关节腔内注射治疗膝骨关节炎的研究进展

doi:10.3877/cma.j.issn.1674-134X.2018.06.013

近年应用关节腔内注射药物治疗膝骨关节炎(KOA)一直存在争议。国内外出版过多部指南，对于关节腔内注射药物的推荐强度是不同的，有的甚至相互矛盾，造成广大临床工作者对于这类治疗心存顾虑与疑惑；且缺少国内针对关节腔内注射药物的大样本数据，一定程度上限制了基于国人临床数据产生循证医学指南的可能。随着与国际骨科的接轨，我国学者们越来越重视循证医学指南的产生，在尚缺乏国人临床数据的前提下，试图通过多项专家共识的产生来呼吁更高级别的基础、临床研究的产生，以期更好地服务临床，服务患者。

关键词: 骨关节炎, 注射，关节内

Numerous guidelines have been developed aiming to optimize the controversial treatments of knee osteoarthritis (KOA) by using intra-articular injection. However, different pieces of evidence lead to a different level of recommendations, some of them even mutual contradiction, which confused most of the clinical workers. Besides, the big clinical data from China about intra-articular injection is lacking, which prevents the establishment of clinical practice guidelines of our own. As the connection with international orthopedics, the domestic scholars are paying attention to the establishment of a real clinical practice guideline. They are working hard and performing expert consensus to call for basic and clinic researches with higher levels of evidence, to better serve the clinic and patients.

Key words: Osteoarthritis, Injection, intra-articular

表1 国际、国内主流指南关于关节内药物注射的的证据等级或推荐意见

组织机构	关节腔注射透明质酸	关节腔注射糖皮质激素	关节腔注射富血小板血浆	关节腔注射几丁糖	关节腔注射间充质干细胞
OARSI国际骨关节炎研究学会^[10]	证据来自于随机对照研究的系统评价	证据来自于随机对照研究的系统评价	未提及	未提及	未提及
AAOS美国骨科医师协会^[11]	不推荐	不确定	不确定	未提及	未提及
ACR美国风湿病协会(手)^[12]	条件不推荐	条件不推荐	未提及	未提及	未提及
ACR美国风湿病协会(膝)^[12]	不推荐	条件推荐	未提及	未提及	未提及
ACR美国风湿病协会(髋)^[12]	不推荐	条件推荐	未提及	未提及	未提及
MOVE英国风湿病学会^[13]	未提及	未提及	未提及	未提及	未提及
NCC-CC国家慢病中心^[14]	不推荐	可考虑	未提及	未提及	未提及
EULAR欧洲抗风湿病联盟^[15]	不推荐	对于伴有肿胀的膝疼痛可以使用	未提及	未提及	未提及
APTA-OS美国康复学会骨科学组^[16]	证据来自于随机对照研究的系统评价	证据来自于随机对照研究的系统评价	未提及	未提及	未提及
Dutch荷兰理疗学会^[17]	未提及	未提及	未提及	未提及	未提及
Ottawa加拿大渥太华指南制定中心^[18]	未提及	未提及	未提及	未提及	未提及
ACCP美国临床药学学会^[19]	未提及	未提及	未提及	未提及	未提及
膝骨关节炎中医诊疗专家共识(2015)^[20]	推荐使用	慎用	推荐使用	推荐使用	未提及
骨关节炎诊断及治疗指南^[21]	每周1次膝关节腔内注射，4～6周为1个疗程	同一关节不应反复注射，注射间隔时间不应短于4个月	未提及	未提及	未提及
骨关节炎诊治指南(2007年版)^[22]	可联合关节腔注射透明质酸钠，但注射前应抽吸关节液	可行节腔内注射糖皮质激素。	未提及	未提及	未提及
骨关节炎诊治指南(2018年版)^[23]	建议根据患者个体情况应用	每年应用不超2～3次，间隔不短3～6月	临床上对有症状的OA患者可选择性使用	适用于早、中期OA患者	未提及

表1 国际、国内主流指南关于关节内药物注射的的证据等级或推荐意见

组织机构	关节腔注射透明质酸	关节腔注射糖皮质激素	关节腔注射富血小板血浆	关节腔注射几丁糖	关节腔注射间充质干细胞
OARSI国际骨关节炎研究学会^[10]	证据来自于随机对照研究的系统评价	证据来自于随机对照研究的系统评价	未提及	未提及	未提及
AAOS美国骨科医师协会^[11]	不推荐	不确定	不确定	未提及	未提及
ACR美国风湿病协会(手)^[12]	条件不推荐	条件不推荐	未提及	未提及	未提及
ACR美国风湿病协会(膝)^[12]	不推荐	条件推荐	未提及	未提及	未提及
ACR美国风湿病协会(髋)^[12]	不推荐	条件推荐	未提及	未提及	未提及
MOVE英国风湿病学会^[13]	未提及	未提及	未提及	未提及	未提及
NCC-CC国家慢病中心^[14]	不推荐	可考虑	未提及	未提及	未提及
EULAR欧洲抗风湿病联盟^[15]	不推荐	对于伴有肿胀的膝疼痛可以使用	未提及	未提及	未提及
APTA-OS美国康复学会骨科学组^[16]	证据来自于随机对照研究的系统评价	证据来自于随机对照研究的系统评价	未提及	未提及	未提及
Dutch荷兰理疗学会^[17]	未提及	未提及	未提及	未提及	未提及
Ottawa加拿大渥太华指南制定中心^[18]	未提及	未提及	未提及	未提及	未提及
ACCP美国临床药学学会^[19]	未提及	未提及	未提及	未提及	未提及
膝骨关节炎中医诊疗专家共识(2015)^[20]	推荐使用	慎用	推荐使用	推荐使用	未提及
骨关节炎诊断及治疗指南^[21]	每周1次膝关节腔内注射，4～6周为1个疗程	同一关节不应反复注射，注射间隔时间不应短于4个月	未提及	未提及	未提及
骨关节炎诊治指南(2007年版)^[22]	可联合关节腔注射透明质酸钠，但注射前应抽吸关节液	可行节腔内注射糖皮质激素。	未提及	未提及	未提及
骨关节炎诊治指南(2018年版)^[23]	建议根据患者个体情况应用	每年应用不超2～3次，间隔不短3～6月	临床上对有症状的OA患者可选择性使用	适用于早、中期OA患者	未提及

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Progress of intra-articular injection treatments for knee osteoarthritis

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Progress of intra-articular injection treatments for knee osteoarthritis