摘要
目的观察富血小板血浆(PRP)治疗术联合关节镜清理术治疗膝关节骨关节炎的临床疗效。方法 2013年12月至2015年5月,解放军广州总医院一五七分院骨科收治25例Kellgren&Lawrence(K-L)2、3级,疼痛评分≥5分,保守治疗3个月以上无效的膝骨关节炎患者,分为治疗组和对照组。治疗组12例,先行关节镜清理术,根据关节镜观察结果分别行滑膜清理、软骨成形、髁间棘骨赘清理和半月板成形等,然后关节腔内注射5 ml PRP,4周后进行第2次PRP注射;对照组13例,单纯行关节镜清理术治疗。比较治疗前、治疗后半年、1年、2年的数字疼痛强度评分(NRS疼痛评分)、西安大略和麦克马斯特大学骨关节炎指数评分(WOMAC评分)、特种外科医院膝关节评分(HSS评分)和SF-36生活质量评分。采用SPSS 17.0统计软件进行统计分析。治疗组和对照组间数值(符合正态分布且方差齐性的评价指标)比较采用t检验,同一评价指标的不同时间点的对比采用重复测量资料方差分析;定性资料采用卡方检验。结果治疗组患者治疗后半年、1年、2年的NRS疼痛评分、WOMAC评分、HSS膝关节评分、SF-36生活质量评分结果均比对照组的评分结果更佳。治疗后半年,治疗组NRS疼痛评分由治疗前的(7.1±1.0)分下降至(1.3±0.6)分(t=13.415,P<0.01),WOMAC评分由治疗前的(74.4±11.1)分下降至(19.2±4.1)分(t=17.994,P<0.01),HSS评分由治疗前的(33.2±6.0)分提高至(79.2±8.1)分(t=-14.175,P<0.01),SF-36生活质量评分由治疗前的(63.2±12.0)分提高到(109.8±10.5)分(t=-44.557,P<0.01),与治疗前比较均有统计学意义;治疗后1年的全部4项评分及治疗后2年的NRS疼痛评分和HSS评分均与治疗后半年时的评分差异无统计学意义(P>0.05);治疗后2年的WOMAC评分和SF-36生活质量评分分别为(21.7±2.7)分(t=15.517,P<0.01)及(98.6±8.7)分(t=-10.454,P<0.01),与治疗前比较仍效果显著且差异有统计学意义。对照组治疗半年后NRS疼痛评分由治疗前的(6.8±0.9)分下降至(2.8±1.3)分(t=18.623,P<0.01),WOMAC评分由治疗前的(73.7±8.3)分下降至(32.5±4.5)分(t=25.059,P<0.01),HSS评分由治疗前的(34.0±9.1)分提高至(63.8±10.4)分(t=-18.553,P<0.01),SF-36生活质量评分由治疗前的(62.2±7.2)分提高到(85.6±4.3)分(t=-13.632,P<0.01);治疗后1年的HSS评分为(39.8±8.8)分,仍比治疗前高且有统计学意义(t=-2.448,P<0.05);治疗后2年的HSS评分为(29.8±7.7)分,比治疗前低且有统计学意义(t=1.732,P<0.01);治疗后1年及2年的其他评分结果与治疗前比较无统计学意义(P>0.05)。结论本研究结果表明,两种方法均可缓解K-L 2、3级膝关节骨关节炎患者的疼痛、改善功能和生活质量;关节镜清理术的治疗效果仅能维持半年,PRP治疗术联合关节镜清理术的效果优于单纯关节镜清理术,且效果更持久。
Objective To investigate the clinical effects of platelet-rich plasma（ PRP） in combination with arthroscopic debridement for moderate knee osteoarthritis. Methods A total of 25 patients with grade two or grade three knee osteoarthritis according to K-L classification,numerical rating scal（ NRS）over five,failed treatment with non-operative methods for more than three months were allocated in the treatment group（ n = 12） or the control group（ n = 13）. In the treatment group,two times of 5 ml of PRP intra-articular injection were performed with four weeks interval. The first time of PRP intra-articular injection was performed during arthroscopy after arthroscopic debridement. In the control group,the patients were only treated with knee arthroscopic debridement. The outcomes were assessed with NRS,Western Ontario and Mc Master Universities osteoarthritis index（ WOMAC）,the Hospital for Special Surgery（ HSS） scores,the short form-36 questionnaire of health survey（ SF-36） scores at baseline and six months,one year and two years after treatment. Statistical analysis was performed using the SPSS version 17. 0. Data of Gaussian distribution were analyzed by ttest（ data between treatment and control groups） or analysis of variance（ data within group）. Categorized data were analyzed using the Chi-square test. Results The scores of NRS and WOMAC of the treatment group at six months,one year and two years after treatment were lower than the control group; the scores of HSS and SF-36 of the treatment group were higher than the control group. In the treatment group,the scores of NRS and WOMAC at six months after treatment decreased from（ 7. 1 ± 1. 0）,（ 74. 4 ± 11. 1） at baseline to（ 1. 3 ± 0. 6）（ t = 13. 415,P 〈 0. 01）,（ 19. 2 ± 4. 1）（ t = 17. 994,P 〈 0. 01）respectively; the scores of HSS and SF-36 increased from（ 33. 2 ± 6. 0）,（ 63. 2 ± 12. 0） at baseline to（ 79. 2 ± 8. 1）（ t =-14. 175,P 〈 0. 01） and（ 109. 8 ± 10. 5）（ t =-44. 557,P 〈 0. 01） respectively. The four scores at one year and the scores of NRS and HSS at two years had no statistically significant difference compared to the scores at six months（ P 〉 0. 05）,while the scores of WOMAC and SF-36 at two years after treatment were（ 21. 7 ± 2. 7）（ t = 15. 517,P 〈 0. 01） and（ 98. 6 ± 8. 7）（ t =-10. 454,P 〈 0. 01）respectively,which were worse than the scores at six months,but still better than the scores at baseline（ P 〈0. 05）. In the control group,the scores of NRS and WOMAC decreased from（ 6. 8 ± 0. 9）,（ 73. 7 ± 8. 3） at baseline to（ 2. 8 ± 1. 3）（ t = 18. 623,P 〈 0. 01）,（ 32. 5 ± 4. 5）（ t = 25. 059,P 〈 0. 01） at six months after treatment respectively. The scores of HSS and SF-36 increased from（ 34. 0 ± 9. 1）,（ 62. 2 ± 7. 2） at baseline to（ 63. 8 ± 10. 4）（ t =-18. 553,P 〈 0. 05）,（ 85. 6 ± 4. 3）（ t =-13. 632,P 〈 0. 05） at six months after treatment respectively. The scores of HSS at one year decreased to（ 39. 8 ± 8. 8） compared to six months（ P 〈 0. 05）,but still higher than the scores at baseline（ t =-2. 448,P 〈 0. 05）. The scores of HSS at two years decreased to（ 29. 8 ± 7. 7）,lower than the scores at baseline（ t = 1. 732,P 〈 0. 05）. The scores of NRS,WOMAC and SF-36 at one and two years had no significant difference statistically compared to the scores at baseline（ P 〉 0. 05）. Conclusions Both the PRP and arthroscopic debridement could reduce pain,restore knee function and improve the life quality of patients with knee osteoarthritis of K-L grade two and three. The PRP combined with arthroscopic debridement may have better and long-term effects of pain reduction,knee function restoration and life quality improvement within two years compared to arthroscopic debridement alone. The effects of the arthroscopic debridement could maintain for only six months.
作者
黄山东
费志军
赵晓亮
辛鹏
徐凯
谢宁灵
林淮
王维
Huang Shandong;Fei Zhijun;Zhao Xiaoliang;Xin Peng;Xu Kai;Xie Ningling;Lin Huai;Wang Wei(Department of Orthopedics,157 Affiliated Hospital of Guangzhou General Hospital of People＇ s Liberation Army,Guangzhou 510510,China)
出处
《中华关节外科杂志（电子版）》
CAS
2018年第3期332-337,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
