葡萄糖增生療法用於肌肉骨骼疾病之疼痛處理及其可能機轉

The review of dextrose Prolotherapy for several painful musculoskeletal diseases and its possible mechanisms

Musculoskeletal diseases are common causes of chronic pain, they severely impair the patients' quality of life. An aging population could lead to enormously large number of patients diagnosed with musculoskeletal diseases. Management of musculoskeletal diseases can be surgical or non-surgical. Surgical modalities include tissue repair, a joint replacement surgery, and so forth. With the rising cost surgical procedures, the financial burden of health care may be growing, and the quality of life among general populations will be affected eventually. Dextrose Prolotherapy is another cost-effective treatment option. Avoiding surgical intervention and with lower cost, some cases reported clinically significant improvement with dextrose Prolotherapy. However, the actual mechanism of dextrose Prolotherapy is yet not totally clear. Most investigators proposed that by injection at least 10% dextrose into tendon or ligament insertions, inflammatory process will be induced, proliferation of various cells at injection site will be noted and finally healing of the injured structures will take place. Some other investigators found that dextrose injections below a 10% solution directly stimulate proliferation of cells and tissue without causing a histological inflammatory reaction. Both mechanisms mentioned above could reduce the pain severity and improve the daily activity and quality. This review focus on dextrose Prolotherapy on some common painful musculoskeletal diseases, the research evidence, and its possible explanations.

骨骼肌肉疾病為慢性疼痛最常見的原因之一，這些疾病可能會嚴重地影響病人的生活品質；隨著人口老化，骨骼肌肉疾病患者數目也不斷增加。臨床上的處理可分為保守治療或是手術，如組織修補、關節置換等。隨著肌肉骨骼外科手術的費用上升，醫療系統的負擔以及群體民眾生活品質都將受影響。葡萄糖增生療法提供一種便宜且有效的治療方式選擇。過去的報告提出透過葡萄糖增生療法可以有效改善病人臨床症狀而不需要進行手術，進而減少相關的醫療花費，然而其確切的原理目前還不完全明朗。大部分研究指出透過注射大於10%的葡萄糖高張溶液於肌腱韌帶處可以誘發發炎反應發生，並進一步促進注射位置的細胞增生然後修復原本受傷或脆弱的地方；另外也有研究發現使用小於10%的葡萄糖液，可以在不引發組織發炎的情況下直接刺激細胞和組織的增生。上述兩種機轉都可以有效的改善疼痛以及病患的生活品質。在本篇文獻回顧中我們整理葡萄糖增生療法在各種常見的骨骼肌肉疾病的治療使用情況，他們的實證，以及可能的機轉說明。