富血小板血浆联合透明质酸钠关节内注射治疗膝骨关节炎的前瞻性随机对照研究(1)
摘 要 目的：评价富血小板血浆(PRP)联合透明质酸钠(HA)治疗膝骨关节炎(KOA)的临床疗效。方法：选取47例KOA患者分成PRP组和PRP+HA组，采用WOMAC、VAS和Lequesne评分评估它们在治疗前后的临床表现及比较临床疗效差异。结果： PRP组患者随访6个月时的有效率为74.1%，而PRP+HA组为80%。2组的WOMAC、VAS和Lequense评分较治疗前比较均有统计学差异(P<0.05)，且PRP+HA组在3个月疗程内的VAS、WOMAC和Lequense评分均优于PRP组(P <0.05)。结论：单纯PRP或联合HA关节内注射治疗KOA均有缓解关节疼痛，改善关节功能的作用，而两者联合的疗效更加明显。
关键词 富血小板血浆 透明质酸钠 膝骨关节炎 软骨
中图分类号：R684.3 文献标识码：B 文章编号：1006-1533(2017)05-0025-04
A prospective randomized controlled study on platelet-rich plasma (PRP) combined with sodium hyaluronate (HA) intra-articular injection in the treatment of knee osteoarthritis*
DING Quanwei1**， LV Shuaijie2， SHEN Xingchao3， TONG Peijian1，2
(1. Zhejiang Chinese Medical University， Hangzhou 310053， China； 2. The First Clinical Medical College of Zhejiang Chinese Medical University， Hangzhou 310053， China； 3. Shaoxing Traditional Chinese Medical Hospital， Shaoxing 312000， China)
ABSTRACT Objective： To evaluate clinical efficacy of platelet-rich plasma (PRP) combined with sodium hyaluronate(HA) in the treatment of knee osteoarthritis (KOA). Methods： Forty-seven cases of patients with KOA were selected and divided into a PRP group and a PRP+HA group and their manifestation in clinic was evaluated before and after treatment and clinical efficacy was compared based on WOMAC， VAS and Lequesne scores. Results： The effective rate was 74.1% in the PRP group and 80% in the PRP+HA group during six months of follow-up. The WOMAC， VAS and Lequense scores of both groups showed significant differences before and after treatment (P<0.05)， and the VAS， WOMAC and Lequense scores were better in the PRP+HA group than in the PRP group during 3 months of treatment (P<0.05). Conclusion： PRP or PRP+HA intra-articular injection in the treatment of KOA can relieve joint pain and improve joint function， and furthermore the efficacy of PRP and HA in association is more significant.
KEY WORDS platelet-rich plasma； sodium hyaluronate； knee osteoarthritis； cartilage
膝關节骨关节炎(knee osteoarthritis， KOA)是一种由多因素导致的慢性进行性骨关节病，65岁以上人群的患病率达68%，表现为关节肿痛和功能障碍等，具有患病率高、晚期功能障碍程度高等特点[1]。目前为止并没有明确的药物和方法能够阻止软骨的退化进程，其治疗的首要目的是缓解膝关节疼痛和改善膝关节功能，包括药物疗法、关节内注射和手术等方法[2-3]。透明质酸钠(sodium hyaluronate ， HA)作为一种关节润滑剂已被广泛应用于临床[4]，具有润滑关节、保护软骨、抑制炎症和缓解疼痛等作用[5]。此外，富血小板血浆(plateletrich plasma，PRP)疗法作为具有修复受损软骨可能的自体生长因子注射疗法正逐渐引起重视。目前，有关PRP与HA联合使用的研究，未见报道。我院自2014年7月至2014年11月期间，对PRP联合HA关节内注射治疗KOA进行了前瞻性随机对照研究，报告如下。 (丁权威 吕帅洁 沈兴潮 童培建)
关键词 富血小板血浆 透明质酸钠 膝骨关节炎 软骨
中图分类号：R684.3 文献标识码：B 文章编号：1006-1533(2017)05-0025-04
A prospective randomized controlled study on platelet-rich plasma (PRP) combined with sodium hyaluronate (HA) intra-articular injection in the treatment of knee osteoarthritis*
DING Quanwei1**， LV Shuaijie2， SHEN Xingchao3， TONG Peijian1，2
(1. Zhejiang Chinese Medical University， Hangzhou 310053， China； 2. The First Clinical Medical College of Zhejiang Chinese Medical University， Hangzhou 310053， China； 3. Shaoxing Traditional Chinese Medical Hospital， Shaoxing 312000， China)
ABSTRACT Objective： To evaluate clinical efficacy of platelet-rich plasma (PRP) combined with sodium hyaluronate(HA) in the treatment of knee osteoarthritis (KOA). Methods： Forty-seven cases of patients with KOA were selected and divided into a PRP group and a PRP+HA group and their manifestation in clinic was evaluated before and after treatment and clinical efficacy was compared based on WOMAC， VAS and Lequesne scores. Results： The effective rate was 74.1% in the PRP group and 80% in the PRP+HA group during six months of follow-up. The WOMAC， VAS and Lequense scores of both groups showed significant differences before and after treatment (P<0.05)， and the VAS， WOMAC and Lequense scores were better in the PRP+HA group than in the PRP group during 3 months of treatment (P<0.05). Conclusion： PRP or PRP+HA intra-articular injection in the treatment of KOA can relieve joint pain and improve joint function， and furthermore the efficacy of PRP and HA in association is more significant.
KEY WORDS platelet-rich plasma； sodium hyaluronate； knee osteoarthritis； cartilage
膝關节骨关节炎(knee osteoarthritis， KOA)是一种由多因素导致的慢性进行性骨关节病，65岁以上人群的患病率达68%，表现为关节肿痛和功能障碍等，具有患病率高、晚期功能障碍程度高等特点[1]。目前为止并没有明确的药物和方法能够阻止软骨的退化进程，其治疗的首要目的是缓解膝关节疼痛和改善膝关节功能，包括药物疗法、关节内注射和手术等方法[2-3]。透明质酸钠(sodium hyaluronate ， HA)作为一种关节润滑剂已被广泛应用于临床[4]，具有润滑关节、保护软骨、抑制炎症和缓解疼痛等作用[5]。此外，富血小板血浆(plateletrich plasma，PRP)疗法作为具有修复受损软骨可能的自体生长因子注射疗法正逐渐引起重视。目前，有关PRP与HA联合使用的研究，未见报道。我院自2014年7月至2014年11月期间，对PRP联合HA关节内注射治疗KOA进行了前瞻性随机对照研究，报告如下。 (丁权威 吕帅洁 沈兴潮 童培建)