肌骨超声用于评价膝骨关节炎患者关节腔内注射富血小板血浆与玻璃酸钠的疗效比较

Comparison of the therapeutic effect of intra-articular injection of platelet-rich plasma and sodium hyaluronate on knee osteoarthritis by musculoskeletal ultrasound

目的使用肌骨超声观察并对比富血小板血浆(platelet-rich plasma,PRP)及玻璃酸钠关节腔内注射对于膝骨关节炎(knee osteoarthritis,KOA)的疗效。方法按照随机数字表法将92例KOA患者分为试验组和对照组(每组46例),分别于膝关节腔注射PRP及玻璃酸钠。记录两组患者治疗前(T_(0))、第1次治疗后1周(T_(1))、第2次治疗后1周(T_(2))、第3次治疗后1周(T_(3))、第4次治疗后1周(T_(4))、第5次治疗后1周(T_(5))的数字分级评分法(Numerical Rating Scale,NRS)评分和T_(0)、T_(5)时西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)评分,采用超声测量两组患者T_(0)、T_(5)时滑膜最大厚度、髌上囊最大积液厚度、滑膜彩色血流分级,采用ELISA法检测两组患者T_(0)、T_(5)时膝关节液中TNF-α及IL-6水平。结果与T_(0)比较:两组患者T_(1)~T_(5)时NRS评分均降低(P<0.05),T_(5)时WOMAC评分、滑膜最大厚度、髌上囊最大积液厚度、滑膜彩色血流分级Ⅲ级例数、IL-6和TNF-α水平均降低(P<0.05)。试验组T_(1)~T_(5)时NRS评分低于对照组(P<0.05),T_(5)时WOMAC评分、滑膜最大厚度、髌上囊最大积液厚度、滑膜彩色血流分级Ⅲ级例数、IL-6和TNF-α水平低于对照组(P<0.05)。其余指标比较差异无统计学意义(P>0.05)结论KOA患者关节腔内注射PRP相对玻璃酸钠短期关节症状缓解更佳,有效改善关节积液、滑膜水肿等炎症表现,并降低膝关节液中TNF-α、IL-6水平。

Objective To observe the effect of intra-articular injection of platelet-rich plasma(PRP)and sodium hyaluronate on knee osteoarthritis(KOA)by musculoskeletal ultrasound.Methods According to the random number table method,92 KOA patients were divided into two groups(n=46):an experimental group and a control group,which were intra-articular injected with PRP and sodium hyaluronate,respectively.Their Numerical Rating Scale(NRS)scores were recorded before treatment(T_(0)),and at one week after the first treatment(T_(1)),one week after the second treatment(T_(2)),one week after the third treatment(T_(3)),one week after the fourth treatment(T_(4)),and one week after the fifth treatment(T_(5)).Meanwhile,their Western Ontario and McMaster Universities osteoarthritis index(WOMAC)scores were recorded at T_(0)and T_(5).The synovial thickness,joint effusion,and blood flow signal in the synovium were measured by ultrasonography at T_(0)and T_(5).The levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in knee joint fluid were detected by enzyme-linked immunosorbent assay(ELISA).Results Compared with those at T_(0),both groups showed decreases in NRS scores at T_(1)‒T_(5)(P<0.05).At T_(5),the WOMAC score,synovial thickness,joint effusion,number of cases with gradeⅢof blood flow signal in the synovium,as well as the levels of TNF-αand IL-6 decreased,compared with those at T_(0)(P<0.05).The NRS score was reduced in the experimental group at T_(1)‒T_(5)compared with that in the control group(P<0.05).At T_(5),the experimental group presented decreases in the WOMAC score,synovial thickness,joint effusion,number of cases with gradeⅢof blood flow signal in the synovium,IL-6 and TNF-αlevels,compared with the control group(P<0.05).There was no statistical difference in other indicators.Conclusions Intra-articular injection of PRP is more effective than sodium hyaluronate to relieve the symptoms of KOA patients in a short-term period,which can effectively improve joint effusion,synovial edema and other inflammatory manifestations,and reduce the levels of TNF-αand IL-6 in synovial fluid.