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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2023, Vol. 09 ›› Issue (05) : 282 -288. doi: 10.3877/cma.j.issn.2096-0263.2023.05.005

膝关节

关节腔内注射富血小板血浆与透明质酸钠治疗Ⅰ-Ⅲ期膝骨关节炎的对比研究
马聪, 李雪靖, 郑晓佐, 张晓阳, 段坤峰, 刘国强, 郄素会†()   
  1. 050000　石家庄，河北医科大学第三医院药剂科
    050000　石家庄，河北医科大学第三医院关节外科
  • 收稿日期:2023-08-21 出版日期:2023-10-05
  • 通信作者: 郄素会
  • 基金资助:
    河北省卫生健康委科研基金项目(20211585)

A comparative study of intraarticular injection of platelet-rich plasma and sodium hyaluronate in the treatment of Stage I-Ⅲ knee osteoarthritis

Cong Ma, Xuejing Li, Xiaozuo Zheng, Xiaoyang Zhang, Kunfeng Duan, Guoqiang Liu, Suhui Qie†()   

  1. Department of Pharmacy, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
    Department of Joint Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
  • Received:2023-08-21 Published:2023-10-05
  • Corresponding author: Suhui Qie
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引用本文：

马聪, 李雪靖, 郑晓佐, 张晓阳, 段坤峰, 刘国强, 郄素会. 关节腔内注射富血小板血浆与透明质酸钠治疗Ⅰ-Ⅲ期膝骨关节炎的对比研究[J/OL]. 中华老年骨科与康复电子杂志, 2023, 09(05): 282-288.

Cong Ma, Xuejing Li, Xiaozuo Zheng, Xiaoyang Zhang, Kunfeng Duan, Guoqiang Liu, Suhui Qie. A comparative study of intraarticular injection of platelet-rich plasma and sodium hyaluronate in the treatment of Stage I-Ⅲ knee osteoarthritis[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 282-288.

目的

探讨比较关节腔内注射富血小板血浆（PRP）与透明质酸（HA）治疗K-L分级Ⅰ-Ⅲ期膝骨关节炎（KOA）的疗效。

方法

前瞻性收集2020年01月至2021年08月在河北医科大学第三医院关节科门诊收治的Ⅰ-Ⅲ期KOA患者100例，采用随机数字表法分为2组，最终96例患者符合纳排标准，PRP组（n=46例）和HA组（n=50例）。两组病例分别接受关节腔内注射PRP（5 ml）或HA（2 ml），每周1次，连续4次。所有患者治疗后均采取相同的康复训练及生活指导，至少接受12个月的定期随访。记录纳入患者的人口统计学资料，并根据BMI分为<30 kg/m2和≥30 kg/m2两个亚组。治疗前、治疗后第1、3、6和12个月时，分别采用VAS、WOMAC、HSS评分和2分钟步行测试（2MWT）对两组患者临床疗效进行评估，并记录治疗过程中出现的任何不良事件。

结果

两组患者接受关节腔内注射PRP或HA治疗后膝关节疼痛程度与功能较治疗前均有改善。在BMI<30 kg/m2亚组中，接受PRP注射治疗后第6和12个月的VAS评分与接受HA注射治疗患者相比，差异存在统计学意义[（1.4±0.8）分vs.（1.9±0.7）分，P=0.014；（1.0±0.6）分vs.（1.4±0.8）分，P=0.028）；治疗后第3、6和12个月的WOMAC[（45.4±7.7）分vs.（28.3）分，P<0.001；（19.6±5.1）分vs.（25.5±3.5）分，P<0.001；（19.6±5.1）分vs.（18.5±4.5）分，P=0.002）、HSS评分（80.9±6.3）分vs.（76.2±6.7）分，P=0.001；（86.3±5.4）分vs.（80.4±5.9）分，P<0.001；（91.4±3.5）分vs.（88.6±4.2）分，P=0.001）及2MWT（134.6±15.5）分vs.（122.5±20.4）分，P=0.002；（134.6±15.5）分vs.（129.0±23.2）分，P=0.041；（139.8±12.6）分vs.（130.8±20.3）分，P=0.012）结果均好于HA组，差异具有统计学意义。在BMI≥30 kg/m2亚组中，接受PRP注射治疗患者在各治疗阶段与HA组相比，在VAS、WOMAC、HSS评分及2MWT结果方面无明显差异（P>0.05）。

结论

膝关节腔内注射PRP对Ⅰ-Ⅲ期非肥胖的KOA患者具有较好治疗效果，可有效改善患者疼痛和膝关节功能。与接受HA注射治疗组相比，接受PRP治疗组3个月后对膝关节功能改善更明显，治疗6个月后对疼痛缓解更明显，值得临床推广。

关键词: 富血小板血浆, 透明质酸钠, 膝骨关节炎, 关节腔内注射, 治疗
Objective

To compare the efficacy of intraarticular injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of K-L stage Ⅰ-Ⅲ knee osteoarthritis (KOA).

Methods

A total of 100 patients with stage Ⅰ-Ⅲ KOA admitted to the joint department of the Third Hospital of Hebei Medical University were prospectively collected and divided into 2 groups by random number table method between January 2020 and August 2021. Finally, 96 patients in PRP group (n=46 cases) and HA group (n=50 cases) met the atretic criteria. The patients of two groups received intra-articular injection of PRP (5 ml) or HA (2 ml) once a week for 4 consecutive times. All patients received the same rehabilitation training and life guidance after treatment, and received regular follow-up for at least 12 months. The demographic data of the enrolled patients were recorded, and were divided into 2 subgroups: <30 kg/m2 and ≥30 kg/m2 according to the BMI. The VAS, WOMAC, HSS scores and 2-minute walking test (2MWT) were used to evaluate the clinical efficacy of the two groups before treatment and 1, 3, 6 and 12 months after treatment, respectively.

Results

The degree of knee pain and function were improved in both groups after intraluminal injection of PRP or HA. In the subgroup of BMI<30 kg/m2, there were statistically significant differences in VAS score at 6 and 12 months after PRP injection compared with HA injection (1.4±0.8 vs. 1.9±0.7, P=0.014; 1.0±0.6 vs. 1.4±0.8, P=0.028); The WOMAC (45.4±7.7 vs. 28.3, P<0.001; 19.6±5.1 vs. 25.5±3.5, P<0.001; 19.6±5.1 vs. 18.5±4.5, P=0.002), HSS scores (80.9±6.3 vs. 76.2±6.7, P=0.001; 86.3±5.4 vs. 80.4±5.9, P<0.001; 91.4±3.5 vs. 88.6±4.2, P=0.001) and 2MWT results (134.6±15.5 vs. 122.5±20.4, P=0.002; 134.6±15.5 vs. 129.0±23.2, P=0.041; 139.8±12.6 vs. 130.8±20.3, P=0.012) at 3, 6 and 12 months after treatment were better than those in HA group, with significant differences. In the subgroup of BMI≥30 kg/m2, there were no significant differences in VAS, WOMAC, HSS scores and 2MWT results between patients receiving PRP injection and patients in HA group at all treatment stages (P>0.05).

Conclusions

Intraarticular injection of PRP in knee joint has a good therapeutic effect on non-obese KOA patients of stage Ⅰ to Ⅲ, and can improve pain and knee joint function in effective patients. Compared with patients treated with HA, PRP treatment can improve knee joint function more significantly after 3 months and relieve pain more significantly after 6 months, which is worthy of clinical application.

Key words: Platelet-rich plasma, Hyaluronic acid, Knee Osteoarthritis, Intraarticular injection, Treatment
表1 两组膝骨关节炎患者一般资料比较
组别 例数 性别（例，男/女） 年龄（岁，±s） BMI（kg/m2，±s） 侧别（例，左/右） K-L分级（例，Ⅰ/Ⅱ/Ⅲ）
PRP组 46 8/38 58.7±5.6 27.9±4.9 14/32 4/23/19
HA组 50 10/40 58.3±7.1 27.3±8.1 19/31 6/24/20
统计值   χ2=0.107 t=1.409 t=1.075 χ2=0.608 χ2=0.281
P值   0.744 0.740 0.675 0.436 0.869
组别 例数 治疗前VAS评分（分，±s） 治疗前WOMAC评分（分，±s） 治疗前HSS评分（分，±s） 治疗前2MWT（m，±s） 随访时间（月，±s）
PRP组 46 5.1±1.6 52.8±2.3 73.2±6.9 108.2±27.0 15.9±2.7
HA组 50 5.3±1.5 52.2±2.7 72.0±6.3 107.5±25.4 16.6±2.4
统计值   t=0.133 t=1.353 t=1.253 t=-0.083 t=0.437
P值   0.830 0.347 0.629 0.815 0.165
表2 治疗前后两组膝骨关节炎患者VAS评分（分，±s）
组别 BMI（kg/m2） 例数 K-L分级（例，Ⅰ/Ⅱ/Ⅲ） 治疗前VAS 治疗结束时 治疗后3个月 治疗后6个月 治疗后12个月 F值 P值
PRP组 <30 38 3/21/14 4.9±1.4 4.5±1.5 2.9±0.8*# 1.4±0.8*#& 1.0±0.6*#& 17.247 <0.001
HA组 <30 40 4/20/16 5.1±1.3 4.6±1.1 2.8±0.8 1.9±0.7 1.4±0.8 12.964 <0.001
统计值     χ2=0.249 F=0.030 F=1.340 F=0.070 F=2.761 F=1.710    
P值     0.883 0.710 0.774 0.950 0.014 0.028    
PRP组 ≥30 8 1/2/5 5.7±1.8 5.4±1.6 5.1±1.4 4.6±1.6* 4.8±2.1* 11.653 0.733
HA组 ≥30 10 2/4/4 5.9±2.0 5.5±1.8 5.3±1.7 4.8±2.0* 5.0±1.9* 18.729 0.485
统计值     χ2=0.900 F=0.245 F=0.240 F=0.731 F=4.325 F=1.160    
P值     0.638 0.682 0.874 0.637 0.802 0.735    
表3 治疗前后两组膝骨关节炎患者WOMC评分（分，±s）
组别 BMI（kg/m2） 治疗前WOMAC 治疗结束时 治疗后3个月 治疗后6个月 治疗后12个月
PRP组 <30 50.2±1.7 45.4±7.7 45.4±7.7 19.6±5.1 19.6±5.1
HA组 <30 50.8±2.0 45.4±8.2 28.3±3.0 25.5±3.5 18.5±4.5
F值   1.775 1.320 0.973 10.856 0.685
P值   0.093 0.973 <0.001 <0.001 0.002
PRP组 ≥30 58.4±3.4 55.8±4.1 52.5±4.6 50.3±3.9 51.4±4.2
HA组 ≥30 57.6±3.1 55.6±3.8 53.4±4.0 51.6±3.4 50.7±4.04
F值   1.253 0.201 0.018 1.507 0.500
P值   0.898 0.873 0.624 0.395 0.642
表4 治疗前后两组膝骨关节炎患者HSS评分（分，±s）
组别 BMI（kg/m2） 治疗前HSS 治疗结束时 治疗后3个月 治疗后6个月 治疗后12个月
PRP组 <30 73.7±6.5 75.1±6.5 80.9±6.3 86.3±5.4 91.4±3.5
HA组 <30 72.3±5.8 73.2±6.1 76.2±6.7 80.4±5.9 88.6±4.2
F值   1.671 0.259 1.539 0.013 0.837
P值   0.259 0.136 0.001 <0.001 0.001
PRP组 ≥30 70.6±7.2 69.8±7.0 72.5±6.8 75.2±7.6 76.1±8.4
HA组 ≥30 71.2±6.9 70.3±6.5 72.8±7.2 76.4±6.4 75.9±5.8
F值   3.373 0.106 0.168 0.066 0.034
P值   0.717 0.848 0.767 0.702 0.631
表5 治疗前后两组膝骨关节炎患者2 MWT评估结果（米，±s）
组别 BMI（kg/m2） 治疗前2MWT 治疗结束时 治疗后3个月 治疗后6个月 治疗后12个月
PRP组 <30 109.5±27.3 113.9±18.5 134.6±15.5 134.6±15.5 139.8±12.6
HA组 <30 107.7±27.4 115.8±19.8 122.5±20.4 129.0±23.2 130.8±20.3
F值   0.051 0.157 2.823 0.002 16.815
P值   0.748 0.633 0.002 0.041 0.012
PRP组 ≥30 105.3±25.1 108.2±24.7 110.5±28.2 112.5±26.4 115.3±28.5
HA组 ≥30 105.8±23.8 107.3±23.5 109.8±25.5 115.6±24.8 116.7±26.1
F值   0.734 0.316 0.013 0.545 0.216
P值   0.957 0.924 0.799 0.805 0.754
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