关节内注射富血小板血浆与玻璃酸钠治疗膝关节骨关节炎的对比研究

A Comparative Study of Platelet-rich Plasma and Hyaluronic Acid Intra-articular Injection for Knee Osteoarthritics

目的比较富血小板血浆（platelet-rich plasma,PRP）与玻璃酸钠（hyaluronic acid sodium,HA）治疗膝关节骨关节炎（knee osteoarthritis,KOA）的近期疗效。方法 2013年3月～2014年1月,将60例KOA按就诊顺序依次分至A、B、C组,每组20例。A组膝关节内注射自体PRP 5 ml,B组膝关节内注射HA 2 ml,C组膝关节内先注射PRP 5 ml,10 min后注射HA 2ml。每周一次,连续5周。治疗结束后4周采用Lysholm膝关节评分系统进行评价。结果 A组、C组各1例注射PRP后出现短暂膝关节炎症反跳,其余患者均未出现并发症。3组治疗后4周Lysholm膝关节评分较治疗前均有明显提高（A组42.3±10.5 vs.54.3±10.4,t=-7.086,P=0.000;B组41.6±10.0 vs.54.2±9.1,t=-5.450,P=0.000;C组41.8±10.4 vs.66.8±7.2,t=-12.887,P=0.000）,且C组明显高于A、B组（F=12.982,P=0.000）。C组有效率（60%,12/20）明显高于A组（20%,4/20）和B组（20%,4/20）（χ2=9.600,P=0.008）。治疗前后血常规和肝、肾功能均未出现异常。结论膝关节腔注射PRP联合HA可以迅速控制疼痛并改善患者膝关节功能,具有显著的近期疗效,是治疗KOA的一种安全有效的方法,长期疗效有待继续观察。

Objective To compare the curative effects between platelet-rich plasma （PRP） and hyaluronic acid sodium （HA） intra-artieular injection for the treatment of knee osteoarthritis （KOA）. Methods From March 2013 to January 2014, 60 cases of KOA were divided into A, B, C groups according to admission sequence, with 20 cases in each group. The Group A was given knee joint injection of PRP 5 ml, Group B was given knee joint injection of HA 2 ml, and Group C received knee joint injection of PRP 5 ml and HA 2 ml at 10 min afterwards, once a week for five weeks. Four weeks after treatment, we evaluated the treatment effect with the Lysholm knee score system. Results One patient in the group A and the group C respectively showed serious and transient inflammation after the injection of PRP. The rest of the all patients had no complications. After treatment, the Lysholm knee scores were obviously improved as compared to before treatment in all the three groups （ Group A： 42.3 ± 10.5 vs. 54.3 ± 10.4, t = -7.086, P=0.000; Group B. 41.6±10.0 vs. 54.2 ±9.1, t= -5.450, P=0.000; Group C： 41.8 ±10.4 vs. 66.8 ±7.2, t = - 12. 887, P = 0. 000）. The scores in the Group C were significantly higher than those in the Group A and the Group B （ F = 12. 982, P =0.000）. The effective rate of the Group C （60% , 12/20） was significantly higher than that in the Group A （20% , 4/20） and Group B （20% , 4/20） （X2 = 9. 600, P = 0. 008 ）. Routine blood and liver and renal functions were normal before and after treatment. Conclusions Knee joint injection of PRP and HA can quickly control the pain and improve patients＇ joint functions. This treatment has significant short-term effects, being a safe and effective method for the treatment of KOA. However, the long-term efficacy requires further investigations.