【摘要】 目的观察不同浓度富血小板血浆治疗早期膝关节骨关节炎的临床疗效,寻找治疗早中期膝骨关节炎的最佳血小板浓度。方法将160例符合入选标准的膝关节骨性关节炎患者随机分为甲、乙、丙、丁四组,所有患者均随访半年,共有155例患者获得随访,根据患者分组予不同血小板浓度富血小板血浆膝关节内注射治疗,于治疗前和治疗后3 d、3个月、6个月时采用视觉模拟评分法(VAS)、安大略西部和麦克马斯特大学骨关节炎指数(WOMAC)评分评估膝关节症状及功能改善情况,并比较四组患者临床有效率及不良反应。结果甲组、乙组、丙组治疗后3 d、3个月、6个月以及丁组治疗后3个月和6个月VAS评分分别与治疗前比较明显下降,差异均有统计学意义(P<0.05);丙组治疗后各时间点VAS评分均低于其它各组(P<0.05),乙组治疗后各时间点VAS评分均低于甲组和丁组(P<0.05),丁组治疗6个月后VAS评分均低于甲组,差异均有统计学意义(P<0.05)。甲组、乙组、丙组治疗后3 d、3个月、6个月以及丁组治疗后3个月和6个月WOMAC评分分别与治疗前比较明显下降,差异均有统计学意义(P<0.05);丙组治疗后各时间点膝关节WOMAC评分均低于其它各组(P<0.05),乙组治疗后3 d WOMAC评分低于甲组和丁组(P<0.05)。6个月后,丙组总有效率最高(92.1%),乙组次之(80.0%),丁组再次之(65.0%),甲组最低(48.6%)(P<0.05)。丁组疼痛发生率明显高于其他三组(P<0.05);甲、乙、丙组疼痛发生率比较差异无统计学意义(P>0.05)。结论不同血小板浓度富血小板血浆对早中期膝关节骨性关节炎患者的疗效在一定程度上呈浓度依赖性,过高或者过低血小板浓度的富血小板血浆对早中期骨性关节炎患者均达不到最佳治疗效果,但存在一个最适宜浓度,可能为(1 100～1 400)×109/L,并且血小板浓度较高的富血小板血浆还会产生较高的不良反应。更多还原

【Abstract】 【Objective】 To compare the clinical effects of intra articular injection of platelet rich plasma(PRP) with different platelet concentrations for the treatment of knee osteoarthritis(KOA) and to find the best clinical platelet concentration of PRP for the treatment of knee osteoarthritis. 【Methods】 One hundred and sixty patients with KOA were selected and randomly divided into A, B, C, D groups, all patients were followed up for half a year, a total of 155 patients received follow-up. The four groups were orally administered intra articular injection of PRP with different platelet concentrations. Before treatment and 3 days, 3 months and6 months after treatment, knee joint symptoms and function improvement were evaluated by VAS pain score and WOMAC score,and clinical effectiveness and adverse reactions were compared among the four groups. 【Results】 VAS scores of group A, group B and group C at three days, 3 and 6 months after treatment and group D at 3 and 6 months after treatment were significantly lower than those before treatment, with statistically significant differences(P<0.05). VAS scores of group C at each time point after treatment were lower than those of other groups(P<0.05), VAS scores of group B at each time point after treatment were lower than those of group A and group D(P<0.05), and VAS scores of group D were lower than those of group A after 6 months of treatment(P<0.05). WOMAC scores of group A, group B and group C at three days, 3 and 6 months after treatment and group D at 3 and 6 months after treatment were significantly lower than those before treatment, with statistically significant differences(P<0.05). The WOMAC score of the knee joint of group C was lower than that of other groups at each time point after treatment(P<0.05), and the WOMAC score of group B was lower than that of group A and group D at three days after treatment(P<0.05). After 6 months, the total effective rate of group C was the highest(92.1%), followed by group B(80.0%), group D(65.0%), and group A(48.6%)(P<0.05).The incidence of swelling and pain in group D was significantly higher than that in the other three groups(P<0.05). There was no statistically significant difference in the incidence of swelling and pain between groups A, B and C(P>0.05). 【Conclusion】 The clinical effects of intra articular injection of platelet rich plasma for the treatment of knee osteoarthritis is dose-dependent on platelet concentration. Too high or too low platlet concentrations of platelet rich plasma in patients with early osteoarthritis cannot achieve the best treatment effect, but there is one of the most suitable concentration, could be(1100～1400)×109/L, and platelet rich plasma with higher platelet comcentration also could produce higher adverse reactions.更多还原