|
|
富血小板血浆注射治疗早中期膝骨关节炎的疗效观察
|
Abstract:
目的：观察超声引导下注射富血小板血浆(PRP)治疗膝骨关节炎(KOA)的临床疗效。方法：回顾性分析比较2022~2023年于康复医学科门诊就诊的35名膝骨关节炎患者，在超声引导下对入组患者注射富血小板血浆(PRP)，每周注射1次，共注射3次。观察治疗前、治疗后1月、3月、6个月视觉模拟评分(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)以及奎森功能演算指数变化。结果：在治疗后1、3、6月KOA患者的VAS评分和WOMAC评分、奎森功能演算指数均较治疗前下降(P < 0.05)，差异具有统计学意义。结论：超声引导下富血小板血浆注射可以有效改善KOA患者的疼痛症状，恢复受损膝关节功能，可作为治疗早中期膝骨关节炎的可行手段，在临床上大力推广。
Objective: To observe the clinical efficacy of ultrasound-guided platelet-rich plasma (PRP) injection therapy for knee osteoarthritis (KOA). Methods: A retrospective analysis was conducted comparing 35 KOA patients who visited the Rehabilitation Medicine Department outpatient clinic from 2022 to 2023. Patients were injected with PRP under ultrasound guidance, once a week for a total of 3 injections. Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne Scale were assessed before treatment, and at 1, 3, and 6 months after treatment. Results: VAS scores, WOMAC scores, and Lequesne Scale showed a significant decrease at 1, 3, and 6 months after treatment compared to before treatment (P < 0.05), indicating statistically significant differences. Conclusion: Ultrasound-guided PRP injection therapy effectively improves pain symptoms and restores damaged knee joint function in KOA patients. It can be considered as a feasible intervention for early to moderate-stage KOA and should be widely promoted in clinical practice.
| [1] | Smith, T.O., Purdy, R., Lister, S., Salter, C., Fleetcroft, R. and Conaghan, P. (2014) Living with Osteoarthritis: A Systematic Review and Meta-Ethnography. Scandinavian Journal of Rheumatology, 43, 441-452. https://doi.org/10.3109/03009742.2014.894569 |
| [2] | Silverwood, V., Blagojevic-Bucknall, M., Jinks, C., Jordan, J.L., Protheroe, J. and Jordan, K.P. (2015) Current Evidence on Risk Factors for Knee Osteoarthritis in Older Adults: A Systematic Review and Meta-Analysis. Osteoarthritis and Cartilage, 23, 507-515. https://doi.org/10.1016/j.joca.2014.11.019 |
| [3] | 樊子娟, 王桂杉, 李川, 等. 《中国骨关节炎诊疗指南(2021年版)》解读和评价[J]. 中国循证医学杂志, 2022, 22(6): 621-627. |
| [4] | Conaghan, P.G. (2016) NSAIDs or Paracetamol for Short-Term Treatment of Mild to Moderate Knee Pain in Early Osteoarthritis: Are They Equivalent? BMJ Evidence-Based Medicine, 21, 14. https://doi.org/10.1136/ebmed-2015-110289 |
| [5] | Everts, P., Onishi, K., Jayaram, P., Lana, J.F. and Mautner, K. (2020) Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. International Journal of Molecular Sciences, 21, Article 7794. https://doi.org/10.3390/ijms21207794 |
| [6] | Shahid, A., Malik, A., Bukhari, A., Shaikh, A., Rutherford, J. and Barkatali, B. (2023) Do Platelet-Rich Plasma Injections for Knee Osteoarthritis Work? Cureus, 15, e34533. https://doi.org/10.7759/cureus.34533 |
| [7] | Hohmann, E. (2024) Editorial Commentary: Platelet-Rich Plasma for Musculoskeletal Conditions Is Supported by a Large Number of Clinical Studies, Particularly for Knee Osteoarthritis. Arthroscopy, 40, 478-480. https://doi.org/10.1016/j.arthro.2023.09.018 |
| [8] | Gupta, A., Jeyaraman, M. and Potty, A.G. (2023) Leukocyte-Rich vs. Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis. Biomedicines, 11, Article 141. https://doi.org/10.3390/biomedicines11010141 |
| [9] | Magalon, J., Frey, A. and Kaux, J.F. (2022) Intra-Articular Platelet-Rich Plasma vs Placebo Injection and Pain and Medial Tibial Cartilage Volume in Patients with Knee Osteoarthritis. JAMA, 327, 1185-1186. https://doi.org/10.1001/jama.2022.1303 |
| [10] | 中华中医药学会. 膝骨关节炎中西医结合诊疗指南(2023年版) [J]. 中医正骨, 2023, 35(6): 1-10. |
| [11] | Vora, A., Borg-Stein, J. and Nguyen, R.T. (2012) Regenerative Injection Therapy for Osteoarthritis: Fundamental Concepts and Evidence-Based Review. PM&R, 4, S104-S109. https://doi.org/10.1016/j.pmrj.2012.02.005 |
| [12] | Eymard, F., Ornetti, P., Maillet, J., et al. (2021) Intra-Articular Injections of Platelet-Rich Plasma in Symptomatic Knee Osteoarthritis: A Consensus Statement from French-Speaking Experts. Knee Surgery, Sports Traumatology, Arthroscopy, 29, 3195-3210. https://doi.org/10.1007/s00167-020-06102-5 |
| [13] | Chu, J., Duan, W., Yu, Z., et al. (2022) Intra-Articular Injections of Platelet-Rich Plasma Decrease Pain and Improve Functional Outcomes than Sham Saline in Patients with Knee Osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 4063-4071. https://doi.org/10.1007/s00167-022-06887-7 |
| [14] | Park, Y.B., Kim, J.H., Ha, C.W. and Lee, D.H. (2021) Clinical Efficacy of Platelet-Rich Plasma Injection and Its Association with Growth Factors in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized Double-Blind Controlled Clinical Trial as Compared with Hyaluronic Acid. The American Journal of Sports Medicine, 49, 487-496. https://doi.org/10.1177/0363546520986867 |
| [15] | Dhillon, R.S., Schwarz, E.M. and Maloney, M.D. (2012) Platelet-Rich Plasma Therapy—Future or Trend? Arthritis Research & Therapy, 14, Article No. 219. https://doi.org/10.1186/ar3914 |
| [16] | Tucker, J.D., Ericksen, J.J., Goetz, L.L. and Elmore, L.W. (2014) Should Clinical Studies Involving “Regenerative Injection Therapy,” Strive to Incorporate a Triad of Outcome Measures Instead of Only Including Clinical Outcome Measures? Osteoarthritis and Cartilage, 22, 715-717. https://doi.org/10.1016/j.joca.2014.04.005 |
| [17] | Guo, G.X., Zhu, Q.G., Chen, Z.Y., Gu, Y.J., Yao, F. and Fang, M. (2021) Complex Mechanisms of Chronic Pain in Knee Osteoarthritis Identified by Neuroimaging Technology. Acta physiologica Sinica, 73, 423-432. |
| [18] | Mougui, A., Belouaham, S. and El Bouchti, I. (2023) Neuropathic Pain in Patients with Primary Knee Osteoarthritis: A Cross-Sectional Study. Romanian Journal of Internal Medicine, 61, 186-194. https://doi.org/10.2478/rjim-2023-0017 |
| [19] | Hassanien, M., Elawamy, A., Kamel, E.Z., et al. (2020) Perineural Platelet-Rich Plasma for Diabetic Neuropathic Pain, Could It Make a Difference? Pain Medicine, 21, 757-765. https://doi.org/10.1093/pm/pnz140 |
| [20] | Malahias, M.A., Nikolaou, V.S., Johnson, E.O., Kaseta, M.K., Kazas, S.T. and Babis, G.C. (2018) Platelet-Rich Plasma Ultrasound-Guided Injection in the Treatment of Carpal Tunnel Syndrome: A Placebo-Controlled Clinical Study. Journal of Tissue Engineering and Regenerative Medicine, 12, e1480-e1488. https://doi.org/10.1002/term.2566 |
| [21] | Anjayani, S., Wirohadidjojo, Y.W., Adam, A.M., Suwandi, D., Seweng, A. and Amiruddin, M.D. (2014) Sensory Improvement of Leprosy Peripheral Neuropathy in Patients Treated with Perineural Injection of Platelet-Rich Plasma. International Journal of Dermatology, 53, 109-113. https://doi.org/10.1111/ijd.12162 |
| [22] | Jlhce, G. (2012) Platelet-Rich Plasma in Treating Peripheral Neuropathic Pain. Preliminary Report. Ceballos, 30, 458-465. |
| [23] | Bennell, K.L., Hunter, D.J. and Paterson, K.L. (2017) Platelet-Rich Plasma for the Management of Hip and Knee Osteoarthritis. Current Rheumatology Reports, 19, Article No. 24. https://doi.org/10.1007/s11926-017-0652-x |
| [24] | Abbas, A., Du, J.T. and Dhotar, H.S. (2022) The Effect of Leukocyte Concentration on Platelet-Rich Plasma Injections for Knee Osteoarthritis: A Network Meta-Analysis. The Journal of Bone and Joint Surgery, 104, 559-570. https://doi.org/10.2106/JBJS.20.02258 |
| [25] | Di Martino, A., Boffa, A., Andriolo, L., et al. (2013) Leukocyte-Rich Versus Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Trial. The American Journal of Sports Medicine, 50, 609-617. https://doi.org/10.1177/03635465211064303 |
| [26] | Berenbaum, F. (2023) Osteoarthritis as an Inflammatory Disease (Osteoarthritis Is Not Osteoarthrosis!). Osteoarthritis and Cartilage, 21, 16-21. https://doi.org/10.1016/j.joca.2012.11.012 |
| [27] | Alves, T.I., Girish, G., Kalume Brigido, M. and Jacobson, J.A. (2016) US of the Knee: Scanning Techniques, Pitfalls, and Pathologic Conditions. RadioGraphics, 36, 1759-1775. https://doi.org/10.1148/rg.2016160019 |
