基于MOCART 2.0评估机采富血小板血浆治疗髌股关节骨关节炎的疗效

Therapeutic effect evaluation of autologous platelet-rich plasma in the treatment of patellofemoral osteoarthritis based on MOCART 2.0 knee score system

目的基于软骨修复组织磁共振评分(MOCART 2.0)探讨机采富血小板血浆(PRP)治疗髌股关节骨关节炎(PFOA)的疗效。方法选取2020年1月-2023年12月因PFOA在广西壮族自治区人民医院诊治的患者22例(28膝)作为研究对象,均接受机采PRP膝关节腔注射治疗。采用MOCART 2.0评估治疗前后的磁共振影像并进行比较分析;疼痛视觉模拟评分(VAS评分)、骨关节炎指数(WOMAC量表)评估临床疗效;观察治疗期间有无不良反应。结果MOCART 2.0评分治疗前后无差异(53.4±12.2 vs 49.9±12.1)(P>0.05)。MOCART 2.0亚组分析中,治疗后“修复组织信号强度”与“软骨下改变”较治疗前明显改善,分别为(5.5±1.5)vs(4.6±1.5)、(15.9±4.3)vs(13.2±6.4)(P<0.05);“软骨填充程度”、“与临近软骨边缘整合”、“修复组织表面结构”、“修复组织结构”、“骨质变化”等指标无明显变化(P>0.05)。治疗后1、3、6个月,VAS、WOMAC评分逐渐降低且优于治疗前(P<0.05)。不良反应发生率为4%(4/112)。结论机采PRP治疗PFOA安全有效,可改善损伤软骨组织信号和软骨下骨髓水肿。

Objective To explore the therapeutic effect of autologous platelet-rich plasma(PRP)in the treatment of patellofemoral osteoarthritis(PFOA)based on the Magnetic Resonance Observation of Cartilage Repair Tissue 2.0(MOCART 2.0)knee score system.Methods A total of 22 patients(28 knees)with PFOA treated by intraarticular PRP injection in our hospital from January 2020 to December 2023 were enrolled in the study.The nuclear magnetic resonance(NMR)images before and after treatment were compared using the MOCART 2.0 knee score system.Visual Analog Scales(VAS)score and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score before and after treatment were evaluated and compared,and adverse reactions were observed during the treatment.Results The MOCART 2.0 knee score showed no difference before and after treatment(53.4±12.2 vs 49.9±2.1)(P>0.05).In the subgroup analysis,the"signal intensity of the repair tissue"score and the"subchondral changes"score were better than those before treatment as(5.5±1.5)vs(4.6±1.5)and(15.9±4.3)vs(13.2±6.4)(P<0.05).There were no significant changes in indicators as"degree of cartilage filling","integration with adjacent cartilage edges","repair of tissue surface structure","repair of tissue structure"and"bone changes"(P>0.05).The VAS score and WOMAC score gradually decreased at 1 month,3 months and 6 months after treatment and were better than before treatment(P<0.05).Incidence of adverse reactions was 4%(4/112).Conclusion Intraarticular PRP injection is an effective and safe option for treatment of PFOA,and can improve the cartilage signal intensity and alleviating subchondral bone edema.