{"title":"通过关节镜清创和关节内透明质酸注射治疗轻度和晚期肘关节 OA 病例","authors":"","doi":"10.1016/j.jorep.2024.100425","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Intra-articular hyaluronic acid (HA) injections have demonstrated efficacy for osteoarthritis in joints such as the hip, knee, and ankle. As few published studies exist on the subject, HA injections for elbow OA have not been proven to be effective. This study investigates the efficacy of arthroscopic debridement with/without intra-articular hyaluronic acid (HA) injections with respect to pain relief, arc of movement, and functional improvement in 24 elbows with osteoarthritis.</p></div><div><h3>Material and methods</h3><p>24 elbows were treated for posttraumatic (n = 11) or primary degenerative (n = 13) osteoarthritis of the elbow by arthroscopic debridement. HA (Synvisc) injection protocol was either preoperative (n = 5), postoperative (n = 5), combined pre- and post-operative (n = 5), or without HA injections (n = 9). A clinical examination and Mayo elbow performance score was conducted at an average of 15 months (range 12–18 months) post-operation. The results were statistically analysed with the Mann-Whitney, Wilcoxon, and ANOVA tests.</p></div><div><h3>Results</h3><p>Intra-articular cartilage changes were observed to be mild fraying (n = 5), significant fraying/fibrilliation (n = 6), and significant fibrillation with areas of bare bone (n = 13). HA injections were associated with worse outcomes in patients with severe cartilage changes and exposed bone. A non-statistically significant trend toward improved outcomes in patients without exposed bone was seen when treated with HA injection.</p></div><div><h3>Discussion and conclusions</h3><p>These results support the use of <span>HA</span> in combination with elbow debridement in earlier stages of osteoarthritis with intact / frayed cartilage layer, but not in advanced cases with bone in communication with the synovial cavity. There is a symptomatic benefit in earlier stages (0–2) and a symptomatic detriment associated with HA in osteoarthritic joints with later stages (3–4), in the short term. Longer term studies are required to better understand the longevity of these results.</p></div><div><h3>Level of evidence</h3><p>II.</p></div>","PeriodicalId":100818,"journal":{"name":"Journal of Orthopaedic Reports","volume":"4 2","pages":"Article 100425"},"PeriodicalIF":0.0000,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773157X24001206/pdfft?md5=651801b9b128343e2149b693c42afc74&pid=1-s2.0-S2773157X24001206-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Treatment of mild and advanced cases of Elbow OA with Arthroscopic Debridement and Intra-Articular Hyaluronic Acid\",\"authors\":\"\",\"doi\":\"10.1016/j.jorep.2024.100425\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Intra-articular hyaluronic acid (HA) injections have demonstrated efficacy for osteoarthritis in joints such as the hip, knee, and ankle. As few published studies exist on the subject, HA injections for elbow OA have not been proven to be effective. This study investigates the efficacy of arthroscopic debridement with/without intra-articular hyaluronic acid (HA) injections with respect to pain relief, arc of movement, and functional improvement in 24 elbows with osteoarthritis.</p></div><div><h3>Material and methods</h3><p>24 elbows were treated for posttraumatic (n = 11) or primary degenerative (n = 13) osteoarthritis of the elbow by arthroscopic debridement. HA (Synvisc) injection protocol was either preoperative (n = 5), postoperative (n = 5), combined pre- and post-operative (n = 5), or without HA injections (n = 9). A clinical examination and Mayo elbow performance score was conducted at an average of 15 months (range 12–18 months) post-operation. The results were statistically analysed with the Mann-Whitney, Wilcoxon, and ANOVA tests.</p></div><div><h3>Results</h3><p>Intra-articular cartilage changes were observed to be mild fraying (n = 5), significant fraying/fibrilliation (n = 6), and significant fibrillation with areas of bare bone (n = 13). HA injections were associated with worse outcomes in patients with severe cartilage changes and exposed bone. A non-statistically significant trend toward improved outcomes in patients without exposed bone was seen when treated with HA injection.</p></div><div><h3>Discussion and conclusions</h3><p>These results support the use of <span>HA</span> in combination with elbow debridement in earlier stages of osteoarthritis with intact / frayed cartilage layer, but not in advanced cases with bone in communication with the synovial cavity. There is a symptomatic benefit in earlier stages (0–2) and a symptomatic detriment associated with HA in osteoarthritic joints with later stages (3–4), in the short term. Longer term studies are required to better understand the longevity of these results.</p></div><div><h3>Level of evidence</h3><p>II.</p></div>\",\"PeriodicalId\":100818,\"journal\":{\"name\":\"Journal of Orthopaedic Reports\",\"volume\":\"4 2\",\"pages\":\"Article 100425\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-06-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2773157X24001206/pdfft?md5=651801b9b128343e2149b693c42afc74&pid=1-s2.0-S2773157X24001206-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2773157X24001206\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2773157X24001206","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景关节内透明质酸（HA）注射对髋关节、膝关节和踝关节等关节的骨关节炎具有疗效。已发表的相关研究很少，因此 HA 注射治疗肘关节 OA 的疗效尚未得到证实。本研究调查了关节镜清创术与/或关节内透明质酸（HA）注射对 24 例肘关节骨性关节炎患者在疼痛缓解、活动弧度和功能改善方面的疗效。材料与方法24 例肘关节骨性关节炎患者接受了创伤后（11 例）或原发性退行性（13 例）关节镜清创术治疗。HA（Synvisc）注射方案为术前（5例）、术后（5例）、术前术后联合（5例）或不注射HA（9例）。平均在术后 15 个月（12-18 个月）进行临床检查和梅奥肘关节功能评分。结果关节内软骨变化为轻度磨损（5 例）、明显磨损/纤维化（6 例）和明显纤维化并伴有裸骨区域（13 例）。在软骨发生严重变化和骨头裸露的患者中，HA注射的效果较差。讨论与结论这些结果支持在软骨层完整/磨损的骨关节炎早期阶段结合肘关节清创术使用 HA，但不支持在骨与滑膜腔相通的晚期病例中使用 HA。在短期内，早期（0-2 期）骨性关节炎患者的症状会有所改善，而晚期（3-4 期）骨性关节炎患者的症状则会受到 HA 的损害。要更好地了解这些结果的持久性，还需要进行更长期的研究。
Treatment of mild and advanced cases of Elbow OA with Arthroscopic Debridement and Intra-Articular Hyaluronic Acid
Background
Intra-articular hyaluronic acid (HA) injections have demonstrated efficacy for osteoarthritis in joints such as the hip, knee, and ankle. As few published studies exist on the subject, HA injections for elbow OA have not been proven to be effective. This study investigates the efficacy of arthroscopic debridement with/without intra-articular hyaluronic acid (HA) injections with respect to pain relief, arc of movement, and functional improvement in 24 elbows with osteoarthritis.
Material and methods
24 elbows were treated for posttraumatic (n = 11) or primary degenerative (n = 13) osteoarthritis of the elbow by arthroscopic debridement. HA (Synvisc) injection protocol was either preoperative (n = 5), postoperative (n = 5), combined pre- and post-operative (n = 5), or without HA injections (n = 9). A clinical examination and Mayo elbow performance score was conducted at an average of 15 months (range 12–18 months) post-operation. The results were statistically analysed with the Mann-Whitney, Wilcoxon, and ANOVA tests.
Results
Intra-articular cartilage changes were observed to be mild fraying (n = 5), significant fraying/fibrilliation (n = 6), and significant fibrillation with areas of bare bone (n = 13). HA injections were associated with worse outcomes in patients with severe cartilage changes and exposed bone. A non-statistically significant trend toward improved outcomes in patients without exposed bone was seen when treated with HA injection.
Discussion and conclusions
These results support the use of HA in combination with elbow debridement in earlier stages of osteoarthritis with intact / frayed cartilage layer, but not in advanced cases with bone in communication with the synovial cavity. There is a symptomatic benefit in earlier stages (0–2) and a symptomatic detriment associated with HA in osteoarthritic joints with later stages (3–4), in the short term. Longer term studies are required to better understand the longevity of these results.
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