切换至 "中华医学电子期刊资源库"

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. 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. 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
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]. 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]. 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。

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.

表1 三组患者一般资料比较
表2 各时间点三组患者VAS评分[分,(±s)]
表3 各时间点三组患者WOMAC评分[分,(±s)]
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)]
图4 治疗后24周右膝关节的膝关节积液几乎消失
[1]
Hawker GA, Croxford R, Bierman AS, et al. All-cause mortality and serious cardiovascular events in people with hip and knee osteoarthritis: a population based cohort study[J/OL]. PLoS One, 2014, 9(3): e91286. DOI:10.1016/j.joca.2014.02.089.
[2]
Rehart S, Wickler B, Nitschmann S. Osteoarthritis of the knee: physical therapy or intra-articular corticoid injection[J]. Internist (Berl), 2020, 61(10): 1087-1090.
[3]
李川,卜鹏飞,韩云峰,等.运动治疗膝骨关节炎的实施方案及临床探索[J/CD].中华关节外科杂志(电子版)202115(1):98-103.
[4]
Cole BJ, Seroyer ST, Filardo G, et al. Platelet-rich plasma: where are we now and where are we going?[J]. Sports Health, 2010, 2(3): 203-210.
[5]
邢丹,余楠生,袁霆,等.关节腔注射富血小板血浆治疗膝骨关节炎的临床实践指南(2018年版)[J/CD].中华关节外科杂志(电子版)201812(4):444-448.
[6]
Görmeli G, Görmeli CA, Ataoglu B, et al. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 958-965.
[7]
Patel S, Dhillon MS, Aggarwal S, et al. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial[J]. Am J Sports Med, 2013, 41(2): 356-364.
[8]
Kavadar G, Demircioglu DT, Celik MY, et al. Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study[J]. J Phys Ther Sci, 2015, 27(12): 3863-3867.
[9]
中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志201838(12):705-715.
[10]
袁霆,张长青.骨组织及软组织修复作用中富血小板血浆的制作及其原理[J].中国临床康复20048(35):7939-7941.
[11]
Mohammad S, Rik K. Platelet-rich plasma (PRP) for knee disorders[J]. Efort Open Reviews, 2017, 2(2):28-34.
[12]
Morishita R, Aoki M, Hashiya N, et al. Safety evaluation of clinical gene therapy using hepatocyte growth factor to treat peripheral arterial disease[J]. Hypertension, 2004, 44(2): 203-209.
[13]
王新刚,黄鹏,雷玉凯.超声半定量评估膝关节软骨退变程度与临床表现的相关性分析[J].中国实验诊断学202024(2):272-274.
[14]
Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition[J]. J Am Acad Orthop Surg, 2013, 21(9): 571-576.
[15]
Van Buul GM, Koevoet WL, Kops N, et al. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes[J]. Am J Sports Med, 2011, 39(11): 2362-2370.
[16]
Mccarrel T, Fortier L. Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression[J]. J Orthop Res, 2009, 27(8): 1033-1042.
[17]
Song S, Cha YD, Han J, et al. Hyaline cartilage regeneration using mixed human chondrocytes and transforming growth factor-beta1- producing chondrocytes[J]. Tissue Eng, 2005, 11(9/10): 1516-1526.
[18]
Chen C, Chen JL, Hsu CC, et al. Injecting autologous platelet rich plasma solely into the knee joint is not adequate in treating geriatric patients with moderate to severe knee osteoarthritis[J]. Exp Gerontol, 2019, 119(5): 1-6.
[19]
齐清华,刘宏建,赵艳萍,等.彩色超微血管成像技术及高频超声在早期幼年特发性关节炎膝关节病变的应用[J].中华实验外科杂志201835(12):2330-2332.
[20]
温朝美.肌骨超声评分系统在类风湿关节炎中的应用[J].中国医学影像技术201632(5):807-810.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志(电子版), 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志(电子版), 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志(电子版), 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志(电子版), 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志(电子版), 2023, 20(08): 809-815.
[8] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志(电子版), 2023, 20(08): 844-848.
[9] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志(电子版), 2023, 20(07): 717-721.
[10] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[11] 黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[12] 樊绪国, 赵永刚, 杨砚伟. 腓骨在膝骨关节炎作用的研究观点[J]. 中华关节外科杂志(电子版), 2023, 17(06): 855-859.
[13] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[14] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[15] 付庆鹏, 邓晓强, 高伟, 姜福民, 范永峰, 吴海贺, 齐岩松, 包呼日查, 徐永胜. 新型股骨测量定位器在全膝关节置换术中的临床应用[J]. 中华临床医师杂志(电子版), 2023, 17(9): 980-987.
阅读次数
全文


摘要