초기 족관절 골관절염 환자에서의 히알루론산 관절강 내 주사 요법

Efficacy of Intra-articular Hyaluronic Acid Injection in Early Stage Ankle Osteoarthritis

  • 이두형 (아주대학교 의과대학 정형외과학교실) ;
  • 김태훈 (아주대학교 의과대학 정형외과학교실) ;
  • 한승환 (아주대학교 의과대학 정형외과학교실)
  • Lee, Doo-Hyung (Department of Orthopedic Surgery, Ajou University School of Medicine) ;
  • Kim, Tae-Hun (Department of Orthopedic Surgery, Ajou University School of Medicine) ;
  • Han, Seung-Hwan (Department of Orthopedic Surgery, Ajou University School of Medicine)
  • 투고 : 2011.01.30
  • 심사 : 2011.02.22
  • 발행 : 2011.03.15

초록

Purpose: This study evaluated the efficacy of an intra-articular injection of sodium hyaluronate in the treatment of early stage osteoarthritis of the ankle. Materials and Methods: Early stage ankle osteoarthritis (Takakura stage I and II) patients who received hyaluronic acid injection therapy were retrospectively reviewed. Patients underwent intra-articular injections of 2 mL of sodium hyaluronate for 3 consecutive weeks. Clinical evaluation and Visual Analogue Scale (VAS) scoring were performed at every three months after treatment. Results: Total 27 patients were involved and mean age was 55 year old (range 33 to 77 years). There were 13 male and 14 female patients. Mean follow up duration was 13 month and. Pre-intra-articular VAS score was $8.9{\pm}0.7$ and three month follow up score was $3.8{\pm}2.8$. VAS score of last follow up was $3.2{\pm}3.4$. The effect of hyaluronic acid continued about one year when analyzed the VAS score change of the patients followed for more than one year. Patients' satisfaction was "very satisfied" in nine, "satisfied" in 12, "fair" in one, and "not satisfied" in five patients. Overall satisfaction rate was 82%. There were no ankle osteoarthritis stage changes in serial follow up radiograph. Conclusion: Symptomatic relief of signs and symptoms of osteoarthritis of the ankle was achieved by injection of an intra-articular hyaluronate injection. Efficacy of Hyaluronate acid injection persisted more than 1 year in our study. Intra-articular hyaluronate injection to ankle osteoarthritis is safe and effective as knee joint and should be considered as a valid conservative treatment for ankle osteoarthritis.

키워드

참고문헌

  1. Howell DS. Pathogenesis of osteoarthritis. Am J Med. 1986; 80:24-8. https://doi.org/10.1016/0002-9343(86)90075-6
  2. Altman RD, Moskowitz R. Intra-articular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatol. 1998;25:2203-12.
  3. Evanich JD, Evanich CJ, Wright MB, Rydlewicz JA. Efficacy of intraarticular hyaluronic acid injections in knee osteoarthritis. Clin Orthop Relat Res. 2001;390:173-81. https://doi.org/10.1097/00003086-200109000-00020
  4. Kelly MA, Kurzweil PR, Moskowitz RW. Intra-articular hyaluronans in knee osteoarthritis: rationale and practical considerations. Am J Orthop. 2004;33:15-22.
  5. Neustadt DH. Long-term efficacy and safety of intra-articular sodium hyaluronate (Hyalgan) in patients with osteoarthritis of the knee. Clin Exp Rheumatol. 2003;21:307-11.
  6. Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004;86:538-45. https://doi.org/10.2106/00004623-200403000-00012
  7. Abatangelo G, O'Regan M. Hyaluronan: biological role and function in articular joints. Eur J Rheumtol Inflamm. 1995; 15:9-16.
  8. Witteveen AG, Sierevelt IN, Blankevoort L, Kerkhoffs GM, van Dijk CN. Intra-articular sodium hyaluronate injections in the osteoarthritic ankle joint: Effects, safety and dose dependency. Foot Ankle Surg. 2010;16:159-63. https://doi.org/10.1016/j.fas.2009.10.003
  9. Cohen MM, Altman RD, Hollstrom R, Hollstrom C, Sun C, Gipson B. Safety and efficacy of intra-articular sodium hyaluronate (Hyalgan) in a randomized, double-blind study for osteoarthritis of the ankle. Foot Ankle Int. 2008;29:657-63. https://doi.org/10.3113/FAI.2008.0657
  10. Salk RS, Chang TJ, D'Costa WF, Soomekh DJ, Grogan KA. Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg Am. 2006;88:295-302. https://doi.org/10.2106/JBJS.E.00193
  11. Takakura Y, Tanaka Y, Kumai T, Tamai S. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br. 1995;77:50-4.
  12. Lussier A, Cividino AA, McFarlane CA, Olszynski WP, Potashner WJ, De Médicis R. Viscosupplementation with hylan for the treatment of osteoarthritis: findings from clinical practice in Canada. J Rheumatol 1996;23:1579-85.
  13. Mankin HJ, Conger KA. The acute effects of intra-articular hydrocortisone on articular cartilage in rabbits. J Bone Joint Surg Am. 1966;48:1383-8. https://doi.org/10.2106/00004623-196648070-00012
  14. Sevastik J, Lemperg R. Local bone destruction after intraarticular injection of corticosteroids. Nord Med. 1969;81: 949-51.
  15. Behrens F, Shepard N, Mitchell N. Alterations of rabbit articular cartilage by intra-articular injections of glucocorticoids. J Bone Joint Surg Am. 1975;57:70-6. https://doi.org/10.2106/00004623-197557010-00012
  16. Leardini G, Perbellini A, Franceschini M, Mattara L. Intra-articular injections of hyaluronic acid in the treatment of painful shoulder. Clin Ther. 1988;10:521-6.
  17. Bragantini A, Molinaroli F. A pilot clinical evaluation of the treatment of hip osteoarthritis with hyaluronic acid. Curr Ther Res. 1994;55:319-30. https://doi.org/10.1016/S0011-393X(05)80175-4
  18. Swann DA. Macromolecules of synovial fluid. In: Sokoloff L, ed. New York: Academic Press; 1978. 407-35.