Abstract：
The purpose of the present paper was to review the available evidence on intra-articular botulinum toxin (BTX) injection in the treatment of knee osteoarthritis and to compare it to other conservative treatment options. A systematic review of the literature was performed on the PubMed, Scopus, Cochrane Library, Web of Science, Pedro and Research Gate databases with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) written in the English language, and (3) published on indexed journals in the last 20 years (2001-2021) dealing with the use of BTX intra-articular injection for the treatment of knee OA. The risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs. Nine studies involving 811 patients in total were included. Patients in the control groups received different treatments: conventional physiotherapy, hyaluronic acid injection or prolotherapy or a combination thereof in 5 studies, steroid infiltrative therapy (triamcinolone) in 1 study, placebo in 2, and local anesthetic treatment in 1 study. Looking at the quality of the available literature, two of the included studies reached \"Good quality\" standard, three were ranked as \"Fair\", and the rest were considered \"Poor\". No major complications or serious adverse events were reported following intra-articular BTX, which provided encouraging pain relief, improved motor function, and quality of life. Based on the available data, no clear indication emerged from the comparison of BTX with other established treatments for knee OA. The analysis of the available RCTs on BTX intra-articular injection for the treatment of knee OA revealed modest methodological quality. However, based on the data retrieved, botulinum toxin has been proven to provide good short-term outcomes, especially in patients with pain sensitization, by modulating neurotransmitter release, peripheral nociceptive transduction, and acting on the control of chronic pain from central sensitization.
摘要：
本文的目的是回顾关节内肉毒杆菌毒素（BTX）注射治疗膝骨关节炎的现有证据，并将其与其他保守治疗方案进行比较。在PubMed上对文献进行了系统的回顾，Scopus,科克伦图书馆,WebofScience,具有以下纳入标准的Pedro和ResearchGate数据库：（1）随机对照试验（RCT），（2）用英语写，和（3）在过去20年（2001-2021年）的索引期刊上发表，涉及使用BTX关节内注射治疗膝关节OA。使用随机对照试验的Cochrane偏差风险工具评估偏差风险。共纳入9项研究，涉及811例患者。对照组患者接受不同的治疗方法:常规理疗,在5项研究中，透明质酸注射或催洛疗法或其组合，1项研究中的类固醇浸润疗法（曲安奈德），安慰剂2例，局部麻醉治疗1例。看看现有文献的质量，纳入的两项研究达到了“高质量”标准，三人被评为“公平”，其余的被认为是“穷人”。关节内BTX后无重大并发症或严重不良事件的报告，提供了令人鼓舞的疼痛缓解，改善电机功能，和生活质量。根据现有数据，BTX与其他已建立的膝OA治疗方法的比较没有明确的适应症。对BTX关节内注射治疗膝关节OA的可用RCTs的分析显示出适度的方法学质量。然而,根据检索到的数据，肉毒杆菌毒素已被证明可以提供良好的短期结果，尤其是疼痛敏感的患者，通过调节神经递质的释放，外周伤害性转导，并从中枢致敏中控制慢性疼痛。
