Effect of Wrist Arthroscopy with Intraarticular Hyaluronan Substitution Therapy: A Randomised, Controlled, Prospective, Non-Blinded, Single-Centre, Comparative Trial

被引:2
|
作者
Schuetz, A. [1 ]
Dobner, P. [2 ]
机构
[1] Sporthopaedicum Straubing, D-94315 Straubing, Germany
[2] TRB Chemed AG, Clin Affairs, Haar, Germany
关键词
Arthroskopie; Hyaluronsaure; Handgelenk; arthroscopy; hyaluronan (hyaluronic acid); wrist; IRRIGATING SOLUTIONS; SYNOVIAL-FLUID; ACID; KNEE; OSTEOARTHRITIS; INTERLEUKIN-1-BETA; INJECTION; HYLAN;
D O I
10.1055/s-0033-1354409
中图分类号
R61 [外科手术学];
学科分类号
摘要
Zusammenfassung Ziel: Die vorliegende Studie untersucht den Effekt einer intra- und postoperativen intraartikularen Hyaluronsaure-Injektion (HS) bei Patienten mit einer Handgelenksarthroskopie. Patienten und Methoden: Insgesamt wurden 140 Patienten mit therapieresistenten persistierenden Handgelenksschmerzen, die fur eine Handgelenksarthroskopie qualifizierten, in die Studie aufgenommen und prospektiv randomisiert einer der beiden Behandlungsgruppen zugeteilt. 69 Patienten wurden ausschlie ss lich einer therapeutischen Handgelenksarthroskopie unterzogen (A-Gruppe), 70 Patienten wurde am Ende der Operation und 3 Wochen postoperativ zusatzlich je 2 ml einer 1%igen Hyaluronsaure-Losung intraartikular (HS-Gruppe) injiziert. Zur Beurteilung der Behandlungsergebnisse wurde der Mayo Wrist Score modifiziert nach Krimmer (MMWS), der DASH-Fragebogen, die dynamometrisch gemessene Griffstarke, die visuelle analoge Schmerzskala (VAS) sowie der Gesamteindruck des Patienten und des Arztes zum Behandlungserfolg (CGI) verwendet. Der Nachbeobachtungszeitraum betrug 6 Monate. Zusatzlich wurde der Therapieerfolg mit der Schwere der zugrundeliegenden pathologischen Veranderung des Handgelenks korreliert. Ergebnisse: In beiden Gruppen nahmen die Schmerzen ab und die Funktion des Handgelenks verbesserte sich. Wahrend Patienten mit zusatzlicher HS-Injektion ab 3 Wochen postoperativ signifikant bessere Werte im MMWS aufwiesen als Patienten ohne zusatzliche HS-Injektion, fanden sich fur den DASH-Score, die absolute Griffkraft und die Schmerzintensitat keine signifikanten Unterschiede. Patienten der HS-Gruppe bewerteten den Therapieerfolg nach 12 und 24 Wochen besser als die der A-Gruppe, wobei Patienten der HS-Gruppe mit geringgradigem oder mittelgradigem Gelenkschaden am meisten profitierten. Schlussfolgerung: Der Therapieerfolg einer therapeutischen Handgelenksarthroskopie kann durch die 2-malige intraartikulare Substitution von Hyaluronsaure im beobachteten Zeitraum signifikant verbessert werden. Abstract Purpose: The present study investigates the effect of an intra- and postoperative intraarticular hyaluronan injection (HS) in patients undergoing wrist arthroscopy. Patients and Methods: A total of 140 adults were included and prospectively randomised to one of 2 treatment groups. All patients presented wrist pain resistant to non-operative therapy. 69 patients were assigned to therapeutic wrist arthroscopy without additional treatment (A-group), another 70 patients were assigned to wrist arthroscopy and additional intraarticular instillation of a 1% HS solution (HS-group). The HS administration (2 mL of 1% HS solution each) was performed directly at the end of arthroscopic procedure and a second time 3 weeks after surgery. For outcome assessment, Mayo wrist score (modified according to Krimmer, MMWS), DASH questionnaire, absolute grip strength, VAS pain (visual analogue scale) and clinical global impression (CGI) of patients and investigators were used. The follow-up was 6 months. Furthermore, the correlation between severity of pathological findings and level of postoperative benefit was investigated. Results: In both groups, pain decreased and the function of the wrist joint improved. While patients with additional HS injection had significantly better values in MMWS than patients without additional HS injection, no significant differences could be observed for DASH score, absolute grip strength and pain intensity. 12 and 24 weeks after surgery, therapeutic success was rated better in HS-group than in A-group. The highest clinical benefit was obtained for patients in the HS-group with marginal to moderate pathological findings. Conclusion: The benefit of therapeutic wrist arthroscopy can be significantly improved by a 2-time intraarticular substitution of hyaluronan.
引用
收藏
页码:277 / 284
页数:8
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