Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis: Letter to the Editor
Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis: Letter to the Editor
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透明质酸和富含血小板的血浆，关节内浸润治疗膝关节病：致编辑的信
DOI：
10.1177/0363546513485064
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
B. Cole
中科院分区：
文献类型：
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作者：
G. Abrams;B. Cole
尊敬的编辑：我们怀着极大的兴趣阅读了Cerza等人在2012年12月号上发表的文章“透明质酸和富血小板血浆之间的比较，膝关节炎治疗中的关节内浸润”。作者在对120名患者（100%随访）进行随机研究时所做的努力值得称赞，该研究的主题与许多不同类型的医生和提供者（包括运动医学医生）高度相关。我们想提出3点与研究设计相关的观点，这可能进一步加强了他们的发现。首先，尽管这是一项1级随机对照试验，但未对患者接受的治疗设盲。正如我们所知，患者的结果可能会受到他们自己对治疗及其声称的有效性的先入之见和期望的影响。最近一项对接受不同方式治疗的骨关节炎患者的荟萃分析发现，安慰剂组的效应量为51%，当注射治疗时，疼痛缓解效果增加。由于未设盲，无法确定确切的治疗效果，但我们怀疑它至少对作者报告的缓解率有部分影响。其次，即使作者排除了初始抽血时血小板计数低于150，000个细胞/mL的参与者，也没有检测富血小板血浆（PRP）以确保足够的血小板浓度并保证患者实际上接受PRP。先前的研究报告称，在使用不同器械制备的PRP中，血小板浓度相对于全血增加了1.99和5.19倍。虽然尚未就富血小板血浆的定义（包括白细胞和生长因子的浓度）达成共识，但一些患者在注射期间可能接受了“不足”浓度的富血小板血浆。第三，作者没有使用成像来验证他们的膝盖注射的准确性。虽然膝关节定期注射没有成像的帮助，最近的一项系统性综述发现，只有79%的膝关节注射没有成像是准确的，相比之下，99%的辅助成像进行。由于本研究中未使用成像，因此我们无法确定所有注射均到达其预期关节内位置。我们感谢作者对使用透明质酸和PRP治疗膝关节骨关节炎患者的临床结局进行的重要研究。在讨论这些主题时，我们希望激发讨论，并强调进行未来研究的方法，这可能会提高研究结果的有效性。
Dear Editor: We read with great interest the article by Cerza et al, ‘‘Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis’’ in the December 2012 issue. The authors should be commended for their efforts in performing a randomized study of 120 patients (with 100% follow-up) on a topic highly relevant to many different types of physicians and providers, including sports medicine physicians. We would like to raise 3 points related to study design that may have further strengthened their findings. First, although this was a level 1 randomized controlled trial, there was no blinding of patients with respect to the treatment received. As we know, patients’ outcomes can be influenced by their own preconceptions and expectations regarding their treatment and its purported effectiveness. A recent meta-analysis of patients with osteoarthritis treated with different modalities found an effect size of 51% for the placebo group, with an increase in pain-relieving effect when the treatment was given with injection. It is impossible to determine the exact treatment effect resulting from the absence of blinding, but we suspect it had at least a partial influence on the response rate reported by the authors. Second, even though the authors excluded participants with platelet counts less than 150,000 cells/mL on initial blood draw, there was no testing of the platelet-rich plasma (PRP) to ensure adequate concentrations of platelets and to guarantee that patients were in fact receiving PRP. Previous investigations reported ranges of 1.99and 5.19-fold increases in the concentrations of platelets over whole blood in PRP prepared with different devices. While no consensus has been reached on the definition of PRP (including concentrations of leukocytes and growth factors), it is possible that some patients may have received an ‘‘inadequate’’ concentration of PRP during their injection. Third, the authors did not use imaging to verify the accuracy of their knee injections. Although the knee is regularly injected without the aid of imaging, a recent systematic review found that only 79% of knee injections performed without imaging were accurate, as compared with 99% of those performed with the aid of imaging. As no imaging was used in the current study, we cannot be certain that all injections reached their intended intra-articular location. We thank the authors for their important investigation comparing the use of hyaluronic acid and PRP on the clinical outcomes of patients with osteoarthritis of the knee. In discussing these topics, we hope to stimulate discussion and highlight methods for conducting future studies which may improve the validity of study findings.