透明质酸、富血小板血浆及两者联合应用对膝骨关节炎的疗效评估

Hyaluronic acid, platelet rich plasma and the combination of both in the treatment of osteoarthritis of the knee

目的本研究旨在评估透明质酸(hyaluronic aicd,HA)与富血小板血浆(platelet rich plasma,PRP)对膝骨关节炎的疗效,同时探讨两者联合应用的潜在治疗效果。方法纳入从2016年1月至2017年12月就诊于南京市第一医院的膝骨关节炎患者101例,按治疗方法的不同分为A组(膝关节腔内注射HA)37例、B组(膝关节腔内注射PRP)33例、C组(联合应用)31例。采用膝关节损伤与骨关节炎评分(knee injury and osteoarthritis outcome score,KOOS)在治疗前和治疗后1、3、6个月对疗效进行评估。结果①治疗1个月后,三组KOOS评分均较治疗前明显改善(P<0.05),其中C组的KOOS疼痛评分显著优于A组及B组(P<0.05);②治疗3个月后,3组较治疗前仍维持较好的疗效(P<0.05),其中B组与C组KOOS部分评分优于A组(P<0.05),B组与C组之间无明显差异(P>0.05);③治疗6个月后,B组与C组KOOS评分仍优于治疗前(P<0.05),两组无显著差异,而A组KOOS评分较治疗前无明显优势(P>0.05)。结论关节腔内注射PRP治疗膝骨关节炎可获得至少6个月的疗效,且在治疗3个月后,疗效优于HA。对于HA+PRP疗法,优势主要表现在短期内更为显著的改善了患者的疼痛症状。

Objective This study aimed at evaluating the efficacy of hyaluronic acid(HA)and platelet rich plasma(PRP)in treating knee osteoarthritis(KOA).It also examined the potential effects of the combination of HA and PRP.Methods From January 2016 to December 2017,101 KOA patients who received treatment at Nanjing First Hospital were included in this study.Patients were grouped according to treatment methods,and there were 37 patients injected with HA(group A),33 patients with PRP(group B),and 31 patients with HA+PRP(group C).Knee injury and Osteoarthritis Outcome Score(KOOS)was applied to all patients pre-and post-treatment(1,3 and 6 months).Results(1)At the end of the 1st month after injection,significant improvements in KOOS were seen in all groups(P<0.05).Group C had greater improvement in KOOS pain scores than groups A and B(P<0.05).(2)At the 3rd month,all groups still had better clinical effect compared with pre-treatment(P<0.05).KOOS sectional scores in groups B and C significantly improved when compared with group A(P<0.05),while the improvements in KOOS were not significantly different between groups B and C(P>0.05).(3)At the 6th month,KOOS improvement was maintained in group B and C and there was not significant difference between the two groups(P<0.05),while the improvement disappeared in group A(P>0.05).Conclusion This study showed that the use of PRP has effective effects on knee osteoarthritis for at least 6 months.It also showed that PRP resulted better outcomes than HA from the 3rd months.Furthermore,the results suggest that combination of PRP and HA could potentially provide better pain relief in the short term compared with PRP or HA alone.