富血小板血浆与透明质酸钠关节腔内注射治疗膝骨关节炎的疗效比较

Comparison of therapeutic effects of platelet-rich plasma and hyaluronic acid intra-articular injection in the treatment of knee osteoarthritis

目的比较自体富血小板血浆(PRP)与透明质酸(HA)钠关节腔内注射治疗膝骨关节炎的临床效果。方法 2011年10月至2013年11月,盐城市第一人民医院门诊205例(278膝)膝关节炎患者纳入了本研究,根据患者选择进行分组,186例(230膝)完成治疗及随访,HA组82例96膝、PRP组104例124膝,二组分别采用药物2 m L HA钠、3 m L自体PRP加4 m L 5%利多卡因关节腔注射,每周1次,共3次。治疗前和治疗后3、6、12个月对患者进行随访并进行安大略西部和麦克马斯特大学骨关节炎指数(WOMAC)评分评估,对膝关节肿胀消退情况进行观察。两组间各时相点WOMAC评分比较采用t检验,组内不同时间点比较采用重复测量方差分析,组内不同时间点两两比较采用Bonferroni检验。结果 PRP组和HA组患者治疗后WOMAC评分均得到显著改善(F=206.430、122.984,P<0.05)。治疗后3个月,两组间WOMAC评分比较差异无统计学意义(t=-0.046,P>0.05),治疗后6个月和治疗后12个月,PRP组WOMAC评分[(21.43±4.92)分、(21.57±7.32)分]与HA组[(23.44±5.41)分、(29.12±8.27)分]比较,差异有统计学意义(t=-2.519、-5.768,P<0.05)。HA组与PRP组膝关节肿胀治疗后消退情况分别为22膝(31.4%)与41膝(56.9%),两组比较差异有统计学意义(χ2=9.362,P<0.05)。结论 PRP关节腔注射治疗膝骨关节炎获得了更持久的症状缓解效果,更多患者膝关节肿胀消退。

Objective To compare the efficacy of Platelet Rich Plasma （PRP）and Hyaluronic Acid （HA）intra-articular injection in patients with knee osteoarthritis.Methods All 205 patients with knee osteoarthritis in Yancheng City No.1 People′s Hospital were enrolled,which were assigned to the PRP and HA group based on patients′voluntary choice and random principle.Eighty two cases 96 knees in HA group and 104 cases 124 knees in PRP group have got the complete follow-up.Both the two groups were added with 4 mL of 5% lidocaine for intra-articular injection.All patients were prospectively evaluated before and at 3,6,and 12 months after the treatment by WOMAC scores.The patients′knee swelling subsided was observed.Between the two groups WOMAC scores were compared using t test at each time point,within groups were compared using repeated measures analysis of variance,at different time points were compared with Bonferroni test.The knee swelling subside were measured over time.Results No serious adverse events were detected in both groups. At the follow-up evaluations, both groups presented a clinical improvement （F=206.430,122.984,P〈0.05 ）.The comparison between the two groups showed a not statistically significant difference 3 months after treatment （t =-0.046,P 〉0.05 ）.Six months and 12 months after treatment,PRP group [（21.43 ±4.92）,（21.57 ±7.32）points]and HA group [（23.44 ±5.41）,（29.12 ±8.27）points]WOMAC score,the difference was statistically significant（t=-2.519 、-5.768,P〈0.05）.HA group and PRP group ofter treatment of knee joint swelling subsided were 22 knees （31.4%）and 41 knees （56.95%）,there was significant difference between the two groups （χ2 =9.362,P〈0.05）.Conclusions PRP intra-articular injection in the treatment of knee osteoarthritis was more durable compared to HA.The more patients′knee swelling was subsided in PRP group.