自体单采富血小板血浆关节腔注射治疗膝骨关节炎的专家共识

Expert consensus on intraarticular injection of autologous apheresis platelet-rich plasma in the treatment of knee osteoarthritis

膝骨关节炎(KOA)是最常见的肌肉骨骼疾病之一,富血小板血浆(PRP)广泛用于KOA治疗,但由于PRP制备技术、贮存方法和关节腔注射治疗方案等差异较大,已影响KOA治疗的效果。本共识由国内多家具备自体单采PRP治疗KOA经验的大型三甲医院的输血医学、骨科学和康复医学等学科(科室)的专家,在充分总结临床PRP治疗KOA的实践经验和全面、系统地回顾分析相关文献的基础上,对自体单采PRP应用于关节腔注射治疗KOA的方法作了深入探讨后而达成。共识包含4方面内容:共识达成的背景、自体单采血小板制备PRP用于KOA治疗的优势、单采PRP冰冻贮存的理论依据和贮存方式、单采PRP关节腔注射治疗KOA的临床应用方案;推荐:使用单采血小板技术制备的自体PRP通过关节腔注射治疗KOA,PRP中的血小板浓度(Plt)(1 000~1 800)×109/L、红细胞混入浓度(RBC)≤3.2×1010/L、白细胞混入浓度(WBC)≤2.0×109/L,PRP宜以-80℃贮存、贮存期≤6个月,1个疗程注射3~4次、每次间隔1~2周,单膝关节的注射量(4~8)mL/人(次),注射前抽去患者关节积液、不与麻醉剂或皮质类固醇激素混合注射关节腔、注射后<48 h限制剧烈运动。本共识意在推动临床自体单采PRP治疗KOA的规范化应用、提高临床治疗KOA的效果及其评价的科学性,为今后制定规范的自体单采PRP治疗KOA指南或(和)标准初步奠定基础。

Knee osteoarthritis(KOA) is one of the most common musculoskeletal diseases. Platelet-rich plasma(PRP) has been widely used in the treatment of KOA. However, the effectiveness of KOA treatment has been affected due to the large differences in PRP preparation technology, storage method, and intra-articular injection treatment plan. Based on a comprehensive and systematic literature review and clinical practice experience, experts in blood transfusion medicine, orthopedics and rehabilitation medicine and other disciplines(departments) from a number of domestic large-scale tertiary hospitals with experience in the treatment of KOA with apheresis PRP formed this expert consensus by in-depth study. The consensus includes four aspects: the background of the formation of the consensus, the advantages of preparing PRP from autologous platelets apheresis for KOA treatment, the theoretical basis and the frozen storage method of apheresis PRP, and the clinical application scheme of apheresis PRP intraarticular injection for the treatment of KOA. Recommendations are as follows: autologous PRP prepared by platelets apheresis is used to treat KOA by intra-articular injection;the platelet concentration(Plt) in PRP prefers(1 000~1 800)×10~9/L, the red blood cells(RBC) contamination should be ≤3.2×1010/L, and the leukocytes(WBC) contamination should be ≤2.0×10~9/L;PRP is suitable to be stored at-80℃, within 6-months storage;a course of treatment prefers 3 to 4 occasions of injection, with an interval of 1 to 2 weeks;the injection volume of one knee joint could be(4~8)mL/person;the joint effusion should be removed before injection without mixing with anesthetics or corticosteroids;restriction of strenuous exercise for 48 hours after injection is necessary. This consensus is intended to promote the standardized application of autologous apheresis PRP in the treatment of KOA, improve the effectiveness of clinical treatment of KOA and the scientificity of its evaluation, so as to lay a preliminary foundation for formulating standardized guidelines or(and) standards for the treatment of KOA with autologous apheresis PRP in the future.