富含血小板的血浆联合透明质酸钠注射治疗膝骨关节炎患者的疗效

Efficacy of platelet-rich plasma combined with sodium hyaluronate injection in the treatment of patients with knee osteoarthritis

目的评价富含血小板的血浆(PRP)联合透明质酸钠(HA)经关节腔注射治疗膝关节骨关节炎(KOA)的临床疗效。方法收集2017年1月至2019年1月在西安交通大学第一附属医院疼痛科和西安市灞桥区中医医院疼痛科门诊KOA患者80例,男39例,女41例,年龄48~70岁,按照随机数字表法分为富含血小板的血浆组(PRP组,n=42)和富含血小板的血浆联合透明质酸钠组(PH组,n=38)。PRP组膝关节内注射自体PRP 4 ml/次,PH组膝关节内注射自体PRP和HA混合物5.5 ml/次,均为1次/周,3周/疗程,共2~3个疗程。于治疗后2个月(T1)、3个月(T2)及6个月(T3)时采用Lysholm膝关节功能评定标准对患者进行膝关节功能评测,并进行临床疗效评价。结果治疗后各时点两组患者Lysholm膝关节总评分均较治疗前提高,PRP组T1、T2、T3时点总评分分别为[(68.3±2.3)、(86.3±3.4)、(84.8±2.5)]分,较T0时总分(55.2±4.6)分提高,差异均有统计学意义(P均<0.05);PH组T1、T2、T3时点总评分分别为[(70.6±3.0)、(89.8±4.1)、(88.0±4.3)]分,与其T0时(56.3±2.2)分提高,差异均有统计学意义(P均<0.05);两组疼痛、不安定度、闭锁感、肿胀度等8个分项得分也均较治疗前提高(P均<0.05)。T2和T3时两组膝关节功能总评分比较差异有统计学意义(P<0.05)。各时点分项评分比较,PH组在T3时疼痛评分为(17.6±3.8)分,高于PRP组(13.5±3.2)分(P<0.05);肿胀度评分为(9.6±1.2)分,高于PRP组(8.7±1.9)分(P<0.05),可见PH组在改善疼痛和肿胀方面优于PRP组。PH组临床优效率和总有效率分别为23.7%(9/38例)和97.4%(37/38例),均高于PRP组4.8%(2/42例)和83.3%(35/42例),差异有统计学意义(P<0.05)。结论PRP和PRP联合HA关节腔注射治疗KOA均可有效减轻关节疼痛和改善关节运动功能,联合组疗效更佳。

Objective To evaluate the clinical efficacy of platelet-rich plasma(PRP)combined with sodium hyaluronate(HA)injected into knee articular cavity in the treatment of osteoarthritis of the knee(KOA).Methods Eighty patients with KOA,39 males and 41 females,aged 48 to 70 years old,in the Pain Clinic of Xi'an Baqiao District Hospital of Traditional Chinese Medicine and the First Affiliated Hospital of Xi'an Jiao tong University from January 2017 to January 2019,were randomly divided into PRP group(n=42)and PH group(n=38).The patients were injected with platelet-rich plasma 4 ml/time in PRP group,platelet-rich plasma and sodium hyaluronate 5.5 ml/time,once a week,3 weeks as a course,a total of 2-3 courses in the two groups respectively.Knee function was evaluated by Lysholm knee function criteria at each time point before and after the treatment,the clinical efficacy was also evaluated.Results Lysholm knee score was increased in both groups after the treatment.The total score of each time point was(68.3±2.3),(86.3±3.4)and(84.8±2.5)at T1,T2 and T3 in PRP group,with significant differences compared with T0(55.2±4.6)(P<0.05).The total score of each time point was(70.6±3.0),(89.8±4.1)and(88.0±4.3)at T1,T2 and T3 in PH group,with significant differences compared with T0(56.3±2.2)(P<0.05).The scores of pain,restlessness,atresia,and swelling were also improved in both groups than that before the treatment(all P<0.05).The knee joint function was improved in both groups.There was significant difference in the total scores between the two groups at T2 and T3(P<0.05).At T3,the pain score was(17.6±3.8),which was higher than that in the PRP group(13.5±3.2)(P<0.05).The swelling score of PH group was(9.6±1.2),which was higher than the PRP group(8.7±1.9)(P<0.05).The excellent effective rate and total effective rate were 23.7%(9/38 cases)and 97.4%(37/38 cases)in PH group,which were higher than those in the PRP group 4.8%(2/42 cases)and 83.3%(35/42 cases)(P<0.05).Conclusions Both PRP and PRP combined with HA can reduce the joint pain,improve joint motor function and have good clinical effect for the treatment of KOA,while the effect is better in the PH group.