应用富血小板血浆混合透明质酸钠治疗膝骨关节炎

doi:10.3877/cma.j.issn.1674-134X.2018.06.023

目的

比较富血小板血浆＋透明质酸钠(PRP＋HA)混合物与单纯使用PRP关节腔内注射治疗Ⅱ期和Ⅲ期膝骨关节炎患者的疗效。

方法

选择2014年2月至2014年5月，山东大学附属省立医院和威海市立医院门诊收治的126例Ⅱ、Ⅲ期(Keligren Lawrence分级)膝关节骨关节炎的患者，随机分为PRP＋HA混合物组(63例，63膝)和PRP组(63例，63膝)，两组患者性别、年龄、身体质量指数、Keligren Lawrence分级、疼痛视觉模拟评分(VAS)、美国西部安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分分别采用t检验和χ²检验比较。患者接受每周1次的HA＋PRP混合物(2 ml HA＋3.5 ml PRP)关节腔内注射或只注射PRP(3.5 ml)治疗持续3周。在第1、3、6和12个月记录VAS评分和WOMAC评分，采用t检验比较治疗后不同时间点的疗效。

结果

两组患者性别、年龄、BMI的差异均无统计学意义(P >0.05)，具有可比性。在使用PRP＋HA混合物和单纯PRP治疗的患者中，相比治疗前患者的状态，VAS评分明显降低，膝关节的功能(WOMAC)明显改善。就VAS和WOMAC而言，两组之间差异没有统计学意义(VAS：t＝0.862，P>0.05；WOMAC：t＝1.765，P>0.05)；然而，PRP＋HA混合物组有1种能获得更好的功能评分的趋势。两组中没有发现重大不良反应或并发症。

结论

PRP＋HA混合物治疗Ⅱ、Ⅲ期膝骨关节炎的患者是安全有效的。

关键词: 骨关节炎, 富血小板血浆, 透明质酸

Objective

To compare the clinic effects of intra-knee-articular injection of PRP+ HA mixture and PRP only on treating grade Ⅱand Ⅲ knee osteoarthritis.

Methods

A total of 126 qualified patients with grade Ⅱ and Ⅲknee osteoarthritis according to Keligren Lawrence classification(K-L classification ) in Weihai Municipal Hospital and Shandong Provincial hospital from February 2014 to May 2014 were included: Exclusion criteria were other knee inflammatory diseases, any bone and joint tumors, history of hormone usage, and severe cardiovascular diseases and diabetes. There were 63 cases in the PRP+ HA mixture group and 63 cases in the PRP group. The pain was evaluated by visual analogue scale (VAS), and the joint function was assessed with Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC). The t-test was used to asscesse the difference of age, body mass index(BMI), visual analogue score (VAS) and WOMAC scores; chi-square test was used to evaluate the difference of gender, K-L classification. Follow-up was carried out at one, three, six and 12 months. VAS score and WOMAC score were assessed the patients’ condition. The t test was used to compare the curative effect at different time points after the treatment.

Results

There was no significant difference between the two groups in gender, age, or BMI (all P>0.05). In the participants treated with PRP+ HA mixture and with PRP only, VAS scores decreased significantly, and accordingly, knee function (WOMAC) improved, compared to the status of patients prior to treatment. Regarding to VAS and WOMAC, no significant difference was observed between the two groups (VAS: t=0.862, P>0.05; WOMAC: t=1.765, P>0.05); however, there was a trend that could obtain better functional scores in PRP+ HA mixture group. No major adverse events or complications were observed in both groups.

Conclusion

PRP+ HA mixture is effective and safe in the management of patients suffering from grade Ⅱ and Ⅲ KOA.

Key words: Osteoarthritis, Platelet rich plasma, Hyaluronic acid

表1 两组患者一般资料的比较

组别	例数	性别(男/女)	年龄[岁，(±s)]	BMI [kg/m^2, (±s)]	左右例数左/右	K-L分期[例(%)]			病史[月，(±s)]	VAS评分(±s)	WOMAC评分(±s)	随访[月，±s)]
组别	例数	性别(男/女)	年龄[岁，(±s)]	BMI [kg/m^2, (±s)]	左右例数左/右	Ⅰ	Ⅱ	Ⅲ	病史[月，(±s)]	VAS评分(±s)	WOMAC评分(±s)	随访[月，±s)]
PRP＋HA组	63	45/18	61±10	24±4	25/38	17(27%)	28(44%)	18(29%)	26±10	7±3	40±13	14±5
PRP组	63	51/12	61±10	25±4	29/34	15(24%)	31(49%)	17(27%)	29±9	7±4	41±13	16±6
统计值	?	χ²＝1.58	t ＝0.21	t ＝0.31	χ²＝0.52	χ²＝0.31			t＝1.65	t＝0.65	t＝0.78	t＝1.64
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05			>0.05	>0.05	>0.05	>0.05

表1 两组患者一般资料的比较

组别	例数	性别(男/女)	年龄[岁，(±s)]	BMI [kg/m^2, (±s)]	左右例数左/右	K-L分期[例(%)]			病史[月，(±s)]	VAS评分(±s)	WOMAC评分(±s)	随访[月，±s)]
组别	例数	性别(男/女)	年龄[岁，(±s)]	BMI [kg/m^2, (±s)]	左右例数左/右	Ⅰ	Ⅱ	Ⅲ	病史[月，(±s)]	VAS评分(±s)	WOMAC评分(±s)	随访[月，±s)]
PRP＋HA组	63	45/18	61±10	24±4	25/38	17(27%)	28(44%)	18(29%)	26±10	7±3	40±13	14±5
PRP组	63	51/12	61±10	25±4	29/34	15(24%)	31(49%)	17(27%)	29±9	7±4	41±13	16±6
统计值	?	χ²＝1.58	t ＝0.21	t ＝0.31	χ²＝0.52	χ²＝0.31			t＝1.65	t＝0.65	t＝0.78	t＝1.64
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05			>0.05	>0.05	>0.05	>0.05

表2 两组患者治疗后结果比较

组别	例数	VAS评分(±s)	WOMAC评分(±s)	满意度[例(%)]
组别	例数	VAS评分(±s)	WOMAC评分(±s)	优/良	中/差
PRP＋HA组	63	1.3 ± 1.1	1.6 ± 0.9	57(90%)	6(10%)
PRP组	63	14.6 ± 6.9	15.7 ± 8.5	52(83%)	11(17%)
统计值	?	t ＝0.862	t ＝1.765	χ²＝1.7
P值	?	>0.05	>0.05	>0.05

表2 两组患者治疗后结果比较

组别	例数	VAS评分(±s)	WOMAC评分(±s)	满意度[例(%)]
组别	例数	VAS评分(±s)	WOMAC评分(±s)	优/良	中/差
PRP＋HA组	63	1.3 ± 1.1	1.6 ± 0.9	57(90%)	6(10%)
PRP组	63	14.6 ± 6.9	15.7 ± 8.5	52(83%)	11(17%)
统计值	?	t ＝0.862	t ＝1.765	χ²＝1.7
P值	?	>0.05	>0.05	>0.05

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Treatment of knee osteoarthritis with mixture of platelet-rich-plasma plus hyaluronic acid

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Treatment of knee osteoarthritis with mixture of platelet-rich-plasma plus hyaluronic acid