中国修复重建外科杂志

中国修复重建外科杂志

关节内注射富血小板血浆对膝关节软骨退行性变的治疗作用

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目的 富血小板血浆(platelet-rich plasma,PRP)能促进软骨细胞增殖和修复软骨缺损,通过比较膝关节退行性变患者关节内注射PRP 及透明质酸钠的疗效,分析PRP 治疗关节软骨退行性变的安全性和可行性。 方法 于2010 年1 月- 6 月收治的膝关节软骨退行性变患者中,选择符合标准的30 例30 膝患者纳入研究。根据注射药物不同,将患者随机分为PRP 组(试验组)和透明质酸钠组(对照组),每组各15 例。两组患者性别、年龄、体重指数、Kellgren-Lawrence 分级等一般资料比较,差异均无统计学意义(P gt; 0.05),具有可比性。试验组患者抽取自体静脉血制备PRP 后,于关节腔内均匀注射3.5 mL PRP;对照组注射2 mL 透明质酸钠。每3 周注射1 次,3 次为一疗程。记录两组患者注射后不良反应发生情况,并采用国际膝关节文献委员会(IKDC)评分、美国西部Ontario 与McMaster 大学骨关节炎指数(WOMAC)评分及Lequesne 指数评定关节功能。 结果 两组患者均获随访6 个月。两组治疗后IKDC 评分、WOMAC 评分及Lequesne 指数与治疗前比较,差异均有统计学意义(P lt; 0.05);试验组治疗后3、4、6 个月间比较,差异均无统计学意义( P gt; 0.05);对照组治疗后6 个月各评价指标较3、4 个月差,但差异有统计学意义(P lt; 0.05)。治疗后3 个月及4 个月, 两组IKDC 评分、WOMAC 评分及Lequesne 指数比较,差异无统计学意义(P gt; 0.05);6 个月时,试验组各指标均优于对照组(P lt; 0.05)。试验组患者12 例31 次出现不良反应,对照组12 例30 次;两组不良反应起始时间、终止时间及持续时间比较,差异均无统计学意义(P gt; 0.05)。 结论 关节内注射PRP 治疗关节软骨退行性变安全,可缓解疼痛、肿胀等症状,提高患者生活质量,但需要大样本长期随访观察进一步验证其安全性和远期疗效。

Objective Platelet-rich plasma (PRP) can enhance the chondrocyte prol iferation and repair of cartilage defects. To explore the safety and efficacy of intra-knee-articular injection of PRP to treat knee articular cartilage degeneration by comparing with injecting sodium hyaluronate (SH). Methods Thirty consecutive patients (30 knees) with knee articular cartilage degeneration were selected between January 2010 and June 2010. According to different injections, 30 patients were
randomly divided into PRP group (test group, n=15) and SH group (control group, n=15). There was no significant difference in gender, age, body mass index, and Kellgren-Lawrence grade between 2 groups (P gt; 0.05). Test group received 3.5 mL of PRP intra-knee-articular injections while control group received 2 mL of SH during the same time period. Both treatments were administered in series of 3 intra-knee-articular injections at 3-week intervals. Then, adverse reactions were recorded. International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Lequesne index were used for evaluation of treatment results. Results The patients of 2 groups were followed up 6 months. There were significant differences in IKDC score, WOMAC score, and Lequesne index between pre- and post-injection in 2 groups (P lt; 0.05); no significant difference was found between different time points (3, 4, and 6 months) in test group (P gt; 0.05), while significant differences were found between the postoperative 6th month and the postoperative 3rd and 4th months in control group (P lt; 0.05). There was no significant difference in IKDC score, WOMAC score, and Lequesne index between 2 groups within 4 months (P gt; 0.05), but the effectiveness of test group was significantly better than that of control group at 6 months after injection (P lt; 0.05). Adverse reactions occurred in 12 patients (31 injections) of test group and in 12 patients (30 injections) of control group. No significant difference in onset time, termination time, and duration of adverse reactions were found between 2 groups (P gt; 0.05). Conclusion Intra-knee-articular injection of PRP to treat knee articular cartilage degeneration is safe, which can alleviate symptoms of pain and swell ing and improve the qual ity of l ife of patients; however, further data of large samples and long-term follow-up are needed to confirm the safety and effectiveness.

关键词: 富血小板血浆; 膝关节内注射; 软骨退行性变

Key words: Platelet-rich plasma; Intra-knee-articular injection; Articular cartilage degeneration

引用本文: 李明,张长青,艾自胜,袁霆,冯勇,贾伟涛. 关节内注射富血小板血浆对膝关节软骨退行性变的治疗作用. 中国修复重建外科杂志, 2011, 25(10): 1192-1196. doi: 复制

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