Li Ming, Huang Zheyu, Wang Shicheng, Di Zhenglin, Zhang Junhui, Liu Hua
Department of Joint Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang 315000, P.R China.
Exp Ther Med. 2021 Jun;21(6):598. doi: 10.3892/etm.2021.10030. Epub 2021 Apr 11.
The aim of the present study was to compare the clinical and economic benefits of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) in Chinese patients with knee osteoarthritis (OA). A total of 86 patients (42 treated with PRP and 44 with HA) were treated with three weekly intra-articular injections. The inclusion criteria included patients between 18 and 75 years of age, with chronic knee pain or swelling lasting >3 months and X-ray findings of degenerative joint alterations according to the Kellgren-Lawrence score grade I-III. Clinical examinations were performed before treatment, at 1- and 6-month post-injection intervals. International Knee Documentation Committee subjective, Western Ontario and McMaster Universities and visual analogue scale scores were determined at each examination. Adverse reactions, average cost, treatment time and patient satisfaction were also recorded. Compared with patients injected with HA, PRP was found to be associated with increased and more severe post-injection pain and swelling, where the duration of adverse reactions was greater in the PRP group (P=0.02). During the follow-up evaluations, both groups showed statistically significant improvements in all clinical scores from pre-injection to 1- and 6-month assessments (P<0.05). However, no significant inter-group (PRP vs. HA) differences were observed in the clinical scores between the two follow-up time points. There were also no significant differences in clinical score between the groups with regards to the Kellgren-Lawrence grade I, II or III. The average cost of PRP injections was 22.8X that of HA administration and the average treatment time was 5X that of HA, but there was no significant difference in patient satisfaction. These preliminary results indicate that although PRP injections can significantly improve clinical outcome in patients with knee OA, PRP is not any more effective compared with HA. Furthermore, PRP injections are associated with higher costs and treatment times. Therefore, additional clinical studies are required before PRP injections can be considered as a first-line treatment option for knee OA.
本研究的目的是比较关节腔内注射富血小板血浆（PRP）和透明质酸（HA）对中国膝骨关节炎（OA）患者的临床和经济效益。共有86例患者（42例接受PRP治疗，44例接受HA治疗）接受了每周一次、共三次的关节腔内注射。纳入标准包括年龄在18至75岁之间、慢性膝关节疼痛或肿胀持续超过3个月且根据Kellgren-Lawrence评分I-III级有退行性关节改变的X线表现的患者。在治疗前、注射后1个月和6个月进行临床检查。每次检查时测定国际膝关节文献委员会主观评分、西安大略和麦克马斯特大学评分以及视觉模拟量表评分。还记录了不良反应、平均费用、治疗时间和患者满意度。与注射HA的患者相比，发现PRP与注射后疼痛和肿胀增加且更严重有关，PRP组不良反应持续时间更长（P=0.02）。在随访评估中，两组从注射前到1个月和6个月评估时所有临床评分均有统计学显著改善（P<0.05）。然而，在两个随访时间点的临床评分中未观察到组间（PRP与HA）有显著差异。在Kellgren-Lawrence I级、II级或III级方面，两组临床评分也无显著差异。PRP注射的平均费用是HA注射的22.8倍，平均治疗时间是HA的5倍，但患者满意度无显著差异。这些初步结果表明，虽然PRP注射可显著改善膝OA患者的临床结局，但与HA相比，PRP并无更显著效果。此外，PRP注射成本更高、治疗时间更长。因此，在将PRP注射视为膝OA的一线治疗选择之前，还需要进行更多临床研究。
