. They were divided into basic therapy+oral glucosamine group(group A) 36 cases, oral celecoxib+basic therapy+oral glucosamine group(group B) 36 cases, intra-articular injection of parecoxib+basic therapy+oral glucosamine group(group C) 35 cases. There was no significant difference in gender, age, BMI and clinical stage(Kellgren-Lawrence classification) between the three groups before treatment. VAS score, HSS score and patient satisfaction were compared before and after treatment in the three groups. The levels of inflammatory cytokines in synovial fluid were measured before and after treatment in the three groups.@*RESULTS@#All cases were followed up for(15.2±2.6) months on average. The VAS score and HSS score of each group were improved after treatment(<0.001). There were significant differences in VAS and HSS scores among the three groups after treatment(<0.001). The clinical efficacy of group C was better than that of group A and B(<0.001), group B was better than that of group A(<0.001), and group C had the highest satisfaction(<0.001). After treatment, the concentration of proinflammatory factor TNF-α and IL-6 in the synovial fluid of each group decreased(<0.001) and the concentration of anti-inflammatory factor IL-10 increased(<0.001). After treatment, the concentrations of TNF-α, IL-6 and IL-10 in the synovial fluid of the three groups were significantly different(<0.001).@*CONCLUSIONS@#For patients with early knee osteoarthritis, intra-articular injection of parecoxib can significantly improve clinical symptoms and avoid adverse reactions of long-term oral NSAIDs, which is an effective treatment.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Injections, Intra-Articular , Isoxazoles , Therapeutic Uses , Osteoarthritis, Knee , Drug TherapyABSTRACT
BACKGROUND: Osteoarthritis (OA), the most common arthritis, is one of the most frequently encountered orthopaedic conditions. As a small number of large joints such as knee and hip are affected in OA, OA is an ideal target for local therapy. Although corticosteroid and hyaluronic acid have been traditionally used for joints through intra-articular (IA) injection, IA injection also provides a minimally invasive route to apply cell therapy to treat OA. IA cell therapy has drawn attention because it may provide regeneration of articular cartilage in addition to palliative anti-inflammatory effects. METHODS: Current progress of IA injection therapy and the author's perspective on this issue are described narratively. RESULTS: It is too premature to have any conclusion on the eventual efficacy of IA cell therapy concerning regeneration of articular cartilage based on current data. Prospective radiological and histological data from larger numbers of patients are needed to prove cost effectiveness of IA cell therapy. CONCLUSION: Expanding research in this field will produce further evidences to provide guidance on the eventual effectiveness of IA cell therapy in the future.
Subject(s)
Humans , Arthritis , Cartilage, Articular , Cell- and Tissue-Based Therapy , Cost-Benefit Analysis , Hip , Hyaluronic Acid , Injections, Intra-Articular , Joints , Knee , Osteoarthritis , Prospective Studies , RegenerationABSTRACT
Objective: To compare the efficacy and safety of intra-articular combined with intravenous administration of tranexamic acid (TXA) with different dosage for reducing blood loss in primary total knee arthroplasty (TKA). Methods: Between January 2017 and June 2017, 90 patients suffering from unilateral osteoarthritis who underwent primary TKA were randomly scheduled to three interventions, named groups A, B, and C. Single dosage of TXA via intravenous injection (IV) and different dosages of TXA via intra-articular injection (IA) were utilized in three groups, respectively. All patients in three groups received 1 g TXA IV at 10 minutes preoperatively, and received 1, 2, and 3 g TXA IA diluted in 50 mL saline after wound closure in groups A, B and C, respectively. The age, gender, body mass index, affected side of the knee, grade of osteoarthritis, grade of America Society of Anesthesiologist, preoperative hemoglobin (Hb) concentration, platelet count, preoperative prothrombin time, and activated partial thromboplastin time were not significantly different between groups ( P>0.05). The postoperative wound blood drainage, Hb concentration at 1, 3, and 7 days after operation, transfusion rate, and thromboembolic complications were observed. All patients were routinely observed for deep vein thrombosis (DVT) by the color Doppler ultrasonography at 1 week, 1 month, and 3 months after operation, and the symptomatic pulmonary embolism (PE) were observed. Results: All patients in three groups were followed up 7-12 months (mean, 8.4 months). There was no significant difference in operation time between groups ( P>0.05). The postoperative wound blood drainage was significantly less in groups B and C than that in group A ( P0.05). Incision skin necrosis occurred in 1 case of group B and fat liquefaction occurred in 1 case of group C. The other incisions of 3 groups healed by first intention. There was no significant difference in incision complication incidence between groups. The Hb concentration was significantly higher in groups B and C than that in group A at 1, 3, and 7 days after operation ( P0.05). The result of color Doppler ultrasonography showed that 1 case got DVT in the contralateral calf at 3 weeks in group B. And there was no symptomatic PE in 3 groups. Conclusion: Combined administration of IV and IA TXA in a clinically relevant reduction in blood loss was effective and safe in primary TKA, and no thromboembolic complication was observed. The combination of 1 g IV with 2 g IA could be the optional choice.
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OBJECTIVE: To examine the clinical benefits of acupuncture combined with intra-articular injection of sodium hyaluronate for knee osteoarthritis (KOA) patients. METHODS: A total of 150 KOA patients were randomized into simple medication and acupuncture plus medication (combined treatment) groups (n＝75 in each). For all the patients, intra-articular injection of sodium hyaluronate (2 mL) was performed once a week for 5 weeks, and for patients of the combined treatment group, filiform needles were separately inserted into unilateral or bilateral Zusanli (ST 36), Liangqiu (ST 34), Yanglingquan (GB 34), Yinlingquan (SP 9), Xiyangguan (GB 33), Dubi (ST 35), Neixiyan (EX-LE 4) and Xuehai (SP 10) according to the focus, and manipulated with the uniform reinforcing and reducing technique, followed by retaining the needles for 30 min. The acupuncture treatment was given once every day or every other day, 5 weeks in total. The visual analog scale (VAS) was used to assess the pain severity of knee-joint, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) employed to assess the 1) pain severity during various positions or movements (20 points), 2) severity of joint stiffness (8 points), and 3) difficulty in performing daily functional activities (68 points). The therapeutic effect was evaluated according to the decreased level of WOMAC subscale scores and improvement of daily activities. RESULTS: After the treatment, the VAS scores of both medication and combined treatment groups were decreased significantly in comparison with their own pre-treatment in each group (P<0.05), and that of the combined treatment group was significantly lower than that of the medication group (P<0.05). WOMAC and daily activity fin-dings showed that of the two 75 KOA patients in the medication and combined treatment groups, 16 (21.33%) and 32 (42.67%) experienced marked improvement, 46 (61.33%) and 38 (50.67%) were improved, and 13 (17.33%) and 5 (6.67%) ineffective, with the total effective rates being 82.67% and 93.33%, respectively. The therapeutic effect of the combined treatment group was apparently superior to that of the simple medication group (P<0.05). CONCLUSION: Acupuncture combined with intra-articular injection of sodium hyaluronate is effective in improving KOA patients' pain severity and other symptoms as well as functional activities.
ABSTRACT
Objective:To compare the effects of different glucocorticoids on the pulmonary infection in patients with rheumatoid arthritis (RA).Methods: From January 2013 to February 2017,128 cases of patients with RA in our hospital were selected as the research object,all the cases were divided into observation group and control group with 64 cases in each group accorded to the random draw envelope principle.The observation group was given intra-articular injection of corticosteroid therapy,the control group was given oral glucocorticoid therapy,two groups were treated for 8 weeks.Results:The total effective rate of the observation group and the control group was 96.9% and 84.4% respectively,and the total effective rate of the observation group was significantly higher than that of the control group(P<0.05).The joint pain and joint swelling index of the observation group and the control group after treatment were sig-nificantly lower than that before the treatment (P<0.05),and the joint pain and joint swelling index of the observation group after treatment were significantly lower than that of the control group (P<0.05).The incidence of pulmonary infection in the observation group and the control group during treatment were 1.6% and 7.8%,respectively.The incidence of pulmonary infection in the observation group was significantly lower than that in the control group (P<0.05).The CRP and RF in the observation group after treatment were (10.11±3.19)mg/L and (50.22±19.82)U/ml that were significantly lower than the control group of (17.49±5.32) mg/L and (59.14±20.59)U/ml (P<0.05),while the CRP and RF values of the two groups after treatment was obviously lower than that before treatment (P<0.05).Conclusion: Compare with oral administration,intra articular injection of glucocorticoid for RA can reduce the incidence of pulmonary infection,inhibit the expression of inflammatory factors and RF,and promote the alleviation of clinical symptoms,thereby enhance the therapeutic effect.