不同浓度富血小板血浆治疗膝关节骨性关节炎的临床研究

发布时间：2018-05-27 05:41

本文选题：富血小板血浆 + 膝骨关节炎　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:通过对不同浓度的富血小板血浆治疗膝关节骨性关节炎的安全有效性分析,评价富血小板血浆治疗膝关节骨性关节炎的临床疗效,并探讨富血小板血浆治疗膝关节骨性关节炎的临床使用浓度。方法:选取符合纳入、排除标准病例101例,将纳入病例按随机数字表法先随机分为对照组及实验组,然后实验组再次通过随机数字表法随机分为A、B、C、D组。各组均口服依托考昔片,每日一次,每次一片基础治疗。对照组患者予膝关节腔内注射2ml玻璃酸钠注射液。实验组予注射2ml富血小板血浆,其中A组富血小板血浆浓度(900-1500)×10~9/L,B组富血小板血浆浓度(1200-1500)×10~9/L,C组富血小板血浆浓度(1500-1800)×10~9/L,D组富血小板血浆浓度(1800-2100)×10~9/L,膝关节注射治疗以5次为一个疗程。治疗前及治疗后3、6、9个月时回访病人,按照WOMAC骨关节炎指数评分、IKDC评分、VAS视觉疼痛评分评定关节功能并根据《中医病症诊断疗效标准》评价治疗有效率(以WOMAC评分为评价指标)。治疗前及治疗完成后均行肝肾功等相关检查,以评估富血小板血浆治疗膝关节骨性关节炎的临床安全性。并通过不同浓度分组观察,探索富血小板血浆应用于膝关节骨性关节炎的临床适宜浓度。结果:对照治疗后3个月随访时显效率为14.29%,有效率为59.52%(综合有效率为73.81%),对照组终末随访时综合有效率为28.57%;实验组治疗后3个月随访时显效率为22.03%,有效率为61.02%(综合有效率为83.05%),实验组终末综合有效率为55.93%。对照组和治疗组患者治疗VAS评分明显下降(3.98±1.26及3.27±1.70),终末随访较前上升(5.29±1.44及4.06±1.63),但低于治疗前,对照组及实验组在治疗后各随访时间点实验组VAS评分均优于对照组。治疗前后各组WOMAC评分治疗后3个月下降最明显(31.05±6.55及29.44±5.63),终末随访对照组与治疗前无明显差异(44.02±11.60),实验组低于治疗前(35.98±9.16),随访过程中实验组评分均低于对照组。治疗前后各组IKDC评分治疗后3个月改善最明显(64.05±11.14及68.64±9.82),终末随访对照组与治疗前无明显差异(55.43±15.59),实验组低于治疗前(60.58±8.68),随访过程中实验组评分均优于对照组。不同实验组间VAS评分,以C组下降最明显,治疗后3个月时为(2.35±1.06),治疗后9个月为(3.53±1.42);WOMAC评分以C组改善效果最满意,治疗后第3、6、9个月分别为(27.71±5.46、24.94±7.68、35.59±7.98);IKDC评分WOMAC评分以C组改善效果最满意,治疗后第3、6、9个月分别为(73.94±9.42、66.06±7.17、65.59±8.99)。不良反应患者注射富血小板血浆中白细胞、红细胞高于不发生不良反应患者(40.17±8.65×10~9/L和24.31±5.72×10~9/L;3.81±1.59×1012/L和1.92±1.07×1012/L)。结论:关节腔注射玻璃酸钠及富血小板血浆均能有效改善膝骨性关节炎患者的临床症状。后者通过修复软骨、消除炎症疗效优于前者。不同血小板浓度的富血小板血浆对膝骨性关节炎患者的疗效在一定程度上呈剂量依赖,最适宜血小板浓度应为(1500-1800)×10~9/L。治疗前后血常规、肝肾功等检查结果正常,无感染、血栓等并发症,少量不良反应的发生可能是由过多的白细胞及红细胞引起,但可迅速自行缓解。因此自体富血小板血浆关节腔注射治疗膝骨性关节炎安全有效。
[Abstract]:Objective: To evaluate the efficacy of platelet rich plasma in the treatment of osteoarthritis of the knee joint, evaluate the clinical efficacy of platelet rich plasma in the treatment of osteoarthritis of the knee joint, and discuss the clinical concentration of platelet rich plasma in the treatment of osteoarthritis of the knee joint. Method: select the standard cases 10 to exclude the standard cases. 1 cases were randomly divided into the control group and the experimental group according to the random number table method. Then the experimental group was randomly divided into A, B, C, and D group by random digital table method. Each group was taken orally Etoricoxib Tablets, once a day, a piece of basic treatment. The control group was injected with 2ml Sodium Hyaluronate Injection in the knee joint cavity. The experimental group was given the injection of 2m. L rich platelet plasma, of which platelet rich plasma concentration (900-1500) x 10~9/L, platelet rich plasma concentration in group B (1200-1500) x 10~9/L, platelet rich plasma concentration (1500-1800) x 10~9/L in group C, platelet rich plasma concentration (1800-2100) x 10~9/L in D group, and 5 times for knee joint injection therapy, before and after treatment, and 3,6,9 months after treatment. The patients were interviewed, according to the WOMAC Osteoarthritis Index score, the IKDC score, the VAS visual pain score to evaluate the joint function and to evaluate the treatment efficiency according to the standard of TCM syndrome diagnosis (the evaluation index of the WOMAC score). The liver and kidney functions were performed before and after the treatment to evaluate the platelet rich plasma for the treatment of the knee joint. Clinical safety of arthrosis. And through the observation of different concentration groups, the clinical suitable concentration of platelet rich plasma used in osteoarthritis of the knee joint was explored. Results: the effective rate was 14.29%, the effective rate was 59.52% (comprehensive effective rate 73.81%) at 3 months after the control treatment, and the comprehensive effective rate was 28.57% at the end of the follow-up group, and the experimental group was 28.57%. After 3 months of follow-up, the effective rate was 22.03% and the effective rate was 61.02% (comprehensive effective rate 83.05%). The final comprehensive efficiency of the experimental group was significantly decreased (3.98 + 1.26 and 3.27 + 1.70) in the 55.93%. control group and the treatment group (3.98 + 1.26 and 3.27 + 1.70), and the final follow-up was higher (5.29 + 1.44 and 4.06 + 1.63) than before (5.29 + 1.44 and 4.06 + 1.63), but lower than the control group and the experimental group before the treatment. The VAS scores in the experimental group were better than those in the control group after the treatment. The 3 months after treatment were the most obvious (31.05 + 6.55 and 29.44 + 5.63) after treatment. There was no significant difference between the control group and the control group (44.02 + 11.60), and the experimental group was lower than before treatment (35.98 + 9.16). The scores of the experimental group were lower than those of the experimental group. Before and after treatment, the improvement of IKDC score was the most obvious (64.05 + 11.14 and 68.64 + 9.82) after treatment, and no significant difference between the control group and before treatment (55.43 + 15.59), and the experimental group was lower than before treatment (60.58 + 8.68). The score of the experimental group was better than the control group. The VAS score between the different experimental groups was the most obvious in the C group, and the treatment was the most obvious in the C group. 3 months after treatment (2.35 + 1.06) and 9 months after treatment (3.53 + 1.42), WOMAC score was most satisfactory in group C, 3,6,9 months after treatment was (27.71 + 5.46,24.94 + 7.68,35.59 + 7.98), WOMAC score of IKDC score was most satisfactory in C group, and (73.94 + 9.42,66.06 + 7.17,65.59 + 8.99) after treatment, respectively. Patients with good reaction were injected with leukocytes in platelet rich plasma, and red blood cells were higher than those without adverse reactions (40.17 + 8.65 x 10~9/L and 24.31 + 5.72 x 10~9/L; 3.81 + 1.59 x 1012/L and 1.92 + 1012/L). Conclusion: intraarticular injection of sodium hyaluronate and platelet rich plasma can effectively improve the clinical symptoms of patients with knee osteoarthritis. The effect of platelet rich plasma on osteoarthritis of the knee is dose-dependent to a certain extent by repairing the cartilage. The most suitable platelet concentration should be (1500-1800) the blood routine before and after the treatment of (1500-1800) x, liver and kidney work and other complications, such as no infection, thrombosis and other complications. The occurrence of adverse reactions may be caused by too many leucocytes and red cells, but it can be relieved quickly and spontaneously. Therefore, autologous platelet rich plasma injection is safe and effective in the treatment of osteoarthritis of the knee.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684.3

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