自体贫白细胞富血小板血浆、富白细胞富血小板血浆治疗膝骨性关节炎疗效差异分析
Difference of efficacy between autologous Lp-PRP and Lr-PRP in the treatment of knee osteoarthritis
花鸣春 1李朝旭 1贝朝勇 2韦凯伦3
作者信息
- 1. 广西中医药大学研究生学院 广西 南宁 530200
- 2. 桂林医学院附属医院骨科 广西 桂林 541001
- 3. 桂林医学院附属医院小儿外科 广西 桂林 541001
- 折叠
摘要
目的 比较自体贫白细胞的富血小板血浆(Lp-PRP)和富白细胞的富血小板血浆(Lr-PRP)治疗膝骨性关节炎的效果.方法 前瞻性选取2021年11月至2024年1月于桂林医学院附属医院接受治疗的膝骨性关节炎患者108例作为研究对象.按照随机数字表法将其分为Lp-PRP组、Lr-PRP组及对照组,每组各36例.Lp-PRP组予以自体Lp-PRP膝关节腔内注射+常规运动疗法,Lr-PRP组给予Lr-PRP膝关节腔内注射+常规运动疗法,对照组则接受常规运动疗法治疗.治疗前及治疗结束后以西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、美国膝关节协会评分(KSS)系统评价患者膝关节功能;治疗前、治疗后3周及治疗结束后以视觉模拟评分法(VAS)、血浆P物质变化评估患者膝关节疼痛程度变化;治疗前及治疗结束后以膝关节滑液白细胞介素(IL)-6、IL-1β、肿瘤坏死因子-a(TNF-α)水平评价患者关节炎症程度;治疗前及治疗结束后以膝关节伸肌群峰力矩、总做功评价患者膝关节伸肌群肌力变化;并统计3组治疗期间不良反应发生情况.结果 治疗结束后,Lp-PRP组WOMAC评分低于Lr-PRP组、对照组,Lp-PRP组KSS评分则显著高于Lr-PRP组、对照组,差异均有统计学意义(P＜0.05);且Lr-PRP组WOMAC评分低于对照组,KSS评分高于对照组,差异均有统计学意义(P＜0.05).治疗结束时,Lp-PRP组VAS评分低于Lr-PRP组、对照组,且Lp-PRP组治疗后3周、治疗结束后血浆P物质水平均低于Lr-PRP组,差异均有统计学意义(P＜0.05);治疗后3周、治疗结束后,Lr-PRP组VAS评分、血浆P物质水平均低于对照组,差异均有统计学意义(P＜0.05).治疗结束后,Lp-PRP组IL-6、IL-1 β及TNF-a水平均显著低于Lr-PRP组与对照组,差异均有统计学意义(P＜0.05);而Lr-PRP组与对照组IL-6、IL-1β及TNF-α水平比较,差异均无统计学意义(P＞0.05).治疗结束后,Lp-PRP组、对照组伸肌峰力矩均高于Lr-PRP组,差异均有统计学意义(P＜0.05),但Lp-PRP组与对照组比较差异无统计学意义(P＞0.05);Lp-PRP组伸肌总做功高于Lr-PRP组及对照组,差异有统计学意义(P＜0.05),但Lr-PRP组、对照组伸肌群总做功比较,差异无统计学意义(P＞0.05).3组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 相较于Lr-PRP,膝骨性关节炎患者应用自体Lp-PRP能更明显获益,对其疼痛控制、炎症控制及功能改善均有积极意义,还有利于膝关节肌肉群力量改善,且安全性高.
Abstract
Objective To compare the efficacy of autologous leukocyte-poor platelet rich plasma(Lp-PRP)and leukocyte-rich plate-let rich plasma(Lr-PRP)in the treatment of knee osteoarthritis.Methods A total of 108 patients with knee osteoarthritis admitted to Affiliated Hospital of Guilin Medical College from November 2021 to January 2024 were divided into Lp-PRP group,Lr-PRP group and control group by random number table method.Lp-PRP group was treated with autologous Lp-PRP intracavitary injection+conventional exercise therapy,Lr-PRP group was treated with Lr-PRP intracavitary injection+conventional exercise therapy,and control group was treated with conventional exer-cise therapy.The knee joint function was evaluated by the Western Ontario and MeMaster Universities osteoarthritis index(WOMAC)and Ameri-can knee society score(KSS)before and after treatment.Before treatment,3 weeks after treatment and after the end of treatment,the visual ana-logue scale(VAS)and plasma substance changes were used to evaluate the changes of knee joint pain in patients.The levels of interleukin(IL)-6,IL-1 β and tumor necrosis factor-α(TNF-α)in synovial fluid of knee joint were used to evaluate the degree of joint inflammation before and after treatment.The changes of knee extensor muscle strength were evaluated by peak torque and total work of knee extensor muscle group be-fore and after treatment.The incidence of adverse reactions during treatment in the three groups was counted.Results After treatment,the WOMAC score of the Lp-PRP group was lower than that of the Lr-PRP group and the control group,the KSS score of the Lp-PRP group was significantly higher than that of the Lr-PRP group and the control group,and the differences were statistically significant(P＜0.05).And the WOMAC score of the Lr-PRP group was significantly lower than that of the control group,the KSS score was significantly higher than that of the control group,the difference was statistically significant(P＜0.05).At the end of treatment,the VAS score of the Lp-PRP group was lower than that of the Lr-PRP group and the control group,and the plasma substance P level of the Lp-PRP group was lower than that of the Lr-PRP group at 3 weeks after treatment and after treatment,the differences were statistically significant(P＜0.05);at 3 weeks after treatment and after treatment,the levels of VAS and plasma substance P in the Lr-PRP group were lower than those in the control group,and the differences were statistically significant(P＜0.05).After treatment,the levels of IL-6,IL-1 β and TNF-α in Lp-PRP group were significantly lower than those in Lr-PRP group and control group,and the differences were statistically significant(P＜0.05);but there was no statistically significant difference in the levels of IL-6,IL-1 β and TNF-α between the Lr-PRP group and the control group(P＞0.05).After treatment,the peak torque of extensor in Lp-PRP group and control group were higher than that in Lr-PRP group,and the difference were statistically significant(P＜0.05);but there was no statistically significant difference between Lp-PRP group and control group(P＞0.05).The total work of extensor in Lp-PRP group were higher than that in Lr-PRP group and control group,and the difference were statistically significant(P＜0.05);but there was no statistically significant difference in the total work of the extensor muscles between the Lr-PRP group and the control group(P＞0.05).There was no statistically significance in the incidence of adverse reactions among three groups(P＞0.05).Conclusion Compared with Lr-PRP,the application of autologous Lp-PRP in knee osteoarthritis patients can benefit more significantly,which has positive significance in pain control,inflammation control and functional improvement,and is also beneficial to the improvement of knee muscle strength with high safety.
关键词
膝骨性关节炎/富血小板血浆/炎症/自体Lp-PRP/Lr-PRP/功能Key words
Knee osteoarthritis/Platelet rich plasma/Inflammation/Autologous Lp-PRP/Lr-PRP/Feature引用本文复制引用
基金项目
国家自然科学基金资助项目(82160416)
出版年
2024
NETL
NSTL
万方数据