富血小板血浆治疗Ⅱ-Ⅲ期膝骨关节炎的疗效评价  

Clinical effects of intra- articular injection with platelet rich plasma on grade Ⅱ and Ⅲ knee osteoarthritis

作　　者：袁林[1] 郭燕庆[1,2] 于洪波[2] 于泓[2] 吕慧利[2] 李伟[1] 满振涛[1] 孙水[1] 

机构地区：[1]山东大学附属省立医院骨关节科,济南250000 [2]威海市立医院创伤关节外科,264200

出　　处：《中华关节外科杂志（电子版）》2016年第4期26-32,共7页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的评价关节腔内注射富血小板血浆(PRP)相对于透明质酸(HA)钠治疗Ⅱ、Ⅲ期膝骨关节炎的临床疗效。方法选择2013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Keligren Lawrence分级(K-L分级)Ⅱ、Ⅲ期膝骨关节炎的患者,采用随机数字表法将患者分为HA组63例63膝,男性18例,女性45例,平均年龄(61±10)岁;PRP组63例63膝,男性12例,女性51例,年龄(61±10)岁。分别采用2 ml HA(施沛特,共5次,分别在第0、1、2、3、4周注射)和3.5 ml PRP(威高富血小板血浆制备套装,共3次,分别在第0、2、4周注射)关节腔内注射进行治疗。患者在治疗前和完成全部注射后的1、3、6、12个月进行复诊并记录视觉模拟评分(VAS)值、国际膝关节文献委员会(IKDC)评分、美国西部Ontario与Mc Master大学骨关节炎指数(WOMAC)评分等。采用单因素方差分析对两组患者的性别、年龄、体重指数、K-L分级、VAS评分、IKDC评分、WOMAC评分进行分析,采用重复测量的方差分析比较治疗后的疗效以及PRP及HA治疗的效果。结果 PRP组58例、HA组55例患者获得随访12个月,平均随访(14±2)个月和(16±3)个月。通过分析,两组在性别、年龄、体重指数、K-L分级、VAS、IKDC评分、WOMAC评分的比较中,差异均无统计学意义(P>0.05),具有可比性。PRP组患者16例40次出现不良反应,HA组14例37次出现不良反应;两组不良反应起始时间、终止时间及持续时间比较,差异均无统计学意义(P>0.05)。两组治疗后VAS评分、IKDC评分及WOMAC评分与治疗前比较,差异均有统计学意义(P<0.05);HA组治疗后6、12个月各评价指标治疗后较1、3个月差,差异有统计学意义(P<0.05)。两组治疗后1、3个月后,VAS评分、IKDC评分及WOMAC评分比较差异无统计学意义(P>0.05);但是治疗后6、12个月时,PRP组各指标均优于HA组(P<0.05)。结论关节内注射PRP治疗膝关节软骨退行性变安全有效,可缓解Objective To observe the clinical effects of intra-knee-articular injection of platelet rich plasma（ PRP） on treating grade Ⅱ and Ⅲ knee osteoarthritis compared to the intra-knee-articular injection of hyaluronic acid（ HA）. Methods A total of 126 qualified patients with grade Ⅱ and Ⅲ knee osteoarthritis according to Keligren Lawrence classification（ K-L classification） of Weihai Municipal Hospital and Shandong Provincial hospital affiliated to Shandong university from February 2013 to May 2014 were included in this study. The patients were randomly divided into PRP group[18 males,45 females,age（ 61 ± 10） years]and hyaluronic acid（ HA） group[12 males,51 females,age（ 61 ± 10） years]using random number sheet method,63 cases each. The PRP group received 3. 5 ml autologous venous blood prepared PRP injection into the joint cavity in week 0,week 2 and week 4; the HA group accepted the injection of 2 ml sodium hyaluronate in week 0,week 1,week 2,and week 4. When all the injections were finished,the patients were followed up at month 1,3,6 and 12. The adverse reactions of the two groups were recorded. The pain was evaluated by visual analogue scale（ VAS） score,and the joint function was assessed with International Knee Documentation Committee（ IKDC） score and Western Ontario and Mc Master Universities Osteoarthritis Index（ WOMAC） score. Analysis of variance（ ANOVA） was used to assess the difference of gender,age,body mass index（ BMI）,K-L classification,VAS score,IKDC score and WOMAC score between the groups. Repeated ANOVA was used to evaluate the difference among different time point between the groups. Results At last 58 patients in the PRP group and 55 patients in the HA group were followed up for 12 months. The average follow-up time were（ 14 ± 2） months and（ 16 ± 3） months respectively. No significantly difference was found in gender,age,body mass index,KL classification,VAS score,IKDC score,WOMAC score and other general information in these two groups�

关 键 词：骨关节炎 富血小板血浆 玻璃酸钠 

分 类 号：R684.3[医药卫生—骨科学]