关节腔内及膝周痛点注射富血小板血浆治疗膝关节骨性关节炎

目的:观察关节腔内及膝周痛点注射富血小板血浆治疗膝关节骨性关节炎的临床疗效,并分析其安全性和可行性。方法:将2017年1月至12月收治的膝关节骨性关节炎患者48例分为观察组和对照组,每组24例。观察组男8例,女16例;年龄43～68(58.04±7.87)岁,病程1～8(4.69±1.96)年;身体质量指数(24.53±5.26) kg/m~2;给予关节腔内注射富血小板血浆2 ml,膝周痛点注射富血小板血浆共2 ml,1次/周,共治疗3次;对照组男7例,女17例;年龄47～72(60.54±8.93)岁;病程1.5～9(5.27±1.68)年;身体质量指数(23.47±4.62) kg/m~2;给予关节腔内注射透明质酸钠20 mg,膝周痛点封闭治疗,每点2 ml药液,1次/周,共治疗3次。记录并比较两组患者治疗前、治疗后1个月及6个月VAS评分和Lysholm评分以进行疗效评估。结果:48例患者均获6个月随访,未发生严重不良反应或并发症。观察组与对照组治疗前、治疗后1和6个月VAS评分分别为7.35±1.47,4.15±1.52,2.26±1.02和7.51±1.39,3.84±1.76,3.66±1.18;治疗后6个月,观察组VAS评分低于对照组(P0.05)。观察组与对照组治疗前、治疗后1和6个月Lysholm评分分别为55.21±5.78,79.16±7.25,85.45±6.87和54.65±6.40,77.58±6.94,82.34±7.12;两组治疗后总分均较治疗前明显改善(P0.05);治疗后1个月,两组总分比较差异无统计学意义(P0.05);治疗后6个月,观察组总分优于对照组(P0.05)。结论:关节腔内及膝周痛点注射富血小板血浆疗法可有效缓解膝关节疼痛,改善膝关节功能,同时安全性较高,虽短期疗效与传统治疗方法无明显差别,但中远期疗效稳定,是一种安全有效治疗膝关节骨性关节炎的方法。     

富血小板血浆修复关节软骨损伤临床研究进展

富血小板血浆（PRP）是自体全血经离心后得到的血小板浓缩物,含有大量生长因子和炎症调节因子,可促进组织修复并调节炎症;PRP中的纤维蛋白原可被激活形成纤维蛋白胶,用以填充组织缺损。已有较多细胞研究和动物实验探讨了PI冲在软骨修复中的作用,也有临床试验提示PRP填充关节软骨缺损可促进软骨修复,但支持的仅有少量Ⅳ级临床证据。目前,较多研究集中在通过关节内注射PRP缓解骨关节炎症状和改善关节功能上,虽有少量I级临床证据支持,但这些随机对照试验间的同质性较差,随访时间嫌短,仍需要大量同质化程度较高、长期随访的随机对照试验来进一步验证。     

自体骨髓浓缩物和富血小板血浆治疗膝关节软骨损伤

目的 通过临床前瞻性随机对照试验比较关节镜清理术(arthroscopic debridement, AD)联合骨髓浓缩物(bone marrow aspirate concentrate, BMAC)或富血小板血浆(platele rich plasma, PRP)治疗膝关节软骨损伤的症状和功能改善以及软骨修复效果。方法 本研究共纳入2020年7月到2021年8月中国人民解放军联勤保障部队第九二〇医院收治的单侧膝关节软骨损伤患者62例,其中男29例,女33例;年龄18～65岁,平均(32.57±8.58)岁;平均身体质量指数(23.02±1.26)kg/m²;国际软骨修复学会(international cartilage repair society, ICRS)分级,I级30例,Ⅱ级32例。临床试验患者随机分为三组,AD+BMAC组22例,AD+PRP组18例,AD组22例。采用Lysholm评分、Tegner评分和疼痛数字评分法(numeric rating scales, NRS)评估症状及功能改善情况,采用膝关节MRI及磁共振软骨修复组织观察(magn...     

富血小板血浆在治疗膝关节骨关节炎中的研究进展

膝关节骨关节炎（KOA）是指由于膝关节软骨变性、骨质增生而引起的一种慢性骨关节疾患,严重影响病人生活质量。目前针对KOA的治疗多为对症处理,对于逆转关节内结构损伤,促进其修复的药物研究仍不是很明确。富血小板血浆（PRP）是一种自体血液制品,富含大量生长因子和抗炎因子,具有改善关节内微环境的功效,可促使关节内组织修复。众多研究证明,PRP单独和（或）联合其他方法治疗,可降低关节内炎性因子水平,营造利于软骨修复的微环境,缓解病人症状。本文就PRP在治疗KOA临床应用中的研究进展进行综述。     

富血小板血浆对兔膝关节滑膜炎的治疗作用

目的富血小板血浆(platelet-rich plasma,PRP)对软组织修复、创伤愈合及骨缺损修复均有促进作用,通过建立蛋白酶诱导的兔膝骨性关节炎模型并以PRP进行干预,探讨PRP对滑膜炎的抑制及治疗作用。方法取6月龄清洁级新西兰大白兔20只,雌雄不限,体重2.5～3.0 kg;于兔耳中央动脉取血采用Landesberg等的方法制备PRP,同时对外周血及PRP进行血小板计数及PDGF、TGF和VEGF浓度检测。于20只兔双侧膝关节内分别注射0.3 mL 4%木瓜蛋白酶建立膝骨性关节炎模型后,随机分为实验组和对照组(n=10)。实验组:双侧膝关节每周注射0.3 mL PRP,共10周;对照组:注射无菌生理盐水。于第1次注射后第2、4、6、8、10周取血检测红细胞沉降率及IL-1β浓度,取膝关节滑膜标本行大体及HE染色观察,并根据Mankin评分标准对滑膜评分。结果血小板计数示PRP中血小板浓度约为外周血的6.8倍。PRP中PDGF、TGF-β和VEGF的浓度分别约为外周血中的5、8、7倍,差异均有统计学意义(P<0.05)。所有实验动物均存活至实验完成。实验组第2、6、8、10周红细胞沉降率与对照组比较,差异均有统计学意义(P<0.05),第4周组间比较差异无统计学意义(P>0.05)。实验组第4、6、8、10周IL-1β浓度与对照组比较,差异均有统计学意义(P<0.05),第2周组间比较差异无统计学意义(P>0.05)。对照组关节滑膜广泛水肿、增厚,表面纤维素性渗出,标本滑膜表面偶见血管翳样组织出现;实验组自第2周开始,可见滑膜渗出减少,随时间延长表面充血现象减轻,水肿程度下降,第10周时可见标本滑膜略增厚,未见明显水肿,表面少量淡黄色关节液覆盖,无粘连现象。实验组第4、6、8、10周Mankin评分与对照组比较,差异均有统计学意义(P<0.05),第2周组间比较差异无统计学意义(P>0.05)。结论 PRP通过修复受损组织、抑制炎性因子释放等途径,对蛋白酶诱导的兔滑膜炎发挥缓解和治疗作用。     

自体富血小板血浆治疗Kellgren-Lawrence Ⅱ、Ⅲ级膝关节骨性关节炎的疗效观察

目的观察膝关节腔内注射自体富血小板血浆治疗Kellgren-Lawrence Ⅱ、Ⅲ级膝关节骨性关节炎的临床疗效。方法纳入自2016-01—2018-01诊治的50例Kellgren-Lawrence Ⅱ、Ⅲ级膝关节骨性关节炎,进行自体富血小板血浆膝关节腔内注射治疗,每2周注射1次,共注射3次。治疗结束后3、6、9、12个月采用IKDC评分、WOMAC评分及Lequesne指数评价疗效。结果 50例均获得随访,随访时间平均14.8(12~18)个月。治疗后3、6、9、12个月IKDC评分、WOMAC评分及Lequesne指数均较治疗前明显改善,差异均有统计学意义(P <0.05)。Ⅱ级患者治疗后6、9、12个月WOMAC评分均低于Ⅲ级患者,差异有统计学意义(P <0.05)。结论自体富血小板血浆膝关节腔内注射治疗Kellgren-Lawrence Ⅱ、Ⅲ级膝关节骨性关节炎安全有效,可获得良好的临床疗效,而且病变程度较轻的患者效果更佳。     

富血小板血浆注射治疗萎缩性骨折不愈合

目的:探讨富血小板血浆(platelet-rich plasma,PRP)注射治疗萎缩性骨折不愈合的临床疗效。方法 :自2015年3月至2017年3月采用PRP注射治疗15例萎缩性骨折不愈合患者,其中男10例,女5例;年龄23～56(40.0±9.1)岁;不愈合时间6～14 (8.87±2.45)个月。抽取外周血60～100 ml,制备PRP,PRP血小板计数587～1 246(947.13±158.58)×10~9/L。透视定位下于骨折断端注射PRP 13～20 ml,分别于治疗后的第1、2周各注射1次,每月复查1次。观察术后患肢是否有短缩、成角、旋转畸形等并发症,并对其影像学检查进行评估。结果:所有患者获得随访,时间6～12(6.8±2.1)个月。治疗后患肢均无短缩、成角、旋转畸形等并发症发生。13例患者骨折愈合,愈合时间4～6(4.8±0.7)个月;2例患者12个月随访时完全无骨痂形成,其中1例治疗期间螺钉松动;其余病例均无并发症。结论:萎缩性骨折不愈合内固定术后骨折断端稳定是局部PRP注射的适应证。PRP治疗萎缩性骨折不愈合局麻穿刺下即可完成,操作安全、疗效可靠。     

富血小板血浆与关节软骨修复

富血小板血浆(PRP)对软骨缺损的修复作用,近几年已成为热门话题。体外研究发现PRP能显著促进动物和人类关节软骨细胞增殖和胞外基质合成,诱导人骨髓基质干细胞向成软骨细胞方向分化。体内试验证实PRP与明胶、聚乳酸-羟基乙酸共聚物、双层胶原基质等载体复合后回植软骨缺损处,起到了较好的修复作用。关节内注射PRP治疗慢性膝关节软骨退行性疾病可减轻关节疼痛、改善关节功能活动、提高患者生活质量,但仍缺乏大样本临床长期随访报道,以证实PRP修复关节软骨的长期疗效和安全性。尽管PRP有制备简便、快捷,对患者损伤小,无免疫排斥等优点,但还存在许多尚未解决的问题。     

踝关节镜联合富血小板血浆治疗距骨软骨损伤

[目的]探讨踝关节镜下联合富血小板血浆治疗距骨软骨损伤的临床疗效.[方法]收集在2018年1月1日～2019年10月31日,通过踝关节镜联合富血小板血浆治疗的距骨软骨损伤病例32例,其中男18例,女14例,年龄28～63岁,Hepple改良分型:Ⅲ期距骨外侧损伤18例,Ⅳ期9例、Ⅴ期5例.术后制动2周,后嘱无负重关节活...     

膝关节腔注射富血小板血浆对老年患者膝关节骨性关节炎疼痛的影响

目的 探讨膝关节腔注射富血小板血浆（PRP）治疗老年患者膝关节骨性关节炎疼痛的临床疗效。
方法 选择膝关节骨性关节炎患者80例,男35例,女45例,年龄65～80岁,Kellgren-Lawrence分级Ⅰ—Ⅲ级,随机均分为两组：PRP组和透明质酸组（HA组）。分别记录治疗前和治疗后4、12、48周的膝关节功能（WOMAC评分和Lequesne指数）、汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评分,观察注射部位的不良反应和并发症。
结果 与治疗前比较,两组治疗后4、12、48周的WOMAC评分和Lequesne指数、HAMA评分和HAMD评分均明显下降（P<0.001）。PRP组治疗后48周的WOMAC评分和Lequesne指数、HAMA评分和HAMD评分明显低于HA组（P<0.001）。两组均无出血、血肿和注射部位感染等不良反应和并发症。
结论 膝关节腔内注射富血小板血浆的疼痛治疗效果优于透明质酸。     

富血小板血浆不同注射次数对膝骨关节炎的疗效

目的探讨富血小板血浆(PRP)不同注射次数对膝骨关节炎疗效的影响。 方法纳入2018年2月至2019年2月河南省人民医院90例膝骨关节炎患者为研究对象,纳入标准：符合膝骨关节炎诊断标准、病程大于4个月、X线Kellgren-Lawrence分级(K-L分级)Ⅱ~Ⅲ级;排除标准：合并类风湿性关节炎、近期膝关节外伤或手术史、痛风、血液病、肿瘤等疾病者。按照注射次数不同,随机分为1次组、3次组、5次组,每组30例,分别给予1、3、5次PRP注射,每周1次。于治疗前、治疗后6、12、24周采用视觉模拟疼痛评分(VAS)评分和美国西安大略与麦克马斯特大学骨关节炎指数(WOMAC)评估患者膝关节功能,采用超声半定量分级评分评估患者膝关节软骨状态。VAS评分、WOMAC评分进行重复测量方差分析,超声半定量评分组内治疗前后采用配对样本t检验,组间比较采用单因素方差分析。 结果治疗后6周,与1次组相比,3次组和5次组VAS评分、WOMAC评分均有显著降低(F＝17.922、22.215,均为P<0.01)。治疗后12周,与1次组相比,3次组和5次组VAS评分、WOMAC评分均有显著降低(F＝71.058、39.592,均为P<0.01)。治疗后24周,与1次组相比,3次组、5次组VAS评分、WOMAC评分、超声半定量评分均有显著降低(F＝163.974、86.980、6.781,均为P<0.01)。 结论3次及5次PRP注射治疗膝骨关节炎较1次有更好的疗效,但3次与5次注射未见明显差异。     

Prevalence of articular cartilage degeneration in the ankle and knee joints of human organ donors

The prevalence of osteoarthritis (OA) is higher in some joints than in others. Fibrillation and full-thickness cartilage defects in the knee have been considered to be evidence of developing OA (pre-OA). While similar changes have been reported in the ankle (talocrural joint), the frequency of these changes is much higher than expected if the degeneration represents pre-OA. These observations suggest that in the ankle degenerative changes do not proceed to OA. The current study was to determine the prevalence of articular cartilage degeneration in ankles in a population of 470 bone donors with no history of joint disease. Knees from 50 donors were also available. Our data suggest that degeneration in the ankle cartilage does not appear to be a normal part of aging, was more frequent in men than women, increased with age, and occurred most often in both limbs with the same severity. In those donors with degeneration in the ankle, the knee also showed degenerative changes with an equal or higher grade. These data suggest that factors (such as altered mechanics) responsible for degeneration in one limb also cause changes in the contralateral limb and that factors affecting the ankle joints also appear to influence the knee joints. Received for publication on Dec. 2, 1998; accepted on April 22, 1999     

关节滑液3B3表位检测对软骨早期退变的诊断价值

[目的]骨性关节炎、髌骨软化症病人膝关节滑液中3B3表位含量是否与软骨退变程度相关。[方法]作者改良了竞争性ELISA检测关节滑液3B3表位的方法。抽吸71例膝骨关节炎、57例髌骨软化症病人及10例正常人志愿者的膝关节滑液，用该方法检测关节滑液中3B3表位含量，比较各组之间的差异。[结果]骨性关节炎组及髌骨软化组病人膝关节滑液中3B3表位均比正常人对照明显升高（P〈0．05），而且骨关节炎Ⅱ级关节软骨退变时关节滑液中3B3表位含量明显比Ⅳ级关节软骨退变增高（P〈0．01），而髌骨软骨软化患者Ⅱ、Ⅲ、Ⅳ级软骨退变各组间无明显差异（P〉0．05）。[结论]检测关节滑液中3B3表位含量具有诊断关节软骨退变的价值，尤其适用于骨性关节炎软骨早期退变（Ⅱ级）的诊断。     

The treatment of intractable plantar fasciitis with platelet-rich plasma injection

BackgroundWhilst most cases of plantar fasciitis can be settled with existing conservative treatment, a few intractable cases can be difficult to resolve. New biologic treatments have been proposed for a variety of soft tissue problems.ObjectiveEvaluate the effectiveness of platelet rich plasma (PRP) in chronic cases of plantar fasciitis.Patients and methodsPatients with plantar fasciitis not responded to a minimum of 1 year standard conservative management were offered PRP therapy. Injections were performed in theatre as a day case. Roles–Maudsley (RM) scores, Visual Analogue Scores (VAS), AOFAS scores and ‘would have injection again’ were collated pre-operatively, three and six months.ResultsProspective data was collected of 50 heels (44 patients). At six month review, RM score improved from mean 4 to 2 (p < 0.001), VAS improved from 7.7 to 4.2 (p < 0.001) and AOFAS improved from 60.6 to 81.9 (p < 0.001). 28 patients (64%) were very satisfied and would have the injection again.No complications were reported.ConclusionIn these chronic cases, PRP produce an efficacy rate, approaching 2 out of every 3. The procedure was safe with no reported complications. The authors feel PRP may have some role in treatment, and merits further study with a prospective randomised trial.     

Change in response with age of human articular cartilage to plasma somatomedin activity

Summary Normal male articular cartilage (34 specimens, age range 1–30 years) has been examined in vitro for response to somatomedin (SM) activity. Basal³H-thymidine and³⁵S-sulfate incorporation both decreased with increasing age of the cartilage donor. However, enhancement of isotope incorporation which was attained on addition of 10% normal plasma (containing IU SM/ml) was greatest in cartilage from adolescents in the age range 12–17 years. The mean enhancement of³H-thymidine incorporation (expressed as % basal) was as follows: age 1–10 years=184 ± 28 (SE),N=9; 12–17 years=436 ± 101 (11); 18–30 years=231 ± 49 (8); and for³⁵S-sulfate incorporation was 1–10 years=389 ± 100 (8); 12–17 years=824 ± 273 (11); and 18–30 years=572 ± 56 (8). The increased response of cartilage in the 12–17 year group suggests that a greater sensitivity to the somatomedins may contribute to the increased skeletal growth during adolescence.     

Similar effect of ultrasound-guided platelet-rich plasma versus platelet-poor plasma injections for chronic plantar fasciitis

BackgroundThere are conflicting reports regarding the therapeutic effect of platelet-rich plasma (PRP) versus autologous whole-blood (platelet poor plasma, PPP) injections for plantar fasciitis. Therefore, this study was conducted to compare the effectiveness of a single ultrasound (US)-guided PRP versus PPP injection in patients with chronic plantar fasciitis.Materials and methods36 patients were recruited with clinical and sonographic evidence of chronic (>6 months) plantar fasciitis, refractory to analgesics and physical therapy in a double-blinded, randomized, prospective study. The patients were randomly allocated into two groups with a sealed envelope method. Group A included 18 patients who underwent a single US-guided PRP injection and group B included another 18 patients who underwent PPP injection with the same technique. Follow-up was set at 3 and 6 months; no patient was lost to follow-up. Pain, function and satisfaction were assessed using visual analogue scales, and occurrence of complications.ResultsAll scores statistically significantly improved for both groups from baseline at the 3- and 6-month follow-up evaluation, without, however, any statistically significant differences between the two groups with respect to pain, function and satisfaction scores. Complications were not observed.ConclusionsA single US-guided PRP injection yields similar results with PPP injection in patients with chronic plantar fasciitis. Both treatments provide significant improvement at 3 and 6-month follow-up after the injection.     

富含血小板血浆与常规药物关节腔注射治疗早期膝骨关节炎的临床疗效比较

目的 比较富含血小板血浆（platelet-rich plasma, PRP）与常规药物关节腔注射治疗早期膝骨关节炎的临床疗效。方法 选择2016年1月至2017年6月深圳市第二人民医院收治的120例早期膝骨关节炎病人,采用随机数字表法分组,PRP组60例采用PRP关节腔注射治疗,常规药物组60例采用透明质酸钠为主的常规药物注射治疗。收集并比较两组病人治疗前及完成全部药物注射治疗后第1、3、6、12个月的西安大略和麦克马斯特大学（the Western Ontario and McMaster Universities, WOMAC）骨关节炎指数及疼痛视觉模拟量表（visual analogue scale, VAS）评分。结果 PRP组58例、常规药物组56例病人完成注射治疗及完整随访。两组病人治疗后各观察时间点的WOMAC评分和VAS评分均较治疗前明显降低,其中PRP组的得分呈持续下降趋势,常规药物组治疗后1个月时的分值最低,而后有所回升。两组治疗后6、12个月时的WOMAC评分、VAS评分比较,差异均有统计学意义（P均＜0.05）。PRP组、常规药物组治疗的总有效率分别为96.55%（56/58）、78.57%（44/56）,差异有统计学意义（χ²=15.467,P=0.001）。在完成治疗12个月后至今的远期随访中,常规药物组共有10例病人行膝关节手术,PRP组仅1例病人行膝关节手术治疗。结论 关节腔注射PRP或透明质酸钠治疗早期膝骨关节炎,短期（治疗后第1、3个月）效果无明显差异;但采用PRP治疗的远期效果更优,更能延缓膝骨关节炎的进展。     

Cryopreservation of intact human articular cartilage.

Damaged articular cartilage (AC) impairs joint function and many treatment techniques are being investigated to determine their long term results. Successful cryopreservation of AC can provide a reliable source of intact matrix with viable chondrocytes to maintain the cartilage over long periods of time. This study investigated the application of an established cryopreservation protocol to determine the recovery of intact chondrocytes from human AC. Ten millimeter diameter osteochondral dowels were harvested from two human donors. The cryopreservation protocol was performed and the samples were rapidly warmed from varying experimental holding temperatures (-10, -20, -30, -40 degrees C), with and without plunging into liquid nitrogen, using 1 M dimethyl sulfoxide as cryoprotectant. The cartilage was stained with membrane integrity dyes and viewed under fluorescence microscopy. The percent of intact chondrocytes was compared to fresh controls. Low recovery of intact chondrocytes was recorded from all temperature levels with and without cryoprotectant. The results of this experiment demonstrated that the cryopreservation procedure used to achieve moderate success with intact sheep AC was not successful with intact human AC and further investigation is required.     

血小板裂解液与富血小板血浆治疗膝骨关节炎的临床研究

目的比较血小板裂解液(PL)与富血小板血浆(PRP)关节腔内注射治疗膝骨关节炎(KOA)的临床疗效。 方法采用前瞻性随机对照研究的方法,选取2012年4月至2015年9月山东省文登整骨医院收治的150例KOA患者的150膝,通过随机数字表法分为血小板裂解液(PL)组、富血小板血浆(PRP)组和玻璃酸钠(HA)组(每组50例),3组关节腔注射PL、PRP和HA频次为每周1次,连续5周。选择治疗前、治疗后1、3、6个月为时间观察点,西安大略和麦克马斯特大学(WOMAC)疼痛评分、Lequesne肿胀评分及WOMAC综合评分评价治疗前后关节疼痛、肿胀情况及综合功能等方面的区别,同时记录3组病例在治疗过程中不良反应发生情况并进行比较。Fisher精确检验、方差分析或t检验用于数据分析比较。 结果PL组49例,PRP组48例,HA组47例成功完成治疗及6个月以上随访。3组患者在治疗后1个月时WOMAC疼痛评分最低;治疗后3及6个月比较,PL组与PRP组低于HA组(3个月：t＝1.115,P<0.01;t＝2.343,P<0.05;6个月：t＝0.463,P<0.05;t＝1.983,P<0.01),PL组与PRP组比较,差异无统计学意义(t＝3.123、2.983,均为P>0.05)。Lequesne肿胀评分在治疗后3个月时PL组低于PRP组与HA组(t＝3.132,P<0.05;t＝1.545,P<0.01),PRP组低于HA组(t＝2.654,P<0.05)。治疗后6个月时,PL组与PRP组均低于HA组(t＝2.513,P<0.05;t＝3.313,P<0.01),PL组与PRP组比较差异无统计学意义(t＝2.343,P>0.05)。3组治疗完成后WOMAC综合评分比较：治疗后3个月PL组低于PRP组与HA组(t＝2.442,P<0.05;t＝2.415,P<0.01),PRP组低于HA组(t＝1.324,P<0.01);治疗6个月比较,PL组与PRP组低于HA组(t＝1.613,P<0.05;t＝2.913,P<0.01),PL组与PRP组比较差异无统计学意义(t＝3.413,P>0.05)。不良反应发生率的比较中,PL组不良反应发生率(2.0%)低于HA组(8.5%)(P<0.05);PL组低于PRP组(P>0.05),PRP组低于HA组(P>0.05),但差异均无统计学意义。 结论血小板裂解液治疗膝骨关节炎能够取得与富血小板血浆同样的治疗效果,均优于玻璃酸钠,同时不良反应发生率低。