學術 關節內注射玻尿酸 專論 治療 ... - tma.org.tw

1 1 2, 3 (Glycosaminoglycans, GAGs) 4 (synovial fluid ) mg/ml D- N - (glycosidic bonds) ( 1)4 (proteoglycan) 10 1000 Dalton 4 (synovium) (pain mediators) 4 ( c y t o k i n e s ) (synovitis) (osteophyte) ( s c l e r o t i c b o n e ) (subchondral cyst) 1 ( c h o n d r o c y t e ) (Ma trix me ta lloprote ina s e s , MMPs) 4 1934 Karl Meyer 1.

2 D- N- 4 2012 56 3 31 1970 NIF-NaHA non-inflammatory fraction of sodium hyaluronan Healon Hylartil-Vet 4 1 9 8 0 50 120 Dalton 1990 cross linking Hylan 6 2000 (American College of Rheumatology) 5 2009 Cochrane review 7 2006 76 ( R C T ) (non-steroid anti-inflammatory drug, NSAID) NSAID 4 5-13 7 20 0 7 (meta-analysis) 8,9 1 6 SYNVISC (hylan G-F 20)Hyalgan Supartz Orthovisc Euflexxa (daltons)6 50~70 60~120 100~290 240~360 3 3-5 5 3-4 3 16 mg20 mg25 mg30 mg20 mg 6 2 (3 )6 (5 )6 6 3 2012 56 3 32 8 (50 73 ) 1(interleukin-1) (NO) E2 (prostaglandin E2) 70% 45% (6 ) 4 3-5 (6 ml) 2 ml 10 ( ) 11,12 (Kellgren Lawrence grade II-III ) ( )

3 11 (anterolateral) (anteromedial) ( 2A) (lateral midpatellar) ( 2B) 90 180 lateral mid patella (93%) 13 N S A I D 5-13 ( ) 1. B i j l s m a J WJ , B e r e n b a u m F, P a l m i e r i B : Osteoarthritis: an update with relevance for clinical practice. Lancet 2011; 377: 2115 26. 2 A ) (anterolateral) / (anteromedial) B) (lateral midpatellar) 13 A B2012 56 3 332. Zhang W, Nuki G, Moskowitz RW, Abramson S : O A R S I r e c o m m e n d a t i o n s f o r t h e management of hip and knee osteoarthritis P a r t I I I : c h a n g e s i n e v i d e n c e f o l l o w i n g systematic cumulative update of research published through January 2009.

4 Osteoarthritis and Cartilage 2010; 18: 476 99. 3. R i n g d a h l E , P a n d i t S : Tr e a t m e n t o f k n e e o s t e o a r t h r i t i s . A m F a m P h y s i c i a n . 2 0 11 ; 83(11): Iannitti T, Lodi D: Intra-Articular Injections for the Treatment of Osteoarthritis Focus on the Clinical Use of Hyaluronic Acid. Drugs R D 2011; 11 (1): 13-27. 5. Altman RD: Recommendations for the medical management of osteoarthritis of the hip and k n e e : 2 0 0 0 u p d a t e . A m e r i c a n C o l l e g e o f Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000; 43(9): 1905-15. 6. Arnold W, Fullerton DS, Holder S, May CS: Viscosupplementation: managed care issues for osteoarthritis of the knee. J Manag Care Pharm. 2007; 13(suppl): Bellamy N, Campbell J, Robinson V, Gee T: Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006; 19(2):CD005321.

5 Review 8. Reichenbach S, Blank S, Juni P: Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis. Arthritis & Rheumatism 2007; 57(8): 1410 18 9. Marshall DC: A review and meta-analysis of hylan versus hyaluronic acid: Comment on the article by Reichenbach et al. Arthritis Rheum. 2008; 15;59(9) C h e v a l i e r X , J e r o s c h J , G o u p i l l e P, v a n Dijk N: Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: a randomised, multicentre, double-blind, placebo controlled trial. Ann Rheum Dis. 2010; 69(1): 113-9. 11. K a w a s a k i T, K u r o s a w a H , I k e d a H : T h e r a p e u t i c h o m e e x e r c i s e v e r s u s i n t r a a r t i c u l a r h y a l u r o n a t e i n j e c t i o n f o r o s t e o a r t h r i t i s o f t h e k n e e : 6 - m o n t h prospective randomized open-labeled trial.

6 J Orthop Sci. 2009; 14(2): 182-91. 12. K a r a t o s u n V, U n v e r B , G o c e n Z : I n t r a -articular hyaluranic acid compared with progressive knee exercises in osteoarthritis of the knee: a prospective randomized trial with long-term follow-up. Rheumatol Int 2006; 26: Douglas WJ, Nicholas AE, Bradley MT: Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am. 2004; 86-A(2): 433-4. 2012 56 3 34