IJkKj KT

IJkjJr IKˆSIJgtrJAKax IKˆSIJgtrJAKax

yÅJaár pπeJPT Kj~πPe rJUMj yÅJaár mqgJ~ náVPZj ?
IJkjJr KYKT&xPTr xJPg k´JgKoT FmÄ krmftL xJãJfxNKY oPj
KnPÛJxJKkäPo≤ Fr xJyJPpq KYKT&xJ
rJUJr \jq FA xy\ IqJkP~≤Po≤ KroJA¥Jr TJctKa mqmyJr Tr∆jÇ TLnJPm IJkjJPT xJyJpq TrPf kJPr ?
IqJkP~≤Po≤ asqJTJr
KYKT&xPTr jJo
k´go KYKT&xJ
KjitJKrf lPuJ­IJk KnK\a
KjitJKrf lPuJ­IJk KnK\a
KjitJKrf lPuJ­IJk KnK\a

Km˜JKrf \JjPf ßpJVJPpJV Tr∆j

cJÎ ßoJÎ IJxJhMöJoJj : 01971600652
Fx. Fo. fJyKxj yJxJj : 01985509362
BD.HYL.14.11.01

xJPjJKl mJÄuJPhv KuKoPac

6/2/F ßxèj mJKVYJ, dJTJ-1000, mJÄuJPhv
ßlJj : 9562893, Fé: 840, 841
SP~n : www.sanofi.com.bd
IJkjJr IKˆSIJgtrJAKax yJÅaár mqgJ Synovial Fluid Repelacement
xŒPTt \JjMj Therapy V´yPer kr TreL~Ç
● AP†T'vPjr \J~VJPf pKh oOhM pπeJ y~ mJ láPu SPb, IJkKj FTaá
IJkKj pKh xŒsKf mJ hLWtKhj iPr yJÅaá xKºr (Knee Joint) mqgJ~ náPV
Kmv´Jo KjPf kJPrj IgmJ 15 ßgPT 20 KoKjPar \jq mJ IJkjJr
gJPTj, fPm IJkjJr ß\Pj rJUJ CKYf ßp IJkKj FTJ jj, KmvõmqJkL
KYKT&xPTr KjPhtvof, yÅJaáPf IJAx' mqJV (Ice bag) uJKVP~ rJUPf
vfTrJ 33 nJV 45 mJ fhMit m~Û mqKÜVe yJÅaár IKˆSIJgtrJAKax F
kJPrjÇ
náPV gJPTjÇ xmtPvw k´TJKvf 2005 xJPur FTKa \Krk*­ F ßhUJ
ßVPZ, 2004 xJPuA mJÄuJPhPv FT ßTJKarS ßmvL oJjMw ßTJj jJ ßTJj ● AP†T'vPjr kPr 48 W≤Jr \jq mJ IJkjJr cJÜJPrr KjPhtvof IJkjJr
oJ©Jr yJÅaár IKˆSIJgtrJAKax­F IJâJ∂ KZPujÇ KTZá Khj IJV kpt∂S yÅJaáPf oJ©JKfKrÜ YJk k´P~JV TrJ FKzP~ YuPmj­ ßpoj ir∆j \KVÄ,
yJÅaár IKˆSIJgtrJAKax­Fr KYKT&xJ mqm˙J, ߈rP~c' FmÄ mqgJjJvT nJrL K\Kjx ßfJuJ mJ hLWtãe hÅJKzP~ gJTJÇ
SwMPir oPiqA xLoJm≠ KZuÇ KT∂á IJkjJr ß\Pj rJUJ nJu, mftoJPj ● IJkjJr pπeJ pKh yPfA gJPT, IjMV´y TPr IJkjJr KYKT&xPTr xPñ
KnPÛJxJKkäPoP≤vj (Synovial Fluid Replcement Therapy)** IKmuPÍ ßpJVJPpJV Tr∆jÇ
Fr oJiqPo hLWtPo~JhL yJÅaM xKºr mqgJ Ckvo x÷mÇ xJ~PjJKn~Ju lîáAc
yu FT irPer Wj fru pJ IJkjJr yJÅaár yJzèPuJPT ˝JnJKmTnJPm
TJ\ TrPf xJyJpq TPrÇ FA Wj fru mJ lîáAc Fr TJrPe IJkKj yJÅaá
nÅJ\ TrPf, hJÅKzP~ gJTPf, yÅJaPf mJ ßhRzJPf kJPrj FmÄ F TJ\èPuJ
TrPf yJÅaár yJzèPuJ kr¸Prr xPñ WwJ UJ~ jJÇ
* xN©: ˆqJKaxKaT'x mJA TJK≤s IKˆSIJgtrJAKax, 2005

FA KulPua'Ka IJkjJPT IKˆSIJgtrJAKax TL, Fr uãexoNy, IJkjJr

yJÅaáPf KbT TL WaPZ FmÄ ßxPãP© KnPÛJxJKkäPo≤ Fr xJyJPpq TJptTrL
KYKT&xJ mqm˙J KjP~ k´P~J\jL~ fgq KhP~ xJyJpq TrPmÇ IKˆSIJgtrJAKax gJTJ yJÅaá xKºr lîáAc IJhvt Viscosupplement IJkjJr yJÅaá
(Synovial Fluid) nJñPf Êr∆ TPr FmÄ xKºr Synovial Fluid Fr Replacement
k´P~J\jL~ Cushoning k´hJPj mqgt y~Ç KyPxPm TJ\ TPr FmÄ IJkKj kMjrJ~ yJÅaár
vKÜ KlPr kJjÇ
A TJKatPu\ F nJXj Êr∆ yPóZÇ
B TÅJaJ\JfL~ mJzKf yJz­Fr IÄvKmPvw ‰frL yPf Êr∆ TPrÇ

** Synovial Fluid Replacement Therapy xŒPTt Km˜JKrf \JjPf kOÔJ 6 F uã Tr∆jÇ

C xKºr lîáAc jÓ yPf Êr∆ TPrÇ
D IJhvt KnPÛJxJKkäPo≤ Synovial Fluid Fr Replacement KyPxPm TJ\
TPrÇ

9
߈rP~c AP†T'vjxoNy
● AjasJ­IJKatTáuJr ߈rP~c AP†TvjxoNy ßTmu
˝·­ßo~JKh IJrJo KhPf kJPrÇ Fr mJrmJr
mqmyJPrr lPu IJkjJr TJKatPuP\r ãKf yPf
kJPrÇ
vuqKâ~J
● xŒNet yÅJaár k´Kf˙Jkj yPóZ ßxxm ßrJVLPhr \jq
FPTmJPr xmtPvw k∫J, pÅJPhr yÅJaár pπeJ IxyjL~
S èr∆fr FmÄ IjqJjq KYKT&xJ KmT· ßgPT
ßTJjS lu kJS~J pJPóZ jJÇ
KnPÛJxJKkäPo≤­Fr xJyJPpq KYKT&xJ ßgPT
x÷Jmq kJvõt­k´KfKâ~JxoNy
IJkjJr pKh yJ~JuMPrJjJj Kk´kJPrv¿ mJ IqJKn~Jj ßk´JKaPj (oMrVL) ßTJjS
rTPor IqJuJK\t gJPT, fPm KnPÛJxJKkäPojPavj KYKT&xJ V´yPer IJPV,
IJkjJr KYKT&xTPT \JjJPjJ CKYfÇ kJvõt­k´KfKâ~JèPuJ xJiJref oOhM
FmÄ xJoK~TÇ fJr oPiq y~PfJ I∂ntMÜ gJTPf kJPr:
● pπeJ ● ßlJuJnJm ● IJzÓfJ ● lîáAc \Po SbJ
ßTJjS CkxVt pKh YuPf gJPT mJ ImjKf WPa, IJkjJr KYKT&xPTr xPñ
IKmuPÍ ßpJVPpJV Tr∆jÇ
8 1
IKˆSIJgtrJAKax KT ?
IKˆSIJgtrJAKax yu Foj FT Im˙J pUj IJkjJr yÅJaár xKºr (Knee
Joint) lîáAc (Synovial Fluid) ã~ yPf Êr∆ TPr FmÄ yJÅaá fJr ˝JnJKmT
TJptãofJ yJrJ~Ç IKˆSIJgtrJAKax­F yJÅaá xKºr lîáAc ã~ yS~Jr
kJvJkJKv TJKatPu\èPuJ (FT irPjr KkKóZu KaxMq pJ yJz­Fr k´J∂PT ßdPT
rJPU mJ Távj' KyPxPm TJ\ TPr) nJñPf Êr∆ TPrÇ
yÅJaár IKˆSIJgtrJAKax (OA*) Fr uãe
FmÄ CkxVtèPuJ TL TL ?
yJÅaár IKˆSIJgtrJAKax xJiJref iLPr iLPr mJzPf gJPT FmÄ
IKˆSIJgtrJAKax Fr TJrPj yJÅaá xKºr lîáAc ã~ yPf Êr∆ TPrÇ fJA
k´JgKoT Im˙J~ IKˆSIJgtrJAKax xjJÜ TrJ ßVPu FmÄ KYKT&xPTr
vreJkjú yPu, FojTL xyjvLu kptJP~r mqJ~Jo IJkjJr yJÅaáPT Totão
rJUPf xJyJpq TrPmÇ IKˆSIJgtrJAKax IJkjJr FT yJÅaá IgmJ hMA
yJÅaáPfA yPf kJPrÇ
ßp xm uãeèPuJ ßhUJ ßpPf kJPr:
● YuJPlrJr xo~ pπeJ FmÄ Joint Space ­F WwJ UJS~Jr IjMnëKf,
FojTL Kmv´JPor xoP~S pπeJ yPf kJPrÇ
● Kmv´Jo ßjS~Jr kPr IJzÓnJmÇ
● yJÅaá xKº (Knee Joint) láPu SbJÇ
● YuJPlrJr ãofJ TPo pJS~J mJ yJrJPjJÇ
* OA = Osteoarthritis (yJÅaár IKˆSIJgtrJAKax)

yÅJaár IKˆSIJgtrJAKax
TL TJrPe y~ ?
m~x m~x Fr xJPg xJPg IKˆSIJgtrJAKax­Fr
^MÅKT mJzPf gJPTÇ IKiTJÄv oJjMPwr oPiq
45 mZr m~x Fr kPr FA IxM˙fJ ßhUJ
ßh~Ç
˙NufJ IKfKrÜ S\j yÅJaár Skr IKfKrÜ YJk
xOKÓ TPrÇ
Kuñ IKˆSIJgtrJAKax xJiJref oKyuJPhr oPiq
ßmKv ßhUJ pJ~Ç
mÄvVf mÄvVf ‰mKvÓq yJÅaá xKºr IJTJr S
K˙rfJPT k´nJKmf TrPf kJPrÇ
yÅJaMPf kMPrJPjJ ßYJa/IJWJf FmÄ
ßYJa/IJWJf
ßkvJVf TJ\TPotr iJrJ, pJ k´KfKj~f
yÅJaár Skr YJk xOKÓ TrPf kJPrÇ
2 7
Synovial Fluid Replacement Therapy ßpnJPm
TJ\ TPr:
pUj High Molecular Weight KnPÛJxJKkäPo≤ yJÅaá xKºPf
(Intra-articular Space) k´Pmv TrJPjJ y~ fUj FKa ãKfV´˜
xJ~PjJKn~Ju lîáAc Fr Replacement KyPxPm TJ\ TPr FmÄ
kNPmtr jqJ~ xM˙ yJÅaár TotãofJ k´KfKÔf TPrÇ FTKa TJptTrL S
hLWtPo~JhL Synovial Fluid Replacement Therapy ­Fr \jq
KjPYr ‰mKvÓqèPuJ Ifq∂ èr∆fôkNet:
● KnPÛJxJKkäPo≤Ka Biocompatible yPf yPm pJPf ßTJj irPer
Allergic Reaction ßhUJ jJ ßh~Ç
● FKaPT Foj yPf yPm ßpj k´P~J\jL~ Metabolite FmÄ
Nutrient kKrmyj TrPf kJPrÇ
● Fr Rheological Property ymÉ xJ~PjJKn~Ju lîáAc Fr of
yPf yPm pJr lPu FKa Shock Absorver FmÄ Lubricant
KyPxPm TJ\ TrPmÇ lPu IJkjJr yJÅaá, xM˙ yJÅaár of Shock
Absorving FmÄ Lubrication Fr ãofJ KlPr kJPmÇ
● ßp xm Inflammetory Cytokines èPuJ yJÅaár Cartilage iÄx
TrJr \jq hJ~L, (ßpoj IL-I, TNF-∞) fJPhrPT ßrJi TrJr
oJiqPo Cartilage Fr ã~ yS~J mº TrPf yPmÇ Hyaluronic
Acid KjÎxrPjr oJiqPo ImKvÓ Cartilage èPuJPT kMjÎVKbf
TrPf yPmÇ
xPmtJkKr, F irPjr IJhvt KnPÛJxJKkäPo≤, yJÅaáPf mqgJ IjMnPmr
\jq Nerve Impulses FmÄ Nerve Sensitivity ToJPjJr oJiqPo
yJÅaár mqgJ Ckvo TrPf xJyJpq TPrÇ
KnPÛJxJKkäPo≤ IKˆSIJgtrJAKax gJTJ yJÅaáPf KbT TL
KnPÛJxJKkäPo≤ yu Foj FT Wj fru khJgt pJ ãKfV´˜ xJ~PjJKn~Ju lîáAc
Fr Replacement KyPxPm TJ\ TPr FmÄ kMjrJ~ xM˙ yJÅaár jmq
WaPZ ?
xJ~PjJKn~Ju lîáK~c Fr of TJptãofJ (Lubricating and cushioning)
k´hvtj TPrÇ FA KnPÛJxJKkäPo≤èPuJ xJiJref hMA irPer yP~ gJPT: ● ßp Synovial Fluid mJ fru IJkjJr yJÅaár xKºÆ~PT KkKóZu
(Lubricate) rJPU, fJ ã~ yPf Êr∆ TPr FmÄ iLPr iLPr xmrTo vT'
mJ ^JÅTáKj xyq TrJr ãofJ yJrJ~Ç

● yJÅaá xKºr TJKatPu\ (FT irPjr KkKóZu KaxMq pJ yJzèPuJr k´J∂

xMrKãf rJPU) âPo ã~ yPf Êr∆ TPrÇ

● yJÅaá xKºr yJzèPuJ fUj kr¸Prr xPñ WwJ ßUPf Êr∆ TPrÇ Fr lPu
Non-crosslinked low molecular Highly-crosslinked high molecular
weight viscosuppliment weight viscosuppliment yJÅaáPf fLms pπeJ S IJzÓnJm IjMnëf y~ FmÄ ˝JnJKmT YuJPlrJ, yJÅaá
nJÅ\ TrJ FmÄ KxÅKz nJñJr of xy\ TJ\èPuJ Ifq∂ pπeJhJ~T yP~
Fr Physical Properties CPbÇ
● ● FKa Gel mJ Wj frPur of
lîáK~c Fr ofÇ TJrj Fr FmÄ Fr Physical
Viscosity, Elasticity FmÄ Properties ÉmÉ xM˙ yJÅaár IJr Fr \jq hrTJr IKf x•ôr KYKT&xJ FmÄ \LmjpJ©J~ kKrmftjÇ xKbT
Average Molecular jmLj xJ~PjJKn~Ju lîáAc Fr mqm˙JkjJ FmÄ Kj~Kof YuJPlrJr InJPm IJkKj IJrS ˙NuTJ~ yP~ CbPf
Weight xM˙ yJÅaár IjMr‡k TPr ‰frL (Design) kJPrj pJ yJÅaMr pπeJPT mÉèe mOK≠ TrPf kJPrÇ
xJ~PjJKn~Ju lîáAc Fr TrJ y~Ç F\jq FPT
fáujJ~ IPjT To yP~ Synovial Fluid
gJPTÇ Replacement Therapy muJ
yP~ gJPTÇ

● F irPjr Viscosupplement ● xJiJrjf mZPr FTKa

èPuJ xJiJref FT x¬Jy kr AP†T'vj KjPf y~ FmÄ
kr 3­5 mJr KhPf y~ FmÄ IJkKj FT mZr* kpt∂ xM˙
IJkKj 4­6 oJx xM˙ gJTPf gJTPf kJPrjÇ
kJPrjÇ
*High molecular weight viscosupplement èPuJ Intra-articular space ­F hLWthLj Im˙Jj TPr FmÄ xŒNetnJPm IkxJre
yPf (44 days) 44 Khj xo~ uJPVÇ

6 3
xM˙ S IKˆSIJgtrJAKax yÅJaár fáujJ
xM˙ yÅJaM (Healthy Knee)
yJÅaár xKºPf TJKatPuP\r CkKrfu gJPT oxOe FmÄ fJ
xMrKãf rJPU xKºr lîáAc mJ fru, pJr lPu KmjJ
pπeJPfA jzJYzJ TrPf kJrJ pJ~Ç
oOhM IKˆSIJgtrJAKax (Mild OA)
IJkjJr yÅJaár xKºPf TJKatPuP\r CkKrfPu ã~ yPf
Êr∆ TPrÇ fUj IJkKj y~PfJ Fr oOhM CkxVtèPuJ,
IjMnm TrPf Êr∆ TrPmjÇ Fr xPñ oJP^ oJP^
mqJ~JPor xoP~ pπeJ mJ xTJPur KhPT xJoJjq
IJzÓnJm IjMnm TrPf kJPrjÇ
xyjvLu IKˆSIJgtrJAKax (Moderate OA)
xKºr TJKatPu\ âoJVf ã~ yPf Êr∆ TPrÇ fUj
yÅJaár yJPzr ßTJeJèPuJPf yJz mJ TÅJaJ \JfL~ KTZá
‰fKr yPf kJPrÇ fUj IJkjJr kPã YuJPlrJ TrJaJ
xKfqA pπeJhJ~T yP~ CPbÇ
èr∆fr IKˆSIJgtrJAKax (Severe OA)
TJKatPu\ y~PfJ kMPrJkMKr ßnPX ßpPf kJPr, pJr lPu
yJzèPuJ kr¸Prr xPñ WwJ ßUPf gJPTÇ IJkKj
y~PfJ IjMnm TrPmj ßp, IJkjJr pπeJ IJrS ßmKv
ßmPz ßVPZ S èr∆fr yP~PZ, IJr IJkjJr ‰hjKªj
TJ\Tot TrJr ãofJ TPo ßVPZÇ
4 5
IJkjJr IKˆSIJgtrJAKax­Fr
KYKT&xJ mqm˙J xŒPTt \JjMj
IJkjJr yÅJaár IKˆSIJgtrJAKax IJPZ mPu pKh Diagnosis yP~ gJPT
fJyPu IJkjJPT Kj~Kof nJPm IJkjJr cJÜJPrr TJPZ ßpPf yPmÇ IJkjJr
KYKT&xT IJkjJr pπeJ ToJPjJ FmÄ ßrJ\TJr TJ\Tot TrJr ãofJ
mJzJPjJr \jq KmKnjú KmT· KjP~ IJPuJYjJ TrPmjÇ
\LmjpJ©JPf kKrmftj
● xyjvLu \Lmj pJ©JPf mqJ~Jo FmÄ
Physiotherapy IJkjJr ßkvLr vKÜ mJzJPjJ
FmÄ IJkjJr YuJPlrJr ãofJ mJzJPf xyJ~fJ
TrPf kJPrÇ
● IJkjJr vrLr pKh ˙NuTJ~ y~, fPm yÅJaár Skr YJk ToJPjJr \Pjq
S\j ToJPjJr krJovt ßh~J y~Ç
oMPU UJS~Jr HwixoNy
● oMPU UJS~Jr HwixoNy, ßpoj­
kqJrJKxaJou, IJAmMPk´JPlj FmÄ IjqJjq
jj­ßˆr~cJu IqJK≤AjPlîPoaKr csJVx'
(FjFxFIJAKc) IJkjJPT pπeJ ßgPT
oMKÜ KhPf kJPrÇ FèPuJ hLWt­ßo~JhL xoJiJj yPf kJPr jJ, TJre fJ
ßkPar ßVJuPpJV FmÄ IjqJjq èr∆fr VqJPˆsJAP≤ÓJAjJu
kJvõt­k´KfKâ~Jr TJre WaJPf kJPrÇ
● VäMPTJxqJoJAj/TjPcsJAKaj xJuPla yPóZ Foj KYKT&xJ KmT·xoNy, pJ
‰hKjT KyPxPm KjPu IJkjJr pπeJr oJ©J UJKjTaJ ToPf kJPrÇ