Therapeutic effects comparison between platelet-rich plasma and sodium hyaluronate intra-articular injection in treatment of knee osteoarthritis

目的关节腔内注射自体富血小板血浆（PRP）与透明质酸钠（SH）,观察并比较其疗效。方法于2012年2月至12月,漳州市解放军第175医院骨科收治的81例Kellgren-Lawrence（KL）分级标准为Ⅱ、Ⅲ级膝关节骨关节炎的患者,年龄48～60岁,平均（52.6±3.6）岁;男性27例,女性53例;左膝38例,右膝43例。K-L分级标准,Ⅱ级47例,Ⅲ级34例,按就诊顺序序贯随机平行分为SH组（40例）和PRP组（41例）,分别采用SH和PRP关节腔内注射进行治疗。治疗前和治疗后3、6、9、12个月对患者进行随访并进行美国西部Ontario与Mc Master大学骨关节炎指数（WOMAC）评分评估,两组间各时间点WOMAC评分比较采用t检验,两组内各时间点WOMAC评分比较采用重复测量方差分析;分别于治疗前和治疗后12个月进行膝关节磁共振检查,评价关节腔内积液的吸收情况。结果治疗前及治疗后3个月PRP组WOMAC评分[（48.42±4.95）分,（25.38±5.12）分]和SH组[（47.17±5.12）分,（25.17±5.09）分]比较,t值分别为-0.625和0.413,差异无统计学意义（P均〉0.05）;治疗后6、9、12个月PRP组WOMAC评分[（21.44±4.73）分,（20.54±4.46）分,（16.53±7.35）分]和SH组[（25.87±5.16）分,（27.22±4.21）分,（29.63±8.21）分]比较,PRP组低于SH组,t值分别为-2.765、-3.447和-4.657,差异具有统计学意义（P均〈0.05）,治疗后12个月复查磁共振,可见PRP组的关节积液吸收例数高于SH组,差异有统计学意义（P〈0.05）。结论膝关节腔内注射自体PRP,临床效果优于透明质酸钠,中长期疗效好。Objective To compare the efficacy of platelet rich plasma （PRP） and sodium hyaluronate （SH） intra-articular injection in the patients with knee osteoarthritis of grade Ⅱand Ⅲ. Methods A total of 81 patients with knee osteoarthritis of grade Ⅱ and Ⅲ （ Kellgren-Lawrence standard） were randomly assigned to the PRP and SH group. All 81 patients were treated in the 175th hospital of PLA, Zhangzhon, with the average age of （52.6 ± 3.6） years. There were 27 males and 53 females. Forty cases in SH group and 41 cases in PRP group had got the complete follow-up. Both the two groups adopted 4 ml of 5% lidocaine for intra-articular injection. All the patients were prospectively evaluated before the treatment and at the 34 , 6th , 9th and 12th month after the treatment by the Western Ontario and McMaster Universities （WOMAC） osteoarthritis index. The swelling subsiding knee was observed. Between the two groups WOMAC scores were compared using t test at each time point, within the groups the scores were compared by repeated measures analysis of variance. The absorption of accumulated fluid in the joint cavity was observed and compared by MRI before and 12 months after the treatment. Results No serious adverse event was detected in the two groups. According to the follow-up evaluations, both the groups presented clinical improvements. The comparison between the two groups showed no statistically significant difference before therapy and three months after the treatment （ t =- 0. 625, 0. 413, P 〉 0. 05 ）. Six months, nine months and 12 months after the treatment, WOMAC score in the PRP group[ （21.44 ±4. 73）, （20. 54 ± 4. 46） ,（16. 53 ± 7. 35 ） pointsl were lower than the SH group[（25.87 ±5.16）, （27.22 ±4.21）, （29. 63 ± 8.21 ） points] ; the difference was statistically signifieant（ t = - 2. 765, - 3. 447, - 4. 657, P 〈 0. 05 ）. Conclusion PRP intra-artieular injection in the treatment of knee osteoarthritis of gradeⅡ and Ⅲ may be more suitable compared to南京军区医学科技创新重点课题项目（15ZD027

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