【摘要】 目的对比关节内联合松质骨内与单纯关节内注射富血小板血浆(PRP)治疗膝骨关节炎的临床疗效。方法 2014年6月至2015年8月河北省沧州市中心医院骨二科收治的40例Kellgren-Lawrence分级Ⅱ~Ⅲ级的膝骨关节炎患者,按随机数字表分为两组。A组20例,男性6例,女性14例,平均年龄(54±3)岁,采用关节腔内注射PRP 2 ml,内侧股骨髁和胫骨平台软骨下的松质骨内分别注射PRP 1.5 ml;B组20例,男性4例,女性16例,平均年龄(49±5)岁,采用关节腔内注射PRP 5 ml。每组患者均间隔2周后再进行如上操作。所有患者于治疗前和完成第2次注射后的1、3、6、12个月使用视觉模拟评分(VAS)、Western Ontario和Mc Master大学骨关节炎指数评分(WOMAC)进行重复测量设计的方差分析。结果治疗前比较两组患者的基本资料差异无统计学意义(P>0.05)。治疗后两组VAS评分和WOMAC评分均有下降,第1个月时下降最为明显;比较两组的VAS评分在第1个月时差异无统计学意义(P>0.05),第3个月时(F=203.15,P<0.05)、第6个月时(F=556.82,P<0.05)、第12个月时(F=1310.56,P<0.05)两组差异有统计学意义;WOMAC评分在第1、3个月时差异无统计学意义(P>0.05),第6个月时(F=185.49,P<0.05)和第12个月时(F=76.09,P<0.05)两组差异有统计学意义。结论用PRP关节内注射法或关节内联合松质骨内注射法治疗膝骨关节炎均能减轻疼痛,改善患肢功能;关节内联合松质骨内注射PRP效果更持久,长期效果优于关节内注射。更多还原

【Abstract】 Objective To compare the therapeutic effects of intra-articular injection combining intra-cancellous bone injection of platelet rich plasma( PRP) and simple intra-articular PRP injection for the treatment of knee osteoarthritis. Methods From June 2014 to August 2015,40 patients with knee osteoarthritis in grade Ⅱ ~ Ⅲ according to Kellgren-Lawrence staging( K-L) were randomly divided into two groups. Group A contained 20 cases [six males,14 females,average age( 54 ± 3) years],which received intra-articular injection of PRP 2 ml combined with medial tibial plateau and medial femoral condyle injection of PRP 1. 5 ml. Group B also included 20 cases [four males,16 females,average age( 49 ± 5) years],which were given intra-articular injection of PRP 5 ml. Two weeks later,both the groups followed the same operation above. All the patients were followed up at month 1,3,6,12 with visual analogue scale( VAS) score and the Western Ontario and Mc Master Universities( WOMAC) osteoarthritis index. The data were analyzed by repeated measurement design chi-square test. Results No significantly difference was found in the two groups before receiving the treatment( P > 0. 05). VAS and WOMAC scores were all declined especially at the end of the first month. Comparing the VAS scores,there was no significant difference in the 1 stmonth( P > 0. 05),but at the 3 rd( F = 203. 15,P < 0. 05),6 th( F =556. 82,P < 0. 05) and 12 th( F = 1310. 56,P < 0. 05) month,the significant differences were found between the two groups. At the 1 stand 3 rdmonth,the improvement in WOMAC scores was similar in group A and B( P > 0. 05),while at the end of 6 th( F = 185. 49,P < 0. 05) and 12 th( F = 76. 09,P < 0. 05)month,the scores in group A were determined to be both statistically and clinically superior than those in group B. Conclusion Intra-articular injection combined with intra-cancellous bone infiltration of PRP can reduce pain and improve function of knee,the long-term efficacy may be better than intra-articular injection.更多还原