Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis
Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis
复制标题
DOI：
10.1177/0363546512461902
复制
发表时间：
2012-12-01
影响因子：
4.8
通讯作者：
Ciuffreda, Michele
中科院分区：
文献类型：
--
作者：
Cerza, Fabio;Carni, Stefano;Ciuffreda, Michele
背景：关节病在膝部特别常见。目的：比较透明质酸(HA)和富含血小板血浆(PRP)治疗两组膝关节炎患者的临床疗效。研究设计：随机对照试验；证据水平：1.方法：共120例经临床和放射学证实的膝关节炎患者。按Kellgren-Lawrence放射学分级标准对膝关节进行分级。120例患者按1：1的比例随机分为两组：60例患者接受4次PRP关节腔内注射(特别是自体条件血浆5.5mL)，60例患者接受4次HA关节腔内注射(20 mg/2mL)。一位非盲目内科医生每周一次对临床相关的膝关节炎患者的膝关节进行渗透治疗(两组均如此)。结果：局部注射ACP后即刻疗效显著，持续改善至24周(HA组和ACP组的WOMAC评分分别为65.1和36.5；P<；0.01)，临床疗效优于HA组。在HA组中，III级膝关节炎的结果最差，而ACP组的临床结果在膝关节分级方面没有任何统计学意义上的差异。三级膝关节炎的平均WOMAC评分，HA组为74.85分，ACP组为41.20分(P<；.001)。结论：ACP组的临床疗效明显好于HA组，且WOMAC评分持续较低。透明质酸治疗对III级膝关节炎患者似乎无效。
Background: Arthrosis is particularly prevalent in the knee. Infiltration treatment for gonarthrosis is among the most widely used techniques in orthopaedic practice.Purpose: To compare the clinical response of hyaluronic acid (HA) and platelet-rich plasma (PRP) treatment in 2 groups of patients affected by gonarthrosis.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A total of 120 patients affected by clinically and radiographically documented gonarthrosis were included in this study. The gonarthrosis was graded using the Kellgren-Lawrence radiographic classification scale. The 120 patients were randomized into 2 study groups in a 1:1 ratio: 60 patients received 4 intra-articular injections of PRP (specifically, autologous conditioned plasma [ACP], 5.5 mL), and 60 patients received 4 intra-articular injections of HA (20 mg/2 mL). An unblinded physician performed infiltration once a week for 4 weeks into the knee affected by clinically relevant gonarthrosis (in both groups). All patients were evaluated with the Western Ontario and McMaster (WOMAC) score before the infiltration and at 4, 12, and 24 weeks after the first injection.Results: Treatment with a local injection of ACP had a significant effect shortly after the final infiltration and a continuously improving sustained effect up to 24 weeks (WOMAC score, 65.1 and 36.5 in the HA and ACP groups, respectively; P < .001), where the clinical outcomes were better compared with the results with HA. In the HA group, the worst results were obtained for grade III gonarthrosis, whereas the clinical results obtained in the ACP group did not show any statistically significant difference in terms of the grade of gonarthrosis. The mean WOMAC scores for grade III gonarthrosis were 74.85 in the HA group and 41.20 in the ACP group (P < .001).Conclusion: Treatment with ACP showed a significantly better clinical outcome than did treatment with HA, with sustained lower WOMAC scores. Treatment with HA did not seem to be effective in the patients with grade III gonarthrosis.