Injections

<中文版>

• Intraarticular joint supplement injections
• Facet joint injections
• Prolotherapy

Intraarticular joint supplement injections

Hyaluronan (also called as hyaluronic acid or hyaluronate) is an anionic, non-sulfated glycosaminoglycan distributed widely throughout connective tissues and in joint fluid. The injection of hyaluronate into a degenerative osteoarthritic joint has been shown to improve joint health for more than 6 months by:- 

• Increasing synovial fluid levels of hyaluronic acid, improving its viscosity, and freedom of joint movement 
• Decreasing levels of prostaglandins improving pain 
• Increasing the cartilage depth on load bearing surfaces 

Hyaluronate injection should be considered for patients with mild to moderate degenerative osteoarthritis where there has been a poor response to the conservative treatment. It does not have significant effects on advanced degenerative osteoarthritis.  

Glucosamine is a precursor of glucosaminoglycan which is a major component of cartilage.  Intra-articular glucosamine injection can achieve pain alleviation in a study done in 1981¹. 

Facet joint injections

The spine is made up of vertebrae. The facet joints link the vertebrae together, provide stability of the spine, control the degree of movement as well as carry some of the load. With age, the facet joints become more prone to injury and wear-and-tear, and are common causes of neck and back pain. 

Facet joint injections can be both diagnostic and therapeutic. To diagnose whether or not a facet joint is the cause of pain, local anaesthetic can be injected into the facet joint. If the pain abolishes shortly, this suggests that the facet joint is causing the pain. Steroid can be injected at the same time to suppress the inflammation inside the facet joint if that is the cause of the pain and restriction of joint movement. For resistant cases, radiofrequency ablation can be used to burn out the nerve supplies the facet to procure permanent cure of the facet joint pain. 

Prolotherapy

Prolotherapy is also known as regenerative injection therapy. It involves the injection of a proliferant solution into the body where connective tissue has been weakened or damaged through injury, strain or sprain, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue which are usually the root causes of musculoskeletal pain.

A commonly used prolotherapy solution used is concentrated glucose solution (usually 15 to 25% depending on the site injected). Since the glucose solution used is more concentrated than the body’s glucose concentration (5%), the injection will trigger a local inflammatory response which will then initiate growth factor production in the injection site. Growth factors are very important for self repair and healing of those weakened or damaged ligaments, tendons, joint capsules, cartilage etc. 

References:

1. Vajaradul Y. Double-Blind Clincal Evaluation of Intra-Articular Glucosamine in Outpatients with Gonarthrosis.Clinical Therapeutic 1981 Vol. 3, No. 5.

注射療法

• 關節腔內補充劑注射
• 脊椎小面關節注射
• 保絡治療

關節腔內補充劑注射

透明質酸是一種陰離子、非硫酸性的粘多醣物質，廣泛分佈於結締組織和關節液中。在退化性骨關節炎關節注射透明質酸，證明能夠透過以下方式改善關節的健康(療效超過六個月)：

• 增加關節液中透明質酸水平，以提高其粘度，增進關節活動的自由度
• 降低前列腺素的水平以減少疼痛
• 增加軟骨承載面的厚度

肌骼科醫生可以考慮為患上輕度至中度退化性骨關節炎而對保守治療反應一般的患者進行透明質酸注射。不過它對退化性骨關節炎屬嚴重程度的患者卻沒有明顯的效果。

葡萄糖氨是粘多醣物質的一種前導體，是組成軟骨的一種重要成分。於1981年發表的一份研究工作報告指出，關節內葡萄糖氨注射液能達到減輕疼痛的目的¹。 

脊椎小面關節注射

脊柱是由椎骨組成。脊椎小面關節將腰椎連接在一起，為脊椎提供穩定性、控制脊椎的活動幅度、以及承擔部分身體重量。隨著年齡的增長，這些脊椎小面關節會容易受傷和磨損，這是頸部和背部疼痛的常見原因之一。

脊椎小面關節注射可同時作診斷和治療之用。要診斷是否由一個脊椎小面關節引起疼痛，醫生會用局部麻醉劑注入關節，如果疼痛很快消失，這就表明這個關節引起疼痛。醫生更可以在同一時間注射類固醇以抑制造成疼痛和活動限制的關節炎症。

對於頑症，用射頻消融術將脊椎小面關節的分佈神經消融是永久止痛的方法。

保絡治療

保絡治療，亦稱為增生注射治療。治療原理是通過將可以刺激人體組織增生的物質注射入體內患處，通常於筋腱受創或被拉傷而被削弱及受損的地方，令受損組織生長達到修復癒合及減輕痛楚的目的。

一種常用的保絡治療溶液是高濃度的葡萄糖（濃度通常為15％至25％，取決於注入的部位）。由於比人體的葡萄糖濃度（5％）為高，注射後將在注射部位引發局部的炎症反應，炎症反應然後啟動生長因子的生產。生長因子是自我修補和癒合那些削弱或破壞韌帶，肌腱，關節囊，關節軟骨等的非常重要元素。

參考文獻:

1. Vajaradul Y. Double-Blind Clincal Evaluation of Intra-Articular Glucosamine in Outpatients with Gonarthrosis.Clinical Therapeutic 1981 Vol. 3, No. 5.