中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (15): 2437-2444.doi: 10.3969/j.issn.2095-4344.3801

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

关节镜联合玻璃酸钠治疗膝骨关节炎效果的Meta分析

李安安1，陈嘉韵1，陈  锦1，宋  敏1，李聪聪1，叶国柱1，吴高艺2，林文政2，蔡宇宁2，刘文刚2     

  1. 1广州中医药大学，广东省广州市   510405；2 广东省第二中医院，广东省广州市   510095
  • 收稿日期:2020-04-09 修回日期:2020-04-16 接受日期:2020-05-19 出版日期:2021-05-28 发布日期:2021-01-05
  • 通讯作者: 刘文刚，博士，主任中医师，硕士生导师，广东省第二中医院，广东省广州市 510095
  • 作者简介:Li An’an, Master candidate, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • 基金资助:
    广东省中医药局科研项目(20183001)，项目负责人：刘文刚；广东省中医药管理局科研项目(20191021) 

Efficacy of arthroscopy combined with sodium hyaluronate for knee osteoarthritis: a meta-analysis

Li An’an1, Chen Jiayun1, Chen Jin1, Song Min1, Li Congcong1, Ye Guozhu1, Wu Gaoyi2, Lin Wenzheng2, Cai Yuning2, Liu Wengang2   

  1. 1Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou 510095, Guangdong Province, China 
  • Received:2020-04-09 Revised:2020-04-16 Accepted:2020-05-19 Online:2021-05-28 Published:2021-01-05
  • Contact: Liu Wengang, MD, Chief TCM physician, Master’s supervisor, Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou 510095, Guangdong Province, China
  • About author:李安安，男，1996年生，广州中医药大学在读硕士。
  • Supported by:
    the Scientific Research Project of Guangdong Provincial Bureau of Traditional Chinese Medicine, No. 20183001 (to LWG); the Scientific Research Project of Guangdong Administration of Traditional Chinese Medicine, No. 20191021

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摘要：

文题释义：
膝骨关节炎：是最常见的退行性骨关节疾病，是引起中老年患者活动功能障碍，甚至致残的主要原因之一。主要症状有膝部酸痛、肿胀、弹响及僵硬等，严重者会发生活动受限。该病病因尚未明确，对于轻中度患者采用膝关节镜下清理术常能获得较优疗效。
关节镜联合玻璃酸钠疗法：指对于轻中度膝骨关节炎患者，在膝关节镜手术治疗后，向膝关节内注射玻璃酸钠，补充术中被灌洗液稀释的关节液，力求重新还原膝关节内的黏弹性环境，以期在术后提高关节活动能力，减轻疼痛与炎症反应。

目的：膝关节镜治疗对轻中度膝骨关节炎具有良好疗效，但在术中灌洗液会带走大量原有关节液，术后通过注射玻璃酸钠补充关节液能否进一步提高疗效尚存争议。文章评价关节镜联合玻璃酸钠治疗相较于单纯关节镜治疗膝骨关节炎的疗效。
方法：检索中国知网、万方、维普、CBM、PubMed、Web of Science、EMBASE及Cochrane Library数据库，检索建库至2020-03-27相关文献，纳入关节镜联合玻璃酸钠治疗膝骨关节炎的随机对照试验，对符合标准的试验采用Cochrane系统评价方法进行评价，采用Revman 5.3软件进行Meta分析。主要结局指标为Lequesne评分、Lysholm评分、WOMAC评分和目测类比评分；次要结局指标为关节液中肿瘤坏死因子α、白细胞介素1β及白细胞介素6水平。
结果：共纳入31个随机对照试验，研究对象1 350例。Meta分析结果显示：①联合组Lequesne评分在术后1周(MD=-0.33，95%CI：0.67至-0.00，P=0.05)、玻璃酸钠注射疗程结束后(MD=-1.00，95%CI：-1.34至-0.66，P < 0.000 01)、术后3个月(MD=-1.04，95%CI：-1.44至-0.64，P < 0.000 01)均优于对照组；②联合组Lysholm评分在术后1周(MD=5.84，95%CI：4.79-6.88，P < 0.000 01)、玻璃酸钠注射疗程结束后(MD=9.21，95%CI：6.93-11.49，P < 0.000 01)、术后3个月(MD=9.14，95%CI：6.34-11.94，P < 0.000 01)、术后半年(MD=10.14，95%CI：6.50-13.78，P < 0.000 01)、术后1年(MD=11.54，95%CI：9.92-13.16，P < 0.000 01)均优于对照组；③联合组WOMAC评分在术后1年(MD= -18.38，95%CI：-28.53至-8.23，P=0.000 4)优于对照组；联合组目测类比评分在术后1周(MD=-0.91，95%CI：-1.11至-0.72，P < 0.000 01)、玻璃酸钠注射疗程结束后(MD=-0.97，95%CI：-1.23至-0.72，P < 0.000 01)、术后3个月(MD=-0.41，95%CI：-0.52，-0.31，P < 0.000 01)均优于对照组；④联合组在治疗全疗程结束后相较于注射1周后Lequense评分(MD=1.47，95%CI：1.14-1.80，P < 0.000 01)更优；⑤联合组更好地降低关节液中肿瘤坏死因子α、白细胞介素1β及白细胞介素6水平(P ≤ 0.05)，能更好地控制炎症情况。
结论：关节镜联合玻璃酸钠治疗膝骨关节炎相较于单纯使用关节镜治疗能获得更好的短中期疗效，但上述结论尚需要更多高质量的研究进行验证。

https://orcid.org/0000-0002-4970-4469 (李安安) ；https://orcid.org/0000-0002-8887-8429 (刘文刚)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 膝, 关节镜, 玻璃酸钠, 透明质酸, 骨关节炎, 膝功能, 疼痛, Meta分析

Abstract: OBJECTIVE: Knee arthroscopy has a good effect on mild to moderate knee osteoarthritis, but the lavage fluid will take away a lot of the original synovial fluid. It is still controversial whether synovial fluid can be further improved by postoperative injection of sodium hyaluronate. This study is designed to evaluate the efficacy of arthroscopy combined with sodium hyaluronate compared with arthroscopy alone for knee osteoarthritis.
METHODS: The relevant literature was searched from CNKI, Wangfang, VIP, CBM, PubMed, Web of Science, EMBASE, and Cochrane Library from inception to March 27, 2020. The randomized controlled trials on arthroscopy combined with sodium hyaluronate for knee osteoarthritis were included. Included studies were evaluated using the Cochrane system evaluation method. Meta-analysis was performed using RevMan 5.3 software. The primary outcomes included Lequesne score, Lysholm score, WOMAC score, and visual analogue scale score. The secondary outcomes included tumor necrosis factor-α, interleukin-1β, and interleukin-6 in synovial fluid.
RESULTS: A total of 31 randomized controlled trials were included with 1 350 cases. Meta-analysis results showed that in primary outcomes: (1) Lequesne score was better in the combined group than that in the control group at 1 week after surgery (MD=-0.33, 95%CI: 0.67 to -0.00, P=0.05), after the full treatment course (MD=-1.00, 95%CI:-1.34 to -0.66, P < 0.000 01), 3 months after surgery (MD=-1.04, 95%CI:-1.44 to -0.64, P < 0.000 01). (2) Lysholm score was better in the combined group than that in the control group at 1 week after surgery (MD=5.84, 95%CI:4.79-6.88, P < 0.000 01), after the full treatment course (MD=9.21, 95%CI:6.93-11.49, P < 0.000 01), 3 months after surgery (MD=9.14, 95%CI:6.34-11.94, P < 0.000 01), half year after surgery (MD=10.14, 95%CI: 6.50-13.78, P < 0.000 01), 1 year after surgery (MD=11.54, 95%CI:9.92-13.16, P < 0.000 01). (3) WOMAC score was better in the combined group than that in the control group at 1 year after surgery (MD=-18.38, 95%CI:-28.53 to -8.23, P=0.000 4). Visual analogue scale score was better in the combined group than that in the control group at 1 week after surgery (MD=-0.91, 95%CI:-1.11 to -0.72, P < 0.000 01), after the full treatment course (MD=-0.97, 95%CI:-1.23 to -0.72, P < 0.000 01), 3 months after surgery (MD=-0.41, 95%CI: -0.52 to -0.31, P < 0.000 01). (4) Lequense score was better in the combined group after the full treatment course compared with that after only one week (MD=1.47, 95%CI: 1.14-1.80, P < 0.000 01). (5) The combined group could better reduce the contents of tumor necrosis factor-α, interleukin-1β, and interleukin-6 in the synovial fluid (P ≤ 0.05), which could better control the inflammation. 
CONCLUSION: Arthroscopy combined with sodium hyaluronate can achieve a better short- and medium-term curative effect in knee osteoarthritis than arthroscopy alone. However, more high-quality studies are needed to verify the above conclusions.

Key words: bone, knee, arthroscopy, sodium hyaluronate, hyaluronic acid, osteoarthritis, knee function, pain, meta-analysis

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