Hyaluronic Acid Injection in Osteoarthritis

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???? ?????? ??????? ??????? ???? ???
????????????Hyaluronic Acid Injection in
Osteoarthritis

• ????? ?.???? ?? ????
• ???? ???? ??????? ???? ???????? ???????

2

• ??? ?????? ??????? ??????? OA osteoarthritis
  ????? ?????? ????? ?? ???????? ??????? , ?????
  ???? ?? 10 ?? ??????, ??? ???????? ???????
  ?????? ???? ???? ??30 ????? ??? ????? ?? ???
  ????? , ? ?? ???? ???? ??? ?? ??????? ???????? .

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• ?????? ?? ????? ?? ?????? ?????? ??????? ??????
  ??????? ,??? ????? ??????? ?????? ?????? ???
  ??????, ????????? ??????? genetic predisposition
  , ???????? ?????????? mechanical stress ,
  ????????? ??????? ??????, ???? trauma , ??????? ,
  ???????? ????? ?? ?????? , ??? ????? ??????? ????
  .

4
?????? ?????

• ?????? ??? ??????? nonpharmacologic , ???????
  ??????? , ??????? ??????? .
• ?????? ??? ??????? ???? ????? ?????? , ? ?????
  ????? ,
• ??????? ?????????physical ? ???????
  occupational ,
• ????????? , ???????? ????????devices .

5
??? ?????? ??????? ?????? ??????
6

• ??????? ??????? ??? ??????? ?????????
  arthroscopic , ??????? ??????? osteotomy , ??????
  ??????? joint replacement .

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• ??????? ?? ?? ????? ?????? ??? ??? ????? ???
  ??????? ???????? ?? ????? , ??? ??? ?? ????
  ?????? ?????? ?????? ?? ??????? ???????
• ???? ??? ???????????? hyaluronic acid HA ????
  ????? ??? ???? ?????

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• ? ??????? ???? ????? ????? ???????? ???? ???
  ???????? ???? ???? ?? ?????? ?????? synovial
  fluid ??????? ?? ??????? ??????? ??????? ???????
  ??????? OA ??? ????? viscosity ? ??? ?????
  elasticity ?? ?????? ?? ??????? ???????? , ????
  ??????? ?? ?????? ???? ?????? viscosupplementation
  ????? ??? ??? ???????????? ???? ?????? ????????
  ??????? ???????? ???????? ?????? ?????? ??????
  ?????? ??????? .

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• ??????? ??? ???????????? ??? ???????? ???????
  ????? ????? cataract ??? ?????????? ??????? ?????
  ???? ?????? ?? ??????? ???????? ??? 1987 , ???
  ???? ??? 1992 , ??? ???? ?????? ??? 1995 , ???
  ???????? ??????? ??? 1997 ??? ????? ????? ???????
  ???????? ?????????the Food and Drug
  Administration (FDA) ??? ?????? ?? ???
  ???????????? ????? ????? ??????? Hyalgan ?
  Synvisc .

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????? ??? ????????????

• ?????? ??????? ??? ???????????? HA ? hyaluronan ?
  hyaluronate ? hylan G-F20 ???? ?????? ?? ????????
  ???????? ???? ????? ???????? ???????? ?? ???????
  ??? ?????

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• ???? ????? ?? ??????? ????? ??? HA?? hyaluronan
  ?? hyaluronate ?????? ??????? ??????? ??
  Hyalgan ????? Orthovisc .

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• ??? ????? ?????? ??? ???? ?????? synthetic ?????
  hylan G-F20 ??? ????? ?? ??? ?????? ?? ???
  ???????????? ?????? ?????? cross-linked HA ???
  ???? ???? ??????? ???? ???????? ?? ?????? ????.
• ??? ?????? ???????? hyalgan , orthovisc ,
  synvisc ,( suplasyn , neovisc) ????????? ???????
  (?? ??? ????? ) ????? ??????? ?? ??? ?????
  rooster combs ????? ?? ?? ?????? ??? ???????
  ????? ????? ?????? ?? ????? ?? ?????? .

13
???? ???????

• ??????? ???????? ???? ???????????? ?? ????? ?????
  ?????? ?????? ?? ?????? ?????? ?????? ??????????
  ?? ???? ????? ??????? ???????? viscoelasticity
  ???? ???? ??????? lubrication ????? ??????
  ??????? .

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• ???????? ?????? ???????? ????? ??????? ???????
  ???? ???????????? ?? ??????? ??????? synovial
  cells , ?????? ????? ????????????? proteoglycan
  ?? ??????? ?????????chondrocytes , ?????? ?????
  ????????? ?????? ??????? chondrodegradative ,
  ????? ??? ???????? ????? nociceptive ?? ??????
  ??????? , ?????? ?? ???? ????????? ?????
  oxygen-free radicals .

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????????? indication

• ??????? ????? ?????? ?? ??????? ????????
  ????????? ?????? ???????? ???? ???????? , ???
  ???? ??? ???????? ( ???? ???? ????? ?? ????
  ????? ???? ??????? NSAIDs ) ,??? ????? OA ????
  ??? ????? ?????, ??? ???? ?? ??? ??????? ?????
  ???????, ?? ??? ??? ????? ????? ( ???? ??? ????
  ??????? ??? ????? ????? ???? ???????? ????????? (
  arthroscopic debridement, ????? ????? ?????
  ?????? ??? ???? ???

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???? ????????? cotraindication

• ????? ????? infection , ??????? ??????? ?? ?????
  ????? , ???????? allergy ????? ?? ?????? ???
  ??????? ?????????? ???????? ?? ??? ????? rooster
  comb , ??????? ???????? ????? bone on bone , ????
  ????? ????????? (?????? locking ???? ) , ??????
  ???? ( ???? ????? ??? ???????? ?? ????? ?????) ,
  ???? ???? ????? ??? ??????? malalignment .
• ????? ??????? ??????? ???? ???? ?????? HA ?????
  ???? ???????? ??????? ???? ? (75-125 ) ????? ???
  ???? ??? ???????? .

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????? ?????

• ???? hyalgan ??? ??? 2ml vial ?? ??? ??? ?????
  ????? ???? 2ml prifilled syring , ????? synvisc
  ??? ??? ????? ????? ???? .
• ????? ???????? ? hyalgan ?? ??? 2?? ?? ?????
  ???? ???? ?????? , ??? synvisc?? ??? 2?? ?? ?????
  ???? ????? ?????? .

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• ???? ????? ??????? ????? ??? ????? ????? ???????
  ??? 90 ???? , ????????? ??????? ?????? ????
  ?????? ??? ?????? ??? ????? ????? ???????
  patellar tendon ???? ?????? ??????? ??????? ???
  ???? ?? ???? ??????? ?????? ???? ??????? medial .

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• ?? ???? ?????? ??????? ???? ??? ???? ??? ???????
  ?????? 45 ???? ?? ???? ????? ?????? ?? ???????
  ??????? ???????superolateral ??????? (????
  ?????? ?? ??????? ?????? ) .

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• ?????? ???? ???? ?? ???? ???? 22-25 gauge , ?????
  ????? ??????? ??????? ????? ??? ???? ??????
  ????????? ????? ?????.
• ??? ??? ???? ?????? ??????? ????? ???? ??? ?????
  ???? ???? HA .

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• ??? ??? ??????? ????? ????? ???? ????? ?????
  ?????? ??? ????? ??? ?? ??? ???? ??????
  intra-articular ,??? ????? ???? ?????? ??????
  intra-synovial ?? ???? ?????? ??? ???? ?????? ??
  ?????? ???????? ????? ????????? ?????????.
• ???? ?????? ???? ?????? ??????? ??????? ??????
  ???? 24-48 ???? ??? ????? .

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?????? ???????? side effects

• ?????? ?? ?????? ??????? ???? ( ??? ????? ?????
  ????? ?????? ???? ) ????? ????? 1-2 ????? ?????
  ??? ???? ???? 1-3 ???? ????? ?????? ?????? ??????
  ??? ice ???? ????? , ?? ???? ????? ???? ???
  ?????? ???????? .

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???????

• ????? ???? ????? ? ??? ????? ?????? ??????
  variable ??? ??? ?????? ???? HA ???????? ????
  ??????? ??? ???? ???????? ???? ???? ???????
  ??????? ??? 65-80 ?? ?????? ??????? ????? ??
  ??? 6-12 ??? ( ????? 8.5 ???) ?????? ?? ?? ????
  HA ?? ?????? ?? ?????? 4 ???? ( ???? ???? ???????
  ?????? ??? ????? ???? HA ??????? ) .

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• ?????? HA ????? ????? ??????? ???? ???? ????? ???
  ???????????? ??????? ???? ???? ?? ???????? ??????
  ????? ??????? ???? ?? ???? ?? ??? ?????? ????
  ????? ???? ???? ???????? .
• ????????? ?? ??? ???????????? ???? ?? ???
  ???????????? ???? ?????? ?????? ???? ????? ?????
  ???? ???? ???????? ???? ????? ???????? ??? ????? .

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• ?????????? ?? ?????? ???????? ??? ????????????
  NSAIDs ( ????? ?????? ?? naproxen ) ??? ???????
  ???? ??????? ??? ????? ???? ???? HA ??? ?????
  ?????? , ??????? HA ?? NSAIDs ???? ?? NSAIDs
  ?????? ,???????? ??????? function ? ????? ??
  ?????? pain with activity ????? ?? HA ???? ??
  NSAIDs .

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• ??????? ?? ???? ?????? ??? ??????? ?????????
  invitro ???? ?? ??? ???????????? ?? ???????
  ????? anabolic ??? ??????? ???????? ????? ???
  ???? ?????? matrix ?? ??????? , ??? ???? ??? ??
  ???? ??? ????? , ??? ?? ???? ????? ??????? ?????
  ??????? ?? ???? ??? ???????????? ?? ???? ??? .

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?????

• ??? ??? ???????????? ???? ?????? ???? ????? ?????
  ?? ???? ????? ??????? , ??? ???? ??????? ?? ????
  ??????? ??????? ????????? , ??? ???? ???????
  ????? ?????? ????? ????? ????? , ??? ???? ????
  ?????? ???????? , ???? ???? ???? ??????? ????
  ???? ???????? ??? ???? ???? ??? ??????? ?? ????
  ?????? ??? ??????? ????? ?? ????? ??? ?????
  ??????? ?? ?????? ????? ???????? ????? ????.

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???????

• - Current Diagnosis and Treatment in Orthopedics
  2000 .
• -http//www.aaos.org/wordhtml/bulletin/feb98/gluco
  .htm .
• ?????? ?????????? ?????????? ????????? ???????
  ???????
• -http//www.aafp.org/afp/20040201/tips/42.html .
• ?????? ?????????? ?????????? ????????? ??? ??????
  
• - http//www.coventrypainclinic.org.uk/jointpain-h
  yaluronicacid.htm .
• - http//www.cfpc.ca/cfp/2004/Feb/vol50-feb-cme-2.
  asp http//answers.google.com/answers/threadview?i
  d439339-
• ?????? ?????????? ?????????? ??????? ??? ??????
• http//www.jr2.ox.ac.uk/bandolier/band123/b123-4.h
  tml-
• http//familydoctor.org/616.xml-
• http//www.cosmeticsurgery-news.com/article2466.h
  tml-
• http//www3.aaos.org/research/imca/OAkneeContents/
  OA_knee_m5_2.htm

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• ???? ????????