關節內注射玻尿酸 Sodium Hyaluronate(Artz) 治療退化性膝關節炎──三年的臨床經驗

Intra-articular Injection with Soidum Hyaluronate (Artz) for the Treatment of Knee Osteoarthritis: 3 years Clinical Experience

前言：退化性膝關節炎病人接受關節內注射玻尿酸（Hyaluronate）的治療，已被證實是具效果及安全性，其在台灣的臨床應用是自民國88年7月開始迄今。本研究乃提供病人關節內注射玻尿酸的臨床經驗。材料與方法：從民國88年10月至91年10月在臺北醫學大學附設醫院風濕科門診接受過玻尿酸關節內注射，至少一個療程（一週一次，連續五週）的退化性膝關節炎病人，收集並分析資料包括年齡、性別、疾病特徵、注射腳數、注射方式、療效期、療程數、及不良反應。結果：共有363人，614個膝關節接受4720次關節注射。第一個療程整體反應及活動度的改變為好和更好者分別為72.7%及72.1%，第二個療程則分別為80.9%及80.0%，第一療程與第二療程平均間隔為7.8 ± 4.0月。38個局部的不良反應發生在22個人之24個膝關節上。不良反應的發生率以注射次數來算為0.8%，以關節數算為3.9%，以人算為6.1%。無發生全身性的副作用。局部不良反應最常見為在注射位置暫時性的疼痛。不良反應的發生率與注射位置有關。結論：關節內注射玻尿酸對退化性膝關節炎病人提供良好的自覺症狀改善及可接受的安全性。

Objective: To evaluate the clinical benefit of intra -articular injection with hyaluronate in current clinical practice in Taiwan. Material and Methodst A retrospective study of all patients with osteoarthritis of the knee treated with hyaluronate at Rheumatology outpatient clink in Taipei Medical University Hospital over a period of 3 years from October 1999 to October 2002. Results: A total 4720 injections were performed in 363 patients involved 614 knees. The overall response and the change of activity level were judged better or much better for 72.7% and 72.1% of the treated knees after the first course of treatment (5 weekly injections), and 80.9 and 80.0% after 2nd course. The mean time elapsing between the first and 2nd course is 7.8 + 4.0 months. Local adverse events were observed in 22 patients (24 knees), with an overall rate 0.8% adverse events per injection, 3.9% per joint, and 6.1% per patient. No systemic adverse events were noted in any patient. The adverse events were characterized by transient pain at site of injection. The incidence of adverse events were considered to be related to the injection technique. Conclusion: Intra-articular injection with hyaluronate (Artz) provided good clinical benefits and an acceptable safety profiles in current clinical practice.