超声引导下关节腔注射富血小板血浆治疗膝骨性关节炎疗效的回顾性研究

A retrospective study of the effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of knee osteoarthritis

目的探讨分析超声引导下关节腔注射富血小板血浆(platelet-rich plasma,PRP)对不同严重程度膝骨性关节炎的疗效及疗效差异。方法回顾分析2018年5月-2019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关节腔PRP注射治疗膝骨性关节炎患者的临床特征和X线影像学资料,并依据Kellgren&Lawrence(K&L)分级标准分为0、Ⅰ、Ⅱ、Ⅲ、Ⅳ级组。各组患者均接受4次PRP关节腔注射治疗,注射间隔1周;并分别于注射治疗前、治疗后3个月、治疗后6个月完成视觉模拟评分(Visual analogue scale,VAS)、西安大略和麦克马斯特大学(Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)骨关节炎指数的疗效评估和不良反应评价。结果共纳入患者102例,无0级病例纳入;其中,K&LⅠ级20例、Ⅱ级37例、Ⅲ级31例、Ⅳ级14例;未有不良事件报告。K&LⅠ、Ⅱ、Ⅲ级组患者VAS评分和WOMAC评分均随时间明显改善(P<0.001);各组治疗后3、6个月分别与治疗前相比,VAS、WOMAC评分均改善明显(P<0.05);各组治疗后3、6个月VAS评分比较,差异均无统计学意义(P>0.05);K&LⅠ级组治疗后3、6个月WOMAC评分比较,差异无统计学意义(P>0.05),但K&LⅡ、Ⅲ级组治疗后3个月WOMAC评分均优于治疗后6个月(P<0.05)。K&LⅣ级组患者随访至3、6个月时,VAS评分和WOMAC评分随时间均无明显变化(P>0.05)。结论超声引导下关节腔注射PRP操作安全、疗效确切,可有效缓解轻、中度膝骨性关节炎疼痛、改善功能障碍,值得进一步临床推广。

Objective To explore the clinical efficacy of the ultrasound-guided intra-articular injection of platelet-rich plasma(PRP) in the treatment of patients with different stages of knee osteoarthritis. Methods We retrospectively analyzed the clinical characteristics and X-ray data of patients with knee osteoarthritis who received ultrasound-guided intra-articular injection of PRP in the Department of Rehabilitation Medicine at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University between May 2018 and June 2019. The patients were grouped according to the Kellgren & Lawrence Classification(K&L 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ). All the patients received four injections with a one-week interval. The Visual Analogue Scale(VAS) and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) were used to evaluate the clinical efficacy before the injection, and 3 and 6 months after the injection. Adverse reactions were recorded. Results A total of 102 patients were included without any grade 0 cases. There were 20 patients in K&L Ⅰ group, 37 in Ⅱ group, 31 in Ⅲ group, and 14 in Ⅳ group. No adverse event was reported. Significant differences of VAS scores and WOMAC index were observed in Ⅰ, Ⅱ and Ⅲ groups at the 3 rd and 6 th month follow-up(P<0.05). VAS and WOMAC scores of the three groups at the 3 rd and 6 th month after the treatment were significantly improved compared with those before the treatment(P<0.05). There was no significant difference in VAS score at the3 rd or 6 th month after the treatment three groups(P>0.05). For K&L Ⅰ group, there was no statistically significant difference in WOMAC score at the 3 rd or 6 th month after the treatment(P>0.05). However, the WOMAC scores at the3 rd month after the treatment were better than those at the 6 th month in K&L Ⅱ and Ⅲ groups(P<0.05). There was no significant time-depended changes in VAS score or WOMAC score in K&L Ⅳ group(P>0.05). Conclusion The ultrasound-guided intra-articular PRP injection is safe and effective for pain relief and function improvement in patients with knee osteoarthritis at the early and middle stage.