關節鏡下清理術聯合關節內透明質酸注射治療膝關節骨關節炎有效性的系統評價_《中國循證醫學雜志》

作者：

蔣勰 ¹ , 占美 ² , 李棋 ¹ , 劉東 ¹ ,  李箭 ¹

1. 四川大學華西醫院骨科（成都 610041）；2. 四川大學華西醫院藥劑科（成都 610041）;

關鍵詞：

關節鏡下清理術膝關節骨關節炎透明質酸系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20120212

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目的　系統評價關節鏡下清理術聯合關節內透明質酸注射治療膝關節骨關節炎的有效性。
方法　計算機檢索The Cochrane Library、SCI、MEDLINE、EMbase、CBM和WanFang Data，查找所有關節鏡下清理術聯合關節內透明質酸注射（聯合療法）與二者任一單一療法比較治療膝關節骨關節炎的隨機對照試驗，檢索時限均從建庫至2012年。由2位研究者按照納入和排除標準獨立篩選文獻、提取資料并評價質量后，采用RevMan 5.0軟件進行Meta分析。
結果　最終納入7個隨機對照試驗，共526例患者。Meta分析結果顯示聯合治療與單用關節內透明質酸注射［RR=1.40，95%CI（0.99，1.98），P=0.06］或單純關節鏡下清理術［RR=1.09，95%CI（0.93，1.26），P=0.29］治療膝關節骨關節炎的優良率相似，其差異無統計學意義。但單用關節內透明質酸注射治療在改善患者Lysholm評分方面不及聯合治療，兩組差異有統計學意義［MD=–14.81，95%CI（–17.55，–12.08）， P lt;0.000 01］。
結論　關節鏡下清理術聯合關節內透明質酸注射治療膝關節骨關節炎的優良率與單一療法的差異無統計學意義，但Lysholm評分高于單用透明質酸注射治療，聯合療法具有一定優勢。受納入研究數量和質量限制，上述結論尚需開展更多高質量的隨機對照試驗加以驗證。

引用本文： 蔣勰,占美,李棋,劉東,李箭. 關節鏡下清理術聯合關節內透明質酸注射治療膝關節骨關節炎有效性的系統評價. 中國循證醫學雜志, 2012, 12(11): 1361-1366. doi: 10.7507/1672-2531.20120212 復制

1.	胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 第3版. 北京: 人民軍醫出版社, 2006: 1337.
2.	Felson DT. Osteoarthritis of the knee. N Engl J Med, 2006, 354: 841-848.
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5.	Peyron JG, Balazs EA. Preliminary clinical assessment of Na-hyaluronate injection into human arthritic joints. Pathol Biol, 1974, 22: 731-733.
6.	Choi HK, Modawal A, Ferrer M, et al. A meta–analysis on the efficacy of intra–articular viscosupplementation therapy for knee osteoarthritis. Arthritis & Rheumatism, 1999, 42(9): 293.
7.	Espallargues M, Pons JMV. Efficacy and safety of viscosupplementation with Hylan G-F 20 for the treatment of knee osteoarthritis. A systematic review. International Journal of Technology Assessment in Health Care, 2003, 19(1): 41-56.
8.	Lo GH, La Valley M, McAlindon T, et al. Intra–articular hyaluronic acid in treatment of knee osteoarthritis. A meta–analysis. JAMA, 290(23): 3115-3121.
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10.	Wang CT, Lin J, Chang CJ, et al. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. The Journal of Bone and Joint Surgery, 2004, 86A(3): 538-545.
11.	American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum, 2000, 43: 1905-1915.
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15.	張智材, 李金德, 韻向東, 等. 膝關節鏡清理術聯合應用玻璃酸鈉關節注射治療膝關節骨關節炎的臨床應用研究. 衛生職業教育, 2010, 28(20): 135-137.
16.	唐新橋, 劉忠, 梁培雄. 膝關節鏡術后注射玻璃酸鈉治療骨性關節炎療效觀察. 中國醫師雜志, 2008, 10(9): 1277-1278.
17.	李有才, 劉晉平, 李正南, 等. 關節鏡術后加玻璃酸鈉治療膝骨性關節炎療效研究. 中國醫師進修雜志, 2011, 34(8): 36-38.
18.	楊海波. 醫用透明質酸鈉在膝骨關節炎關節鏡術后的應用價值. 中華臨床醫師雜志(電子版), 2010, 4(7): 1094-1095.
19.	陳建鋒, 熊昌源, 陳大偉, 等. 聯合順次法治療膝關節骨性關節炎的臨床研究. 中國中醫骨傷科雜志, 2007, 15(4): 1-5.
20.	Hempfling H. Intra-articular hyaluronic acid after knee arthroscopy: a two-year study. Knee Surg Sports Traumatol Arthrosc, 2007, 15: 537-546.
21.	Heybeli N, Doral MN, Atay OA, et al. Intra-articular sodium hyaluronate injections after arthroscopic debridement for osteoarthritis of the knee: a prospective, randomized, controlled study. Acta Orthop Traumatol Turc, 2008, 42(4): 221-227.
22.	American Academy of Orthopaedic Surgeons Treatment of osteoarthritis of the knee (non-arthroplasty): fullguideline.December 6, 2008.Available from: http://www.aaos.org/Research/guidelines/GuidelineOA Knee.asp. Accessed February 16, 2009.
23.	Felson DT, Buckwalter J. Debridement and lavage for ostecoarthritis of the knee. N Engl J Med, 2002, 347: 132-133.
24.	Buckwalter JA, Lohmander S, Operative treatment of osteoarthrosis. Current practice and future development (Current Concepts Review). J Bone Joint Surg Am, 1994, 76(9): 1405-1418.

1. 胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 第3版. 北京: 人民軍醫出版社, 2006: 1337.
2. Felson DT. Osteoarthritis of the knee. N Engl J Med, 2006, 354: 841-848.
3. 吳在德, 吳肇漢. 外科學. 第6版. 北京: 人民衛生出版社, 2004: 330.
4. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol, 1993, 39(Suppl): 3.
5. Peyron JG, Balazs EA. Preliminary clinical assessment of Na-hyaluronate injection into human arthritic joints. Pathol Biol, 1974, 22: 731-733.
6. Choi HK, Modawal A, Ferrer M, et al. A meta–analysis on the efficacy of intra–articular viscosupplementation therapy for knee osteoarthritis. Arthritis & Rheumatism, 1999, 42(9): 293.
7. Espallargues M, Pons JMV. Efficacy and safety of viscosupplementation with Hylan G-F 20 for the treatment of knee osteoarthritis. A systematic review. International Journal of Technology Assessment in Health Care, 2003, 19(1): 41-56.
8. Lo GH, La Valley M, McAlindon T, et al. Intra–articular hyaluronic acid in treatment of knee osteoarthritis. A meta–analysis. JAMA, 290(23): 3115-3121.
9. Berstein J. Therapeutic effects of hyaluronic acid onosteoarthritis of the knee. The Journal of Bone and Joint Surgery, 2004, 86(11): 2567- 2567.
10. Wang CT, Lin J, Chang CJ, et al. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. The Journal of Bone and Joint Surgery, 2004, 86A(3): 538-545.
11. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum, 2000, 43: 1905-1915.
12. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated February 2011]. The Cochrane Collaboration, 2011. Available from: http://www.cochrane-handbook.org.
13. RevMan 2011 Review Manager (Revman) [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
14. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from: http://www.cochrane-handbook.org.
15. 張智材, 李金德, 韻向東, 等. 膝關節鏡清理術聯合應用玻璃酸鈉關節注射治療膝關節骨關節炎的臨床應用研究. 衛生職業教育, 2010, 28(20): 135-137.
16. 唐新橋, 劉忠, 梁培雄. 膝關節鏡術后注射玻璃酸鈉治療骨性關節炎療效觀察. 中國醫師雜志, 2008, 10(9): 1277-1278.
17. 李有才, 劉晉平, 李正南, 等. 關節鏡術后加玻璃酸鈉治療膝骨性關節炎療效研究. 中國醫師進修雜志, 2011, 34(8): 36-38.
18. 楊海波. 醫用透明質酸鈉在膝骨關節炎關節鏡術后的應用價值. 中華臨床醫師雜志(電子版), 2010, 4(7): 1094-1095.
19. 陳建鋒, 熊昌源, 陳大偉, 等. 聯合順次法治療膝關節骨性關節炎的臨床研究. 中國中醫骨傷科雜志, 2007, 15(4): 1-5.
20. Hempfling H. Intra-articular hyaluronic acid after knee arthroscopy: a two-year study. Knee Surg Sports Traumatol Arthrosc, 2007, 15: 537-546.
21. Heybeli N, Doral MN, Atay OA, et al. Intra-articular sodium hyaluronate injections after arthroscopic debridement for osteoarthritis of the knee: a prospective, randomized, controlled study. Acta Orthop Traumatol Turc, 2008, 42(4): 221-227.
22. American Academy of Orthopaedic Surgeons Treatment of osteoarthritis of the knee (non-arthroplasty): fullguideline.December 6, 2008.Available from: http://www.aaos.org/Research/guidelines/GuidelineOA Knee.asp. Accessed February 16, 2009.
23. Felson DT, Buckwalter J. Debridement and lavage for ostecoarthritis of the knee. N Engl J Med, 2002, 347: 132-133.
24. Buckwalter JA, Lohmander S, Operative treatment of osteoarthrosis. Current practice and future development (Current Concepts Review). J Bone Joint Surg Am, 1994, 76(9): 1405-1418.

《中國循證醫學雜志》

關節鏡下清理術聯合關節內透明質酸注射治療膝關節骨關節炎有效性的系統評價

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《中國循證醫學雜志》

關節鏡下清理術聯合關節內透明質酸注射治療膝關節骨關節炎有效性的系統評價

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