超声引导髋关节腔富血小板血浆注射对股骨头坏死的疗效分析  

Effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of osteonecrosis of the femoral head: a retrospective study

作　　者：王少玲 栾烁[1] 范胜诺[1] 刘翠翠[1] 栗晓[1] 马超[1] 伍少玲[1] WANG Shaoling;LUAN Shuo;FAN Shengnuo;LIU Cuicui;LI Xiao;MA Chao;WU Shaoling(Department of Rehabilitation Medicine,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510120,P.R.China)

机构地区：[1]中山大学孙逸仙纪念医院康复医学科,广州510120

出　　处：《华西医学》2021年第5期617-622,共6页West China Medical Journal

基　　金：中山大学孙逸仙纪念医院临床培育常规项目(SYS-C-202002)。

摘　　要：目的探讨分析超声引导下髋关节腔注射富血小板血浆(platelet-rich plasma,PRP)对股骨头缺血性坏死的临床疗效及安全性。方法回顾分析2019年6月-2020年6月在中山大学孙逸仙纪念医院康复医学科接受超声引导下髋关节腔PRP注射的股骨头坏死患者的临床特征、影像学表现和临床疗效。患者均接受4次注射,每次注射间隔1周;分别在治疗前和开始治疗后1、3、6个月时进行视觉模拟评分(Visual Analogue Scale,VAS)、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities Index,WOMAC)、Harris髋关节功能评分(Harris评分)等疗效评估和不良事件记录。正态分布资料用均数±标准差表示,行单因素重复测量方差分析;非正态分布资料用中位数(下四分位数,上四分位数)表示,行Friedman检验。结果共纳入患者29例,依据国际骨循环研究学会骨坏死分期标准,Ⅰ期2例,Ⅱ期11例,Ⅲ期11例,Ⅳ期5例。治疗前及治疗后1、3、6个月的VAS评分分别为7.0(5.5,8.0)、4.0(3.0,5.0)、3.0(2.0,3.0)、3.0(2.0,5.0)分,WOMAC评分分别为(39.27±11.70)、(28.34±8.08)、(22.82±6.09)、(24.13±7.55)分,Harris评分分别为46.0(40.0,64.0)、71.0(57.5,75.0)、78.0(68.0,80.5)、78.0(64.0,80.0)分,各指标治疗前后的差异均有统计学意义(χ^(2)=65.423,P<0.001;F=46.710,P<0.001;χ^(2)=66.347,P<0.001)。治疗后1、3、6个月时与治疗前比较,以及治疗后3个月时和治疗后1个月时比较,各评分差异均有统计学意义(P<0.05);治疗后6个月时与治疗后3个月时相比,各评分差异均无统计学意义(P>0.05);治疗后6个月时与治疗后1个月时相比,WOMAC评分差异有统计学意义(P=0.016),而VAS评分和Harris评分的差异无统计学意义(P>0.05)。随访期间无不良事件报告。结论超声引导下髋关节腔PRP注射能有效缓解股骨头坏死患者的疼痛程度,改善髋关节功能,且效果持续至少6个月。但未来需更大样本量的随机对�Objective To explore the clinical efficacy and safety of ultrasound-guided intra-articular injection of platelet-rich plasma(PRP) in the treatment of avascular necrosis of the femoral head. Methods We retrospectively collected and analyzed the clinical characteristics, imaging data, and clinical outcomes of patients with femoral head necrosis who received ultrasound-guided intra-articular PRP injection in the Department of Rehabilitation Medicine of Sun Yat-sen Memorial Hospital, Sun Yat-sen University between June 2019 and June 2020. All the patients received4 injections at one-week intervals. The Visual Analogue Scale(VAS), Western Ontario and McMaster University Osteoarthritis Index(WOMAC), and Harris Hip Joint Function Scale(HHS) were evaluated before treatment and1 month, 3 months, and 6 months after the first injections. Adverse events were recorded. The normally distributed data were presented as mean±standard deviation, and analyzed by one-way repeated measures analysis of variance;the nonnormally distributed data were presented as median(lower quartile, upper quartile), and analyzed by Friedman test.Results A total of 29 patients were included. According to the Association Research Circulation Osseous classification standard, 2 patients were classified as stageⅠ, 11 as stageⅡ, 11 as stage Ⅲ, and 5 as stage Ⅳ. Before treatment and1 month, 3 months, and 6 months after treatment, the VAS scores were 7.0(5.5, 8.0), 4.0(3.0, 5.0), 3.0(2.0, 3.0), and 3.0(2.0, 5.0), respectively, the WOMAC scores were 39.27±11.70, 28.34±8.08, 22.82±6.09, and 24.13±7.55, respectively, and the HHS were 46.0(40.0, 64.0), 71.0(57.5, 75.0), 78.0(68.0, 80.5), and 78.0(64.0, 80.0), respectively. The time effects in VAS(χ^(2)=65.423, P<0.001), WOMAC(F=46.710, P<0.001), and HHS(χ^(2)=66.347, P<0.001) were all statistically significant.There were significant differences in each index between the values 1 month, 3 months, and 6 months after treatment and those before treatment respectively, and there was also a significant

关 键 词：股骨头坏死 富血小板血浆 超声引导下髋关节腔注射 回顾性研究 

分 类 号：R681.8[医药卫生—骨科学]