Chen Jean-Lon, Chen Chien-Hung, Cheng Chih-Hsiu, Chen Chih-Chi, Lin Kuan-Yu, Chen Carl P C
Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2021 Dec;44(6 Suppl 1):S144-S153. doi: 10.1016/j.bj.2020.08.011. Epub 2020 Sep 1.
To investigate whether the addition of injecting 5% dextrose water to the genicular nerves can augment the effect of platelet rich plasma (PRP) injections in treating elderly patients with moderate degree of knee osteoarthritis (OA).
Forty-six elderly patients with grade 3 on the Kellgren and Lawrence knee OA grading system were divided into control and genicular nerve block groups. Both groups received 4 milliliters (mL) of PRP injected into the knee joint and 2 mL of PRP to the pes anserinus complex. In the nerve block group, 2 mL of 5% dextrose water was also injected to each genicular nerve. In the control group, normal saline was used to inject the genicular nerves. Proteomic technique of 2-dimensional electrophoresis was used to detect the changes in synovial fluid (SF) protein concentrations. Lequesne Functional Index was used to evaluate knee functional status.
After 3 monthly PRP injections, concentrations of SF total protein, and proteins associated with inflammation decreased. Protein concentrations associated with chelation increased. In the nerve block group, improvements in pain and in the functional status of the knee joint lasted up to a period of 6 months. At 1 month and 3 months after the injections, Lequesne Functional Index was less than 7 (a value of 7 or higher indicates knee OA).
The concept of combining 5% dextrose water injection to the genicular nerves, and PRP injection into the knee joint and to the pes anserinus complex can be a feasible non-operative conservative treatment option for elderly patients with knee OA.
探讨向膝神经注射5%葡萄糖水是否能增强富血小板血浆（PRP）注射治疗老年中度膝骨关节炎（OA）的效果。
将46例Kellgren和Lawrence膝关节OA分级系统为3级的老年患者分为对照组和膝神经阻滞组。两组均在膝关节内注射4毫升PRP，并在鹅足复合体处注射2毫升PRP。在神经阻滞组中，还向每条膝神经注射2毫升5%葡萄糖水。在对照组中，用生理盐水注射膝神经。采用二维电泳蛋白质组学技术检测滑液（SF）蛋白浓度的变化。采用Lequesne功能指数评估膝关节功能状态。
每月注射PRP 3次后，SF总蛋白及与炎症相关的蛋白浓度降低。与螯合相关的蛋白浓度升高。在神经阻滞组中，疼痛和膝关节功能状态的改善持续长达6个月。注射后1个月和3个月时，Lequesne功能指数小于7（7或更高的值表明存在膝OA）。
将5%葡萄糖水注射到膝神经，并将PRP注射到膝关节和鹅足复合体的联合治疗方案，对于老年膝OA患者可能是一种可行的非手术保守治疗选择。
