Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Prolotherapy

프롤로치료

  • Moon, Sang Ho (Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital) ;
  • Lee, Song (Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital) ;
  • Bae, Dae Kyung (Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital)
  • 문상호 (서울성심병원 정형외과) ;
  • 이송 (서울성심병원 정형외과) ;
  • 배대경 (서울성심병원 정형외과)
  • Received : 2017.10.13
  • Accepted : 2018.06.20
  • Published : 2018.10.30
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Abstract

Prolotherapy is defined as "the rehabilitation of an incompetent structure such as ligament or tendon by induced proliferation of new cells" in the dictionary. It may include any treatment promoting the proliferation of new cells such as stem cell therapy. Traditionally, prolotherapy has been thought of as a method of strengthening a lax ligament by injecting various types of sclerosing or proliferant solutions which have commonly included hypertonic dextrose. And this therapy should involve the process of injecting solutions at the enthesis, where tendons and ligaments attach to the bone, to cause an inflammatory reaction. This inflammation initiates the regeneration and repair processes of the injured tissue in and around the joint to promote tissue proliferation and growth. Therefore, the method of prolotherapy includes the injection of small volumes of an irritant solution at painful ligament and tendon insertion sites over several treatment sessions. Because prolotherapy is a treatment modality that may provide a solution to a patient who complains of enthesopathic pain symptoms, it may be beneficial prior to long-term medication treatment or surgical intervention. Despite controversies over prolotherapy, its usage appears to be increasing gradually. This article discusses the current state of knowledge on prolotherapy and informs it to the physicians who manage the musculoskeletal pains.

사전적인 의미로서 프롤로치료란 "새로운 세포들의 증식을 유도함으로써 약해진 인대나 건 등과 같은 조직의 재건을 도모하려는 치료"라고 광범위하게 정의되어 있다. 즉 줄기세포 치료를 포함한 새로운 세포를 재생되도록 유도하는 치료를 모두 프롤로치료에 포함할 수 있는 것이다. 전통적으로 프롤로치료는 고농도 포도당 액 등 경화시키거나 증식시키는 물질을 주사함으로써 이완되어 있는 인대를 강화시키는 치료로 알려져 왔다. 프롤로치료는 인대 혹은 건의 골 부착부(enthesis)에 약제를 주입하여 이 부위에 염증을 발생시켜야 한다. 이러한 염증은 조직의 증식과 성장을 촉진하여 관절내 혹은 관절 주위의 손상된 조직을 재생 혹은 복원시키는 과정을 시작하게 하는 역할을 한다. 그러므로 프롤로치료의 방법은 소량의 자극성 물질을 인대와 건이 뼈에 부착하는 부위에 여러 차례 주사하는 과정으로 이루어진다. 이 치료는 환자에게서 건 혹은 인대가 뼈에 부착하는 부위의 통증을 효과적으로 해결함으로써 장기간의 약제 복용이나 수술적 치료 전에 시행할 수 있다는 이점이 있다. 프롤로치료는 현재 그 효과에 대한 논란에도 불구하고 점점 더 많은 환자들에게서 시술되고 있다. 저자는 재생치료로서의 프롤로치료에 대한 최신 지견을 논하고 그것을 근골격계 통증의 치료를 담당하는 의사들에게 소개하고자 한다.

Keywords

References

  1. Gove P. Webster's third new international dictionary, unabridged. Springfield: Merriam-Webster; 2002.
  2. Moon SH. A trip to prolotherapy with doctor Moon. Seoul: Youngchang publishing Company; 2016.
  3. Rabago D, Best TM, Beamsley M, Patterson J. A systematic review of prolotherapy for chronic musculoskeletal pain. Clin J Sport Med. 2005;15:376-80. https://doi.org/10.1097/01.jsm.0000173268.05318.a4
  4. Dorman TA. Prolotherapy: a survey. J Orthop Med. 1993;15: 49-50. https://doi.org/10.1080/1355297X.1993.11719720
  5. Banks AR. A rationale for prolotherapy. J Orthop Med. 1991; 13:54-9.
  6. Liu YK, Tipton CM, Matthes RD, Bedford TG, Maynard JA, Walmer HC. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res. 1983;11:95-102. https://doi.org/10.3109/03008208309004846
  7. Hackett GS, Henderson DG. Joint stabilization; an experimental, histologic study with comments on the clinical application in ligament proliferation. Am J Surg. 1955;89:968-73. https://doi.org/10.1016/0002-9610(55)90568-7
  8. Harrison ME. The biomechanical effects of prolotherapy on traumatized achilles tendons of male rats [thesis]. Utah: Brigham Young University; 1995. 66p.
  9. Klein RG, Dorman TA, Johnson CE. Proliferant injections for low back pain: histologic changes of injected ligaments and objective measurements of lumbar spine mobility before and after treatment. J Neurol Orthop Med Surg. 1989;10:123-6.
  10. Kim SR, Stitik TP, Foye PM, Greenwald BD, Campagnolo DI. Critical review of prolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: a physiatric perspective. Am J Phys Med Rehabil. 2004;83:379-89. https://doi.org/10.1097/01.PHM.0000124443.31707.74
  11. Hackett GS. Ligament and tendon relaxation treated by prolotherapy. Springfield: Thomas; 1956.
  12. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med. 2008;18:248-54. https://doi.org/10.1097/JSM.0b013e318170fc87
  13. Rabago D, Lee KS, Ryan M, et al. Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow): results of a single-blind, pilot-level, randomized controlled trial. Am J Phys Med Rehabil. 2013; 92:587-96. https://doi.org/10.1097/PHM.0b013e31827d695f
  14. Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. 2005;86:697-702. https://doi.org/10.1016/j.apmr.2004.10.007
  15. Maxwell NJ, Ryan MB, Taunton JE, Gillies JH, Wong AD. Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study. AJR Am J Roentgenol. 2007;189:W215-20. https://doi.org/10.2214/AJR.06.1158
  16. Yelland MJ, Sweeting KR, Lyftogt JA, Ng SK, Scuffham PA, Evans KA. Prolotherapy injections and eccentric loading exercises for painful achilles tendinosis: a randomised trial. Br J Sports Med. 2011;45:421-8. https://doi.org/10.1136/bjsm.2009.057968
  17. Ryan MB, Wong AD, Gillies JH, Wong J, Taunton JE. Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: a pilot study for the treatment of chronic plantar fasciitis. Br J Sports Med. 2009;43:303-6. https://doi.org/10.1136/bjsm.2008.050021
  18. Rabago D, Patterson JJ, Mundt M, et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11:229-37. https://doi.org/10.1370/afm.1504
  19. Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000;6:68-74, 77-80.
  20. Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med. 2000;6:311-20. https://doi.org/10.1089/10755530050120673
  21. Krsticevic M, Jeric M, Dosenovic S, Jelicic Kadic A, Puljak L. Proliferative injection therapy for osteoarthritis: a systematic review. Int Orthop. 2017;41:671-9. https://doi.org/10.1007/s00264-017-3422-5
  22. Rabago D, Nourani B. Prolotherapy for osteoarthritis and tendinopathy: a descriptive review. Curr Rheumatol Rep. 2017;19:34. https://doi.org/10.1007/s11926-017-0659-3
  23. Mathews JA, Mills SB, Jenkins VM, et al. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheumatol. 1987;26:416-23. https://doi.org/10.1093/rheumatology/26.6.416
  24. Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ. A new approach to the treatment of chronic low back pain. Lancet. 1987;2:143-6.
  25. Klein RG, Eek BC, DeLong WB, Mooney V. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.
  26. Dechow E, Davies RK, Carr AJ, Thompson PW. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999;38:1255-9. https://doi.org/10.1093/rheumatology/38.12.1255
  27. Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine (Phila Pa 1976). 2004;29:9-16. https://doi.org/10.1097/01.BRS.0000105529.07222.5B
  28. Myers A. Prolotherapy treatment of low back pain and sciatica. Bull Hosp Joint Dis. 1961;22:48-55.
  29. Dorman TA. Treatment for spinal pain arising in ligaments using prolotherapy: a retrospective survey. J Orthop Med. 1991;13:13-9.
  30. Dorman TA. Whiplash injuries: treatment with prolotherapy and a new hypothesis. J Orthop Med. 1999;21:13-21. https://doi.org/10.1080/1355297X.1999.11719897
  31. Schneider RC, Williams JJ, Liss L. Fatality after injection of sclerosing agent to precipitate fibro-osseous proliferation. J Am Med Assoc. 1959;170:1768-72. https://doi.org/10.1001/jama.1959.03010150012003
  32. Keplinger JE, Bucy PC. Paraplegia from treatment with sclerosing agents. Report of a case. JAMA. 1960;173:1333-5. https://doi.org/10.1001/jama.1960.03020300045014
  33. Hunt WE, Baird WC. Complications following injection of sclerosing agent to precipitate fibro-osseous proliferation. J Neurosurg. 1961;18:461-5.
  34. Moon SH. Prolotherapy of lumbar spine. Stem Cell Regen Med. 2014;1:42-8.

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