中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (26): 4249-4256.doi: 10.12307/2021.129

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

关节镜清理联合透明质酸钠注射治疗老年膝骨关节炎：疼痛、炎症因子及关节功能变化的Meta分析

黄林峰1，2，顾蓥璇3，全小明4，何  伟2，陈雷雷2   

  1. 1 广州中医药大学第三临床医学院，广东省广州市   510000； 2 广州中医药大学第三附属医院，广东省广州市   510000； 3广东省人民医院，广东省广州市   510000； 4 广州中医药大学第一附属医院，广东省广州市   510000
  • 收稿日期:2020-10-15 修回日期:2020-10-22 接受日期:2020-11-21 出版日期:2021-09-18 发布日期:2021-05-14
  • 通讯作者: 陈雷雷，博士生导师，副主任中医师，广州中医药大学第三附属医院关节骨科，广东省广州市 510010
  • 作者简介:黄林峰，男，1995年生，广东省兴宁市人，汉族，广州中医药大学在读硕士，主要从事中医药治疗骨与关节疾病的临床及基础研究。
  • 基金资助:
    国家自然科学基金资助项目(81673999)，项目负责人：陈雷雷；广东省杰出青年科学基金项目(2015A030306037)，项目负责人：陈雷雷

Arthroscopic debridement combined with sodium hyaluronate injection for the treatment of senile knee osteoarthritis: a Meta-analysis of changes in pain, inflammatory factor, and joint function

Huang Linfeng1,2, Gu Yingxuan3, Quan Xiaoming4, He Wei2, Chen Leilei2   

  1. 1The Third Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China; 2The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China; 3Guangdong Provincial People’s Hospital, Guangzhou 510000, Guangdong Province, China; 4The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
  • Received:2020-10-15 Revised:2020-10-22 Accepted:2020-11-21 Online:2021-09-18 Published:2021-05-14
  • Contact: Chen Leilei, Doctoral supervisor, Associate chief physician, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
  • About author:Huang Linfeng, Master candidate, The Third Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China; The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81673999 (to CLL); Guangdong Provincial Outstanding Youth Science Fund, No. 2015A030306037 (to CLL)

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摘要：


文题释义：
关节镜清理术：是临床治疗早中期膝骨关节炎的常用手术方式，主要用于伴有机械交锁或半月板撕裂等症状的患者，通过关节镜游离体清理、半月板成型等手段，能有效改善部分早、中期患者的症状。
透明质酸钠：是一种高分子多糖体生物材料，由N-乙酰葡萄糖醛酸反复交替形成，主要产生于细胞外基质、滑膜液和软骨等人体组织中。在关节内，透明质酸钠可由滑膜β细胞产生，是关节滑液和软骨基质内的重要组分，具有润滑关节及滋养软骨作用，其作为关节黏弹性补充剂常用于治疗骨关节炎。

目的：相关临床研究表明关节镜清理联合透明质酸钠治疗老年膝骨关节炎具有积极的作用，然而其有效性及安全性尚未完全明确，缺乏充足的循证依据。文章以此对关节镜清理联合透明质酸钠治疗老年膝骨关节炎的临床疗效进行Meta分析。
方法：计算机检索PubMed、Cochrane library、Web of science、EMbase、维普、中国知网、CBM、万方数据库以及百度学术资源系统中关节镜清理联合透明质酸钠注射治疗老年膝骨关节炎的随机对照试验，检索时间2016-01-01/2020-10-30。由2名研究者独立完成检索和筛选文献，利用Cochrane风险偏倚评估工具对纳入研究进行质量评价，提取数据资料并运用RevMan 5.3软件进行Meta分析。
结果：①共纳入12项随机对照试验，包括老年单侧膝骨关节炎患者1 072例。②Meta分析结果显示，对比单纯关节镜清理术，联合透明质酸钠注射治疗老年膝骨关节炎具有更高的临床总有效率(RR=1.24，95%CI：1.15-1.33，P < 0.000 01)，在Lysholm评分(SMD=9.80，95%CI：8.09-11.51，P < 0.000 01)和目测类比评分(MD=-1.19，95%CI：-1.58至-0.80，P < 0.000 01)上更有优势，而且膝关节液白细胞介素1水平(MD=-9.95，95%CI：-11.31至-8.59，P < 0.000 01)、白细胞介素6水平(MD=-33.68，95%CI：-42.42至-24.93，P < 0.000 01)和肿瘤坏死因子α水平(MD=-84.72，95%CI：-91.49至-77.95，P < 0.000 01)更低，两组不良反应发生率无显著差异(RR=0.60，95%CI：0.30-1.18，P=0.14)。
结论：与单纯关节镜清理术相比，关节镜清理联合透明质酸钠治疗老年膝骨关节炎具有更高的临床疗效，具体体现在缓解关节疼痛、改善膝关节功能和降低炎性因子水平方面，但未来仍需更多质量高、样本量大的随机对照试验加以验证。
https://orcid.org/0000-0002-0062-2972 (黄林峰)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 骨, 膝, 关节, 骨关节炎, 透明质酸钠, 关节镜, 不良反应, Meta分析

Abstract:

OBJECTIVE: Relevant clinical studies have shown that arthroscopic debridement combined with sodium hyaluronate plays a positive role in the treatment of senile knee osteoarthritis, but its efficacy and safety are not completely clear, lack of sufficient evidence-based basis. Herein, we conducted a Meta-analysis on the clinical efficacy of arthroscopic debridement combined with sodium hyaluronate in the treatment of senile knee osteoarthritis. 

METHODS: A systematic search of relevant literatures in PubMed, Cochrane library, EMbase, Web of Science, CNKI, CBM, WanFang and Baidu Scholar from January 1, 2016 to October 30, 2020 was performed. We collected all the randomized controlled trials of arthroscopic debridement combined with sodium hyaluronate injection in the treatment of senile knee osteoarthritis. Two researchers screened the study strictly according to the inclusion and exclusion criteria, and extracted data and evaluated the quality of the literature. Meta-analysis of the included literatures was processed by Revman5.3 software. 
RESULTS: A total of 12 randomized controlled trials were collected in this meta-analysis, including 1 072 knees in the experimental group and 532 in the control group. The results of Meta-analysis showed that arthroscopic debridement combined with sodium hyaluronate injection in the treatment of senile knee osteoarthritis was superior to arthroscopic debridement alone with regard to the total clinical effective rate (relative risk (RR)=1.24, 95% confidence interval (CI): 1.15 to 1.33, P < 0.000 01), Lysholm score (standardized mean difference (SMD)=9.80, 95%CI: 8.09 to 11.51, P < 0.000 01), and Visual Analogue Scale score (MD=
-1.19, 95%CI: -1.58 to -0.80, P < 0.000 01). Compared with the arthroscopic debridement alone, the combination therapy showed a significant decrease in the levels of intra-articular interleukin-1 (MD=-9.95, 95%CI: -11.31 to -8.59, P < 0.000 01), interleukin-6 (MD=-33.68, 95%CI: -42.42 to -24.93, P < 0.000 01) and tumor necrosis factor-α (MD=-84.72, 95%CI: -91.49 to -77.95, P < 0.000 01). There was no significant difference in the incidence of complications between the two groups (RR=0.60, 95%CI: 0.30 to 1.18, P=0.14]. 
CONCLUSION: Compared with arthroscopic debridement alone, arthroscopic debridement combined with sodium hyaluronate is more effective in the treatment of senile knee osteoarthritis, which is embodied in relieving joint pain, improving knee joint function and reducing the level of inflammatory factors. However, more randomized controlled trials with high quality and large sample size are still needed in the future.

Key words: bone, knee, joint, osteoarthritis, sodium hyaluronate, arthroscopic, adverse reactions, Meta-analysis

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