The Clinical And Experimental Research Of Knee Osteoarthritis Treated With High Titer Glucocorticoids

Objective:To observe the clinical effect of the patients with osteoarthritis treated by the intraarticular injection of high-titer glucocorticosteroid combined with Sodium Hyaluronate.And to investigate the effect of the high-titer glucocorticoid on the normal cartilage through the animal experiment.Thus to rearch a rational,safe,and effctive meathod of using glucocorticoid,then directing the clinical medication.Methods:Clinical part:To devide 90 patients with osteoarthritis accompany with the acute synovitis into two groups according the different visiting time.Research group include 50 patients,while the control group has 40.The research group is given Betamethason Copound Injection and Sodium Hyaluronate at first time,then simplely given one course of treatment of Sodium Hyaluronate.At the time of before treatment,after treatment 1 week,2 weeks,4 weeks,5 weeks,3 months and 6 months, to evaluate the index of knee joint,and making the Lysholm score.All tiaras are Statistically analysed by the sofeware of Spss11.5.Experimental part:Twenty-seven healthy Japanese white rabbits were divided randomly and evenly into three groups,i.e.interventional group 1(n=9), interventional group 2(n=9) and control group(n=9).We devided interventional group 1 to three subsets,1a,1b and 1c.All animals were given Betamethason Copound Injection at a dosge of 0.05ml/kg into bilateral knee joints at the first time. After 1 week,2 weeks and 3 weeks respectively of the three subsets,giving the medication once more at the same method.We also devided interventional group 2 into three subsets,2a,2b and 2c.Betamethason Copound and Sodium Hyaluronate were injected into bilateral knee joints at a dosage of 0.05ml/kg and 0.2ml respectively,then repeat the administration once again after 1 week,2 weeks,3 weeks respectively for the three subsets.Control group was also devided into three subsets: 3a,3b and 3c.Sterile saline was injected into bilateral knee joints at a dose of 0.3ml in all animals at the first time,then repeat the administration once again after 1 week, 2 weeks,3 weeks respectively for the three subsets.All rabbits of each group were killed at the time of the first day two weeks after the sencond administration,and preparing the specimen(femoral endo-condyle and trochlea).All the femoral endo-condyle specimens were stained with hematoxylin and eosin.Optic microscopic examinations were conducted to observe the pathological changes of articular cartilage,and count empty lacune.All the trochlea specimen were biomechanical examined by the device called EnduraTEC ELF3200,to compare the diference of the values of maximal tensile stress.Results:Clinical part:Before treatment:the compare of the course of disease,gender and age composition,scores of index of knee joint and Lysholm has no statistical significance(p＞0.05).1 week after treatment:the compare of the therapeutic effect and Lysholm scores between the two groups has no statistical significance(p＞0.05).5 weeks and 3 months after treatment:the compare of the therapeutic effect and Lysholm scores between the two groups has significance(p＜0.05).6 months follow-up:the compare of the therapeutic effect and Lysholm scores between the two groups has no statistical significance(p＞0.05).Experimental part:1.Macroscopic observation:The articular cartilage was bright blue-white in control group.Interventional group 1,the glossiness of the surface of catilage was gradually increased accompany with the prolonged interval time of the two administration,from slight greyish white to greyish white.While the performance of Interventional group 2 is relatively better.The result of 2c is best.2.HE stain showed:Control group:The superficial of articular cartilage was smooth.The shape and arrangements of all zone chondrocyte appear in order.The tide mark was intact.Interventional group 1 happened cataplasia caused by the glucocorticosteroid,manifesting the surface is gross,the chondrocytes are disordered, the colum of chondrocytes is disappeared,some gregaloid and hypertrophic chondrocyte appears,and some chondrocytes are vaculous changed,manifesting the empty lacune.The situation of Interventional group 2 is relatively better.The group 2c is the best,which chondrocytes is ordered in arrangement and not so much empty lacunes.The compare of the ratio of empty lacunes between the any two groups of 1a, 1b,1c,2a,2b has no statistical significance(p＞0.05) throughχ~2 test.The compare of Group 2c and other interventional group has statistical significance(p＜0.05),but no statistical significance compared with the contrast group(p＞0.05). 3.Biomechanical examination:Among the three groups of 3a,3b and 3c,the compare results have no statistical significance(p＞0.05).The compare between any other two groups have statistical significance(p＜0.05).The result of anti-tensile strength is 3a=3b=3c＞2c＞2b＞2a＞1c＞1b＞1a.Conclusions:Compared with the conventional glucocorticoid,intra-articular injection of high-titer glucocorticoid(Betamethason Copound Injection),combined with Sodium Hyaluronate,could relieve the symptom of acut synovitis of osteoarthritis significantly,and especially has the merit of controlling the effusion and pain.This kind of glucocorticoid need a low dosage,and could provide a long time symptom-relief.Thus avoiding the disadvantages of repeated using glucocorticoid.Through animal experiment,we confirm that when using glucocorticoid injected into knee joint,one should select the glucocorticoid that need little dosage, titer is high.And prolonging the interval time between the two administration as long as possible,and combined with Sodium Hyaluronate is safe and rational.