葡萄糖注射劑減輕膝蓋疼痛症狀


  【24drs.com】阿根廷Provincial de Rosario醫院物理治療與復健科Gaston Andres Topol醫師等人在10月3日小兒科期刊發表研究發現指出,對於患有難治型「脛突牽引骨膜炎(Osgood-Schlatter disease,OSD)」的運動員,相較於一般治療,在突起處和髕骨韌帶注射葡萄糖可安全且耐受良好地獲得更迅速地達到改變運動情況。
  
  根據研究人員表示,OSD一般用來形容因為脛骨結節上次級骨化中心重複性壓力造成之脛骨結節的牽引骨突炎;研究發現,葡萄糖溶液對於成年患者受傷的韌帶、肌腱與軟骨是安全且有效的,不過,之前並無研究特別探討小兒科病患。
  
  Topol醫師等人寫道,這個假設是,葡萄糖注射劑優於lidocaine注射劑或一般照護。
  
  研究包括了患有OSD的9-15歲女孩與10-17歲男孩,研究人員共治療了54名研究對象的65個膝蓋患部,這篇研究包括了單腳蹲姿時脛骨結節前膝疼痛的病患、從事跳躍或踢擊運動時疼痛達至少3個月,嘗試過至少2個月的正規且溫和地逐步腿筋伸展、股四頭肌加強,並且逐漸恢復運動。
  
  病患被隨機指派接受3個月受治療師監督的一般照護、或每月注射一次1% lidocaine溶液-併用或未併用12.5%的葡萄糖;一般照護組一開始由物理治療師監督進行特定的伸展運動,之後至少有1次以上確認適當的運動表現。
  
  3個月時,「如故的運動」定義為「Nirschl Pain Phase Scale」量表分數小於4分,相較於一般照組,葡萄糖治療組(21/ 21 vs 13/22;P = .001)和lidocaine治療組(20/22 vs 13/22;P = .034)的膝蓋都比較會達到前述結果。
  
  相對的,「無症狀的運動」定義為「Nirschl Pain Phase Scale」量表分數0分,葡萄糖治療組優於lidocaine治療組(14/21 vs 5/22;P = .006)、也優於一般照護組(14/21 vs 3/22; P < .001)。
  
  1年後,葡萄糖治療組的「無症狀的運動」比率依舊高於只有lidocaine組(32/38 vs 6/13;P = .024)或一般照護組(32/38 vs 2/14;P < .0001)。
  
  Topol醫師等人結論表示,這些結果認為,對於難治型OSD,葡萄糖注射劑可減少運動限制期間與運動相關症狀期間。
  
  作者們指出,這篇研究是首度針對小兒族群進行探討,首次在突起的肌腱附著處進行注射。
  
  根據研究者表示,細胞外葡萄糖值上升可促進產生生長因素,而有助於受傷害的肌腱,作者們指出,葡萄糖上升或胰島素值相對下降,可減少疼痛產生的神經胜肽活性。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=6622&x_classno=0
  

Dextrose Injection Reduces Symptoms of Knee Pain

By Emma Hitt, PhD
Medscape Medical News

October 3, 2011 — In athletes with intractable Osgood-Schlatter disease (OSD), dextrose injected over the apophysis and patellar tendon origin appears to be safe and well tolerated and resulted in more rapid and more frequent achievement of unaltered sport compared with usual care, according to new research.

Gaston Andres Topol, MD, from the Department of Physical Medicine and Rehabilitation at the Hospital Provincial de Rosario in Argentina and colleagues reported their findings online October 3 in Pediatrics.

According to the researchers, OSD is typically described as "a traction apophysitis of the tibial tubercle because of repetitive strain on the secondary ossification center of the tibial tuberosity." Dextrose solution has been found to be safe and effective in areas of damaged ligament, tendon, and cartilage in adults. However, there have been no previous reports specifically in a pediatric population.

"The hypothesis was that dextrose injection would be superior to either lidocaine injection or supervised usual care," Dr. Topol and colleagues write.

The study included girls aged 9 to 15 years and boys aged 10 to 17 years with OSD. Investigators treated 65 knees in 54 participants. The study included patients who had anterior knee pain at the tibial tuberosity during a single leg squat. They also must have had pain with a jumping or kicking sport for at least 3 months, after attempting at least 2 months of formal and gently progressive hamstring stretching, quads strengthening, and gradual sport reintroduction.

Patients were randomly assigned to receive for 3 months of therapist-supervised usual care or a once-monthly injection of 1% lidocaine solution with or without 12.5% dextrose. Those in the usual care group met with a physical therapist initially to go over specific stretching and exercises, and then at least once more to confirm proper exercise performance.

At 3 months, "unaltered sport," defined as a score less than 4 on the Nirschl Pain Phase Scale, was more common in both dextrose-treated (21 of 21 vs 13 of 22; P = .001) and lidocaine-treated (20 of 22 vs 13 of 22; P = .034) knees compared with usual care.

By contrast, "asymptomatic sport," defined as a Nirschl Pain Phase Scale score of 0, was more common in knees treated with dextrose compared with the lidocaine-treated knees (14 of 21 vs 5 of 22; P = .006) or those receiving usual care (14 of 21 vs 3 of 22; P < .001) knees.

After 1 year, "asymptomatic sport" continued to be more common in dextrose-treated knees than in knees treated with only lidocaine (32 of 38 vs 6 of 13; P = .024) or usual care only (32 of 38 vs 2 of 14; P < .0001).

"These results suggest that both the duration of sports limitation and the duration of sports-related symptoms may be reducible by dextrose injection in those with recalcitrant OSD," Dr. Topol and colleagues conclude.

The authors note that the current study represents the first study in an exclusively pediatric population and the first in which a tendon attachment on an apophysis was injected.

According to the researchers, elevation of extracellular glucose may promote the production of growth factors that may help damaged tendons. In addition, the authors note that dextrose elevations or a related reduction in insulin levels may downregulate the activity of pain-producing neuropeptides.

The study was not commercially funded. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online October 3, 2011.

    
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