摘要
目的:探讨比较关节腔内注射富血小板血浆（PRP）与透明质酸（HA）治疗K-L分级Ⅰ-Ⅲ期膝骨关节炎（KOA）的疗效。方法:前瞻性收集2020年01月至2021年08月在河北医科大学第三医院关节科门诊收治的Ⅰ-Ⅲ期KOA患者100例，采用随机数字表法分为2组，最终96例患者符合纳排标准，PRP组（n=46例）和HA组（n=50例）。两组病例分别接受关节腔内注射PRP（5 ml）或HA（2 ml），每周1次，连续4次。所有患者治疗后均采取相同的康复训练及生活指导，至少接受12个月的定期随访。记录纳入患者的人口统计学资料，并根据BMI分为<30 kg/m2和≥30 kg/m2两个亚组。治疗前、治疗后第1、3、6和12个月时，分别采用VAS、WOMAC、HSS评分和2分钟步行测试（2MWT）对两组患者临床疗效进行评估，并记录治疗过程中出现的任何不良事件。结果:两组患者接受关节腔内注射PRP或HA治疗后膝关节疼痛程度与功能较治疗前均有改善。在BMI<30 kg/m2亚组中，接受PRP注射治疗后第6和12个月的VAS评分与接受HA注射治疗患者相比，差异存在统计学意义[（1.4±0.8）分vs.（1.9±0.7）分，P=0.014；（1.0±0.6）分vs.（1.4±0.8）分，P=0.028）；治疗后第3、6和12个月的WOMAC[（45.4±7.7）分vs.（28.3）分，P<0.001；（19.6±5.1）分vs.（25.5±3.5）分，P<0.001；（19.6±5.1）分vs.（18.5±4.5）分，P=0.002）、HSS评分（80.9±6.3）分vs.（76.2±6.7）分，P=0.001；（86.3±5.4）分vs.（80.4±5.9）分，P<0.001；（91.4±3.5）分vs.（88.6±4.2）分，P=0.001）及2MWT（134.6±15.5）分vs.（122.5±20.4）分，P=0.002；（134.6±15.5）分vs.（129.0±23.2）分，P=0.041；（139.8±12.6）分vs.（130.8±20.3）分，P=0.012）结果均好于HA组，差异具有统计学意义。在BMI≥30 kg/m2亚组中，接受PRP注射治疗患者在各治疗阶段与HA组相比，在VAS、WOMAC、HSS评分及2MWT结果方面无明显差异（P>0.05）。结论:膝关节腔内注射PRP对Ⅰ-Ⅲ期非肥胖的KOA患者具有较好治疗效果，可有效改善患者疼痛和膝关节功能。与接受HA注射治疗组相比，接受PRP治疗组3个月后对膝关节功能改善更明显，治疗6个月后对疼痛缓解更明显，值得临床推广。
Abstract
Objective:To compare the efficacy of intraarticular injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of K-L stage Ⅰ-Ⅲ knee osteoarthritis (KOA).Methods:A total of 100 patients with stage Ⅰ-Ⅲ KOA admitted to the joint department of the Third Hospital of Hebei Medical University were prospectively collected and divided into 2 groups by random number table method between January 2020 and August 2021. Finally, 96 patients in PRP group (n=46 cases) and HA group (n=50 cases) met the atretic criteria. The patients of two groups received intra-articular injection of PRP (5 ml) or HA (2 ml) once a week for 4 consecutive times. All patients received the same rehabilitation training and life guidance after treatment, and received regular follow-up for at least 12 months. The demographic data of the enrolled patients were recorded, and were divided into 2 subgroups: <30 kg/m2 and ≥30 kg/m2 according to the BMI. The VAS, WOMAC, HSS scores and 2-minute walking test (2MWT) were used to evaluate the clinical efficacy of the two groups before treatment and 1, 3, 6 and 12 months after treatment, respectively.Results:The degree of knee pain and function were improved in both groups after intraluminal injection of PRP or HA. In the subgroup of BMI<30 kg/m2, there were statistically significant differences in VAS score at 6 and 12 months after PRP injection compared with HA injection (1.4±0.8 vs. 1.9±0.7, P=0.014; 1.0±0.6 vs. 1.4±0.8, P=0.028); The WOMAC (45.4±7.7 vs. 28.3, P<0.001; 19.6±5.1 vs. 25.5±3.5, P<0.001; 19.6±5.1 vs. 18.5±4.5, P=0.002), HSS scores (80.9±6.3 vs. 76.2±6.7, P=0.001; 86.3±5.4 vs. 80.4±5.9, P<0.001; 91.4±3.5 vs. 88.6±4.2, P=0.001) and 2MWT results (134.6±15.5 vs. 122.5±20.4, P=0.002; 134.6±15.5 vs. 129.0±23.2, P=0.041; 139.8±12.6 vs. 130.8±20.3, P=0.012) at 3, 6 and 12 months after treatment were better than those in HA group, with significant differences. In the subgroup of BMI≥30 kg/m2, there were no significant differences in VAS, WOMAC, HSS scores and 2MWT results between patients receiving PRP injection and patients in HA group at all treatment stages (P>0.05).Conclusions:Intraarticular injection of PRP in knee joint has a good therapeutic effect on non-obese KOA patients of stage Ⅰ to Ⅲ, and can improve pain and knee joint function in effective patients. Compared with patients treated with HA, PRP treatment can improve knee joint function more significantly after 3 months and relieve pain more significantly after 6 months, which is worthy of clinical application.
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