| 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 approach a rational meathod of using glucocorticoid, which could minimize the side-effect of the glucocorticoid.Then directing the clinical medication.Methods:Clinical part:To devide100patients with osteoarthritis accompany with the acute synovitis into two groups according the different visiting time. Research group include50patients,while the control group has50. We select unilateral ill knee joint as the observation unit. 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 treatment1week,5weeks,3months and6months, to score and grade the index of knee joint, and making the Lequesne score. All datas are statistically analysed by the sofeware of Spssl1.5.Experimental part:Twenty-fouth healthy Japanese white rabbits were divided randomly and evenly into two groups, We devided interventional group1to three subsets,1a,1b and1c. Betamethason Copound Injection and Sodium Hyaluronate was injected into bilateral knee joints at a dosage of0.05mg/kg and0.2ml respectively, then repeat the administration once again after1week,2weeks,3weeks respectively for the three subsets. Control group was also devided into three subsets:2a,2b and2c. Sodium Hyaluronate was injected into bilateral knee joints at a dose of0.2ml in all animals at the first time, then repeat the administration once again after1week,2weeks,3weeks 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 of the knee of these rabbits. 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 significant difference (p>0.05), indicating that there is comparability between the two groups.1week after treatment:the compare of the therapeutic effect and Lysholm scores between the two groups has statistical significant difference (p<0.05) indicating that the short term effect of two groups is similar.5weeks and3months after treatment: the compare of the therapeutic effect and Lysholm scores between the two groups has statistical significant difference (p<0.05), indicating that the therapeutical effect of the research group is superior to the control group.6months follow-up:the compare of the therapeutic effect and Lysholm scores between the two groups has no statistical significant difference (p>0.05), indicating that the long term effect of two groups is similar.Experimental part:1.Macroscopic observation:Without infected,the face of the articular cartilage was smooth and no crack.The articular cartilage was bright blue-white in control group. The other group, the glossiness of the surface of catilage was gradually increased accompany with the prolonged interval time of the two administration, from greyish white to blue-white and the synovial fluid is gradually diminished.2.Hematoxylin and eosin stain showed:In control group:The articular cartilage was stained evenly purplish red. The superficial of articular cartilage was smooth. The shape and arrangements of all zone chondrocyte appear in order. The tide mark was intact, Interventional group1happened 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 lis relatively better.The group lc 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 has no significant difference through x2test. The compare of Group1c and other interventional group has significant difference through X2test, but no significant difference compared with the contrast group.3.Biomechanical examination: Except among the groups2a,2b,2c,the compare results have no significant difference(p>0.05).The compare between any other two groups have significant difference(p<0.05).The result of anti-tensile strength is2c=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 as block therapy, 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 effective. This method of administration could minimize the side-effect of glucocorticoid on the cartilage.When using single or few times, low dosage, high-titers glucocorticosteroid, prolonging the interval time between the two administration, and accompany with Sodium Hyaluronate, could minimize the side-effect on the cartilage. |
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