富血小板血浆不同注射次数对膝骨关节炎的疗效

doi:10.3877/cma.j.issn.1674-134X.2022.03.002

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 267 -272. doi: 10.3877/cma.j.issn.1674-134X.2022.03.002

临床论著

富血小板血浆不同注射次数对膝骨关节炎的疗效

李弯月¹, 尚亚茹², 庄卫生³^,^†(

), 钱宝延³, 张莹³, 王笑林³

^1. 510632　广州，暨南大学附属第一医院康复医学科；450003　郑州，河南省人民医院康复医学科
^2. 510632　广州，暨南大学附属第一医院康复医学科
^3. 450003　郑州，河南省人民医院康复医学科

收稿日期:2021-02-26 出版日期:2022-06-01
通信作者: 庄卫生
基金资助:
河南省科技攻关项目(202102310452); 河南省卫生厅科技攻关项目(2017075)

Effect of different injection times of platelet-rich plasma on knee osteoarthritis

Wanyue Li¹, Yaru Shang², Weisheng Zhuang³^,^†(), Baoyan Qian³, Ying Zhang³, Xiaolin Wang³

^1. Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China; Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
^2. Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
^3. Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China

Received:2021-02-26 Published:2022-06-01
Corresponding author: Weisheng Zhuang

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引用本文：

李弯月, 尚亚茹, 庄卫生, 钱宝延, 张莹, 王笑林. 富血小板血浆不同注射次数对膝骨关节炎的疗效[J/OL]. 中华关节外科杂志(电子版), 2022, 16(03): 267-272.

Wanyue Li, Yaru Shang, Weisheng Zhuang, Baoyan Qian, Ying Zhang, Xiaolin Wang. Effect of different injection times of platelet-rich plasma on knee osteoarthritis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(03): 267-272.

目的

探讨富血小板血浆(PRP)不同注射次数对膝骨关节炎疗效的影响。

方法

纳入2018年2月至2019年2月河南省人民医院90例膝骨关节炎患者为研究对象，纳入标准：符合膝骨关节炎诊断标准、病程大于4个月、X线Kellgren-Lawrence分级(K-L分级)Ⅱ~Ⅲ级；排除标准：合并类风湿性关节炎、近期膝关节外伤或手术史、痛风、血液病、肿瘤等疾病者。按照注射次数不同，随机分为1次组、3次组、5次组，每组30例，分别给予1、3、5次PRP注射，每周1次。于治疗前、治疗后6、12、24周采用视觉模拟疼痛评分(VAS)评分和美国西安大略与麦克马斯特大学骨关节炎指数(WOMAC)评估患者膝关节功能，采用超声半定量分级评分评估患者膝关节软骨状态。VAS评分、WOMAC评分进行重复测量方差分析，超声半定量评分组内治疗前后采用配对样本t检验，组间比较采用单因素方差分析。

结果

治疗后6周，与1次组相比，3次组和5次组VAS评分、WOMAC评分均有显著降低(F＝17.922、22.215，均为P<0.01)。治疗后12周，与1次组相比，3次组和5次组VAS评分、WOMAC评分均有显著降低(F＝71.058、39.592，均为P<0.01)。治疗后24周，与1次组相比，3次组、5次组VAS评分、WOMAC评分、超声半定量评分均有显著降低(F＝163.974、86.980、6.781，均为P<0.01)。

结论

3次及5次PRP注射治疗膝骨关节炎较1次有更好的疗效，但3次与5次注射未见明显差异。

关键词: 膝, 骨关节炎, 富血小板血浆, 注射, 超声检查

Objective

To explore the effect of different injection frequencies of PRP on the efficacy of knee osteoarthritis.

Methods

A total of 90 patients with knee osteoarthritis in Henan Provincial People's Hospital from February 2018 to February 2019 were included in the study. Inclusion criteria: the patient met the diagnostic criteria of knee osteoarthritis, the duration of the disease were more than four months, and the X-ray Kellgren-Lawrence classification (K-L grading) were grade Ⅱ-Ⅲ. Exclusion criteria: patients with rheumatoid arthritis, recent knee trauma or surgical history, gout, blood diseases, tumors and other diseases. According to the frequency of injection, they were randomly divided into the one-time group, three-time group and five-time group, 30 patients in each group receiving one, three and five times PRP injection respectively, once a week. The knee joint function was assessed by visual analogue pain scale (VAS) and Western Ontario and McMaster University osteoarthritis index (WOMAC) before the treatment, and six, 12, 24 weeks after the treatment, and the knee joint cartilage status was assessed by ultrasonic semi-quantitative grading. VAS score and WOMAC score were evaluated by repeated measure ANOVA, paired sample t test was used before and after treatment in ultrasound semi-quantitative evaluation within the group, and one-way ANOVA was used for comparison between groups.

Results

At six weeks after the treatment, VAS score and WOMAC score in the three-and five-time groups were significantly lower than those in the one-time group (F =17.922, 22.215, both P<0.01). In 12 weeks after the treatment, VAS score and WOMAC score in the three-and five-time groups were significantly lower than those in the one-time group (F=71.058, 39.592, both P<0.01). In 24 weeks after the treatment, VAS score, WOMAC score and ultrasonic semi-quantitative score in the three- and five-time groups were significantly lower than those in the one-time group (F=163.974, 86.980, 6.781, all P<0.01).

Conclusion

The efficacy of three and five injections of PRP is better than one injection of PRP, but there is no obvious difference between three and five injections.

Key words: Osteoarthritis, Knee, Platelet-rich plasma, Injections, Ultrasonography

表1 三组患者一般资料比较

组别	例数	性别[例(%)]		年龄[岁，(±s)]	病程[年，(±s)]	初始血小板浓度[10⁹个/L，(±s)]	BMI[ kg/m²，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	病程[年，(±s)]	初始血小板浓度[10⁹个/L，(±s)]	BMI[ kg/m²，(±s)]
1次组	27	9(33.3)	18(66.7)	59.7±6.3	4.8±2.6	208.6±32.1	27.1±1.1
3次组	28	8(28.6)	20(71.4)	60.9±5.4	4.9±2.5	209.3±33.0	27.6±1.5
5次组	28	10(35.7)	18(64.3)	60.7±5.5	4.8±1.9	206.7±27.7	27.7±1.3
统计值		χ²＝0.337		F＝0.333	F＝0.022	F＝0.051	F＝1.496
P值		>0.05		>0.05	>0.05	>0.05	>0.05

表1 三组患者一般资料比较

组别	例数	性别[例(%)]		年龄[岁，(±s)]	病程[年，(±s)]	初始血小板浓度[10⁹个/L，(±s)]	BMI[ kg/m²，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	病程[年，(±s)]	初始血小板浓度[10⁹个/L，(±s)]	BMI[ kg/m²，(±s)]
1次组	27	9(33.3)	18(66.7)	59.7±6.3	4.8±2.6	208.6±32.1	27.1±1.1
3次组	28	8(28.6)	20(71.4)	60.9±5.4	4.9±2.5	209.3±33.0	27.6±1.5
5次组	28	10(35.7)	18(64.3)	60.7±5.5	4.8±1.9	206.7±27.7	27.7±1.3
统计值		χ²＝0.337		F＝0.333	F＝0.022	F＝0.051	F＝1.496
P值		>0.05		>0.05	>0.05	>0.05	>0.05

表2 各时间点三组患者VAS评分[分，(±s)]

组别	例数	治疗前	治疗后6周	治疗后12周	治疗后24周	F值	P值
1次组	27	6.7±0.9	3.5±0.8^a	4.3±0.9^a	5.3±0.9^a	239.696	<0.001
3次组	28	6.7±0.9	2.3±0.8^ab	2.2±0.7^ab	2.1±0.8^ab	592.563	<0.001
5次组	28	6.7±0.8	2.1±1.1^ab	1.8±0.8^ab	1.8±0.6^ab	681.948	<0.001
F值		0.001	17.922	71.058	163.974	1 260.85	<0.001^c
P值		>0.05	<0.001	<0.001	<0.001	49.091	<0.001^d
						20.056	0.003^e

表2 各时间点三组患者VAS评分[分，(±s)]

组别	例数	治疗前	治疗后6周	治疗后12周	治疗后24周	F值	P值
1次组	27	6.7±0.9	3.5±0.8^a	4.3±0.9^a	5.3±0.9^a	239.696	<0.001
3次组	28	6.7±0.9	2.3±0.8^ab	2.2±0.7^ab	2.1±0.8^ab	592.563	<0.001
5次组	28	6.7±0.8	2.1±1.1^ab	1.8±0.8^ab	1.8±0.6^ab	681.948	<0.001
F值		0.001	17.922	71.058	163.974	1 260.85	<0.001^c
P值		>0.05	<0.001	<0.001	<0.001	49.091	<0.001^d
						20.056	0.003^e

表3 各时间点三组患者WOMAC评分[分，(±s)]

组别	例数	治疗前	治疗后6周	治疗后12周	治疗后24周	F值	P值
1次组	27	160±27	106±17^a	113±17^a	142±29^a	135.450	<0.001
3次组	28	171±19	83±20^ab	81±19^ab	80±18^ab	590.078	<0.001
5次组	28	170±15	74±19^ab	71±18^ab	69±17^ab	565.488	<0.001
F值		2.282	22.215	39.592	86.980	502.315	<0.001^c
P值		0.109	<0.001	<0.001	<0.001	27.845	<0.001^d
						20.009	<0.001^e

表3 各时间点三组患者WOMAC评分[分，(±s)]

组别	例数	治疗前	治疗后6周	治疗后12周	治疗后24周	F值	P值
1次组	27	160±27	106±17^a	113±17^a	142±29^a	135.450	<0.001
3次组	28	171±19	83±20^ab	81±19^ab	80±18^ab	590.078	<0.001
5次组	28	170±15	74±19^ab	71±18^ab	69±17^ab	565.488	<0.001
F值		2.282	22.215	39.592	86.980	502.315	<0.001^c
P值		0.109	<0.001	<0.001	<0.001	27.845	<0.001^d
						20.009	<0.001^e

表4 三组患者治疗前及治疗后24周超声半定量分级评分[级，(±s)]

组别	例数	治疗前	治疗完成后24周	t值	P值
1次组	27	2.4±0.6	2.1±0.7^a	3.911	0.001
3次组	28	2.4±0.6	1.6±0.7^ab	7.318	<0.001
5次组	28	2.5±0.6	1.4±0.7^ab	10.510	<0.001
F值		0.107	6.781
P值		>0.05	0.002

表4 三组患者治疗前及治疗后24周超声半定量分级评分[级，(±s)]

组别	例数	治疗前	治疗完成后24周	t值	P值
1次组	27	2.4±0.6	2.1±0.7^a	3.911	0.001
3次组	28	2.4±0.6	1.6±0.7^ab	7.318	<0.001
5次组	28	2.5±0.6	1.4±0.7^ab	10.510	<0.001
F值		0.107	6.781
P值		>0.05	0.002

图4 治疗后24周右膝关节的膝关节积液几乎消失

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Effect of different injection times of platelet-rich plasma on knee osteoarthritis

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Effect of different injection times of platelet-rich plasma on knee osteoarthritis