本文選題：骨關(guān)節(jié)炎 + 富血小板血漿��； 參考：《山東大學(xué)》2017年博士論文

【摘要】：研究背景骨關(guān)節(jié)炎(osteoarthritis,OA)是影響人類健康最常見(jiàn)的關(guān)節(jié)疾患之一,沒(méi)有明顯的種族差異和地區(qū)差異,以疼痛和喪失活動(dòng)能力為主要臨床表現(xiàn),以關(guān)節(jié)軟骨退變和軟骨下骨改變、骨贅形成和非細(xì)菌性滑膜炎為病理特征。在超過(guò)50歲以上人群中,骨關(guān)節(jié)炎在導(dǎo)致長(zhǎng)期殘疾的疾病中僅次于心血管疾病排名第二[1],其中膝關(guān)節(jié)發(fā)生骨關(guān)節(jié)炎的發(fā)生率最高。膝骨關(guān)節(jié)炎(Knee Osteoarthritis,KOA)是指以膝關(guān)節(jié)軟骨發(fā)生原發(fā)性或繼發(fā)性退變及結(jié)構(gòu)紊亂,伴隨軟骨下骨質(zhì)增生硬化、軟骨剝脫、滑膜無(wú)菌性炎癥為病理特征,從而使關(guān)節(jié)逐漸破壞、畸形,最終導(dǎo)致膝關(guān)節(jié)功能障礙的一種退行性疾病,是老年人膝關(guān)節(jié)疼痛和功能障礙的主要原因[2]。近年來(lái),KOA發(fā)病率逐年增高,在55歲以上的人群中約6O%有KOA的X線影響表現(xiàn),在65歲以上的人群中約80%有KOA的X線影像表現(xiàn),是導(dǎo)致50歲以上人群功能殘疾、造成經(jīng)濟(jì)損失和影響社會(huì)發(fā)展的主要疾病之一。其發(fā)病因素較多,與:高齡、性別、遺傳、激素、供應(yīng)關(guān)節(jié)的血流減少導(dǎo)致關(guān)節(jié)軟骨細(xì)胞的功能和軟骨性質(zhì)改變、對(duì)細(xì)胞因子和生長(zhǎng)因子的應(yīng)答改變、慢性勞損、肥胖、骨質(zhì)疏松、外傷和力學(xué)的改變、遺傳因素等均有關(guān)系。骨關(guān)節(jié)炎的治療可分為手術(shù)治療(四期及部分三期患者)和保守治療(所有患者)。保守治療包括理療、藥物、注射療法和中醫(yī)中藥治療等,均為對(duì)癥治療。關(guān)節(jié)腔內(nèi)注射目前常用藥物大體包括激素、玻璃酸鈉兩大類。激素注射可以顯著改善癥狀,但會(huì)加速關(guān)節(jié)退變,不建議使用第三次;玻璃酸鈉廣泛應(yīng)用,有一定的癥狀緩解率,但最新的詢證醫(yī)學(xué)沒(méi)有明顯的證據(jù)支持其對(duì)骨關(guān)節(jié)炎的治療有效,2013年美國(guó)骨科醫(yī)師協(xié)會(huì)《膝骨關(guān)節(jié)炎治療指南》不推薦玻璃酸鈉作為關(guān)節(jié)腔內(nèi)注射的治療,推薦等級(jí)為強(qiáng)烈[3];2014年國(guó)際骨關(guān)節(jié)炎研究協(xié)會(huì)在KOA保守治療指南中認(rèn)為關(guān)節(jié)腔內(nèi)注射玻璃酸鈉療效不確切[4]。2013年美國(guó)骨科醫(yī)師協(xié)會(huì)《膝骨關(guān)節(jié)炎治療指南》中首次探討了富血小板血漿(plate-rich-plasma,PRP)對(duì)于KOA的治療效果,依據(jù)2012年以前的病例對(duì)照研究和1項(xiàng)隨機(jī)對(duì)照研究,得出的結(jié)論是既不贊成,也不反對(duì),推薦等級(jí)為不確定[3];PRP是通過(guò)分離自體靜脈血制備的含有高濃度血小板的血漿,其內(nèi)含有大量的活性生長(zhǎng)因子和炎癥調(diào)節(jié)因子,能夠促進(jìn)軟骨細(xì)胞的再生,消除關(guān)節(jié)滑膜的無(wú)菌性炎癥[5-8],理論上具有類似于KOA病因治療的可能性。目前國(guó)內(nèi)缺乏高質(zhì)量系統(tǒng)性的PRP治療KOA的臨床研究,故本研究通過(guò)比較PRP和玻璃酸鈉(Hyaluronic acid,HA)、PRP+HA關(guān)節(jié)腔內(nèi)注射治療KOA的臨床治療效果。第一部分:富血小板血漿(PRP)治療Ⅱ、Ⅲ期膝骨關(guān)節(jié)炎的臨床療效評(píng)價(jià)目的評(píng)價(jià)關(guān)節(jié)腔內(nèi)注射富血小板血漿(PRP)相對(duì)于玻璃酸鈉(HA)鈉治療II、Ⅲ期膝骨關(guān)節(jié)炎的臨床療效。方法選擇2013年2月-2014年5月,山東大學(xué)附屬省立醫(yī)院和威海市立醫(yī)院門診收治的126例Ⅱ、Ⅲ期(Keligren Lawrence分級(jí))126膝關(guān)節(jié)骨性關(guān)節(jié)炎的患者,隨機(jī)分為HA組(63例,63膝)和PRP組(63例,63膝),兩組患者性別、年齡、體重指數(shù)、Keligren Lawrence分級(jí)、視覺(jué)模擬評(píng)分(VAS)、國(guó)際膝關(guān)節(jié)文獻(xiàn)委員會(huì)(IKDC)評(píng)分、美國(guó)西部Ontario與McMaster大學(xué)骨關(guān)節(jié)炎指數(shù)(WOMAC)評(píng)分比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。分別采用2ml HA(施沛特,共5次,分別在第0、1、2、3、4周注射)和3.5ml PRP(威高富血小板血漿制備套裝,共3次,分別在第0、1、2周注射)關(guān)節(jié)腔內(nèi)注射進(jìn)行治療�；颊咴谥委熐昂屯瓿扇孔⑸浜蟮牡�1月、3月、6月、12月進(jìn)行復(fù)診并記錄VAS評(píng)分值、IKDC評(píng)分、WOMAC評(píng)分,比較治療后不同時(shí)間點(diǎn)的療效。結(jié)果PRP組58例、HA組55例患者獲得隨訪12個(gè)月。PRP組患者16例40次出現(xiàn)不良反應(yīng),HA組14例37次;兩組不良反應(yīng)起始時(shí)間、終止時(shí)間及持續(xù)時(shí)間比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組治療后VAS評(píng)分、IKDC評(píng)分及WOMAC評(píng)分與治療前比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);PRP組治療后1、3、6、12個(gè)月間比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);HA組治療后6、12月各評(píng)價(jià)指標(biāo)較1、3月差,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組治療1、3月后,VAS評(píng)分、IKDC評(píng)分及WOMAC評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);但是6、12月時(shí),PRP組各指標(biāo)均優(yōu)于HA組(P0.05)。結(jié)論關(guān)節(jié)內(nèi)注射PRP治療膝關(guān)節(jié)軟骨退行性變安全有效,可緩解疼痛,改善功能,提高生活質(zhì)量。治療后短期效果與HA無(wú)明顯差異,但長(zhǎng)期效果要優(yōu)于HA。第二部分PRP+HA聯(lián)合治療與僅使用富血小板血漿治療膝骨性關(guān)節(jié)炎的對(duì)比研究背景與目的:玻璃酸鈉(HA)聯(lián)合使用富血小板血漿(PRP)治療膝骨關(guān)節(jié)炎的確切效果尚不清楚。本文的目的是比較PRP + HA混合物與單純使用富血小板血漿關(guān)節(jié)腔內(nèi)注射治療膝骨關(guān)節(jié)炎患者的療效。材料和方法:納入了一批總數(shù)為126的膝關(guān)節(jié)骨性關(guān)節(jié)炎患者為研究對(duì)象:PRP+HA組和PRP組各63例。在臨床和影像學(xué)評(píng)估后,患者接受每周一次的HA+PRP混合物(2mlHA+3.5mlPRP)關(guān)節(jié)腔內(nèi)注射或只注射PRP(3.5ml)治療持續(xù)3周。在第1、3、6和12個(gè)月進(jìn)行隨訪。結(jié)果:在使用PRP+HA混合物和單純PRP治療的患者中,相比治療前患者的狀態(tài),VAS評(píng)分明顯降低,膝關(guān)節(jié)的功能(WOMAC)明顯改善。就VAS和WOMAC而言,兩組之間沒(méi)有觀察到顯著性差異;然而,PRP+HA混合物組有一種能獲得更好的功能性評(píng)分的趨勢(shì)(VAS,P = 0.392;WOMAC,P = 0.082)。PRP+HA 組發(fā)現(xiàn)了 6 個(gè)失敗病例和PRP組有11個(gè)。而兩組中沒(méi)有發(fā)現(xiàn)重大不良事件或并發(fā)癥。結(jié)論:PRP+HA的聯(lián)合使用治療患有輕中度膝骨關(guān)節(jié)炎的患者是安全有效的。雖然在功能性結(jié)果上兩組沒(méi)有明顯差異,但是PRP+HA組有可以獲得相對(duì)更好的功能評(píng)分的趨勢(shì)。
[Abstract]:Background osteoarthritis (OA) is one of the most common joint disorders affecting human health. There is no obvious racial difference and regional difference. The main clinical manifestations are pain and loss of activity. Articular cartilage degeneration and subchondral bone change, osteophyte formation and non bacterial synovitis are pathological features. It is over 50 years old. In the above population, osteoarthritis is ranked next to second [1] in the cause of chronic disability after cardiovascular disease, of which the incidence of osteoarthritis of the knee is the highest. Knee osteoarthritis (Knee Osteoarthritis, KOA) refers to the occurrence of primary or secondary degeneration and structural disorder in the cartilage of the knee joint with subchondral osseosis and sclerosis. Cartilage exfoliation and synovial aseptic inflammation are the pathological features of the knee, resulting in a gradual destruction of the joints, deformity, and eventually a degenerative disease of the knee joint dysfunction. It is the main cause of pain and dysfunction of the knee joint in the elderly [2]., the incidence of KOA has increased year by year, and about 6O% in the population over 55 years old has the X - ray effect of KOA. About 80% of the people over 65 years old have KOA X - ray imaging, which is one of the major diseases that lead to functional disability in the population over 50 years old and cause economic loss and social development. The response changes of cytokines and growth factors, chronic strain, obesity, osteoporosis, trauma and mechanical changes, genetic factors are related. The treatment of osteoarthritis can be divided into surgical treatment (phase four and part three patients) and conservative treatment (all patients). Conservative treatment includes physiotherapy, medicine, injection therapy, and traditional Chinese medicine treatment, etc. The commonly used drugs in the joint intracavitary injection include hormone and sodium hyaluronate in two major categories. Hormone injection can significantly improve symptoms, but it will accelerate joint degeneration, not recommended for use third times; sodium hyaluronate is widely used and has a certain rate of relief, but the latest evidence medicine has no obvious evidence to support its bone clearance. The treatment of arthritis is effective. The American Association of Department of orthopedics physicians, 2013 guidelines for the treatment of knee osteoarthritis, does not recommend sodium hyaluronate as an intracavitary injection, and the recommended grade is strong [3]. In 2014, the International Association of osteoarthritis studies found that intraarticular injection of sodium hyaluronate in the KOA conservative treatment guideline was not accurate for [4].2013 years of American bone For the first time, the association of physicians' Association of knee osteoarthritis (plate-rich-plasma) was the first to discuss the therapeutic effect of plate-rich-plasma (PRP) on the treatment of KOA. According to the case control study before 2012 and the randomized controlled study, the conclusion was that it was neither in favor nor objection, and that the recommendation grade was uncertain [3]; PRP was by separating autologous vein blood. The plasma containing high concentration of platelets contains a large number of active growth factors and inflammatory regulators, which can promote the regeneration of cartilage cells and eliminate the aseptic inflammation of the synovial membrane of the joint [5-8]. It is theoretically similar to the possibility of KOA etiological treatment. At present, a clinical study of high quality and systematic PRP for KOA is lacking in China. So by comparing PRP and sodium hyaluronate (Hyaluronic acid, HA), PRP+HA intra-articular injection for the treatment of KOA, the first part: evaluation of the clinical efficacy of platelet rich plasma (PRP) treatment II, stage III knee osteoarthritis objective evaluation of intraarticular injection of platelet rich plasma (PRP) relative to sodium hyaluronate (HA) sodium (HA) for the treatment of II, III Methods the clinical efficacy of knee osteoarthritis was selected in February 2013 -2014 -2014 May, 126 patients with 126 knee osteoarthritis (63 cases, 63 knees) and PRP group (63 cases, 63 knees) treated in the outpatient department of the provincial and Weihai municipal hospitals affiliated to the Shandong University were randomly divided into group HA (63 cases, 63 knees), and two groups of patients, sex, age and weight. Index, Keligren Lawrence grading, visual analogue scale (VAS), International Knee Joint literature Committee (IKDC) score, compared to the Ontario and McMaster University bone arthritis index (WOMAC) scores in western United States, the difference was not statistically significant (P0.05), with a comparability. The division adopted 2ml HA (5 times, respectively, 0,1,2,3,4 week injection) and 3.5ml. PRP (VH high platelet plasma preparation set, 3 times, respectively in the 0,1,2 week) was injected into the articular cavity for treatment. The patients were retreated before and after first months of all injection, in March, June, and December to record the VAS score, IKDC score, and WOMAC score, compared with 58 cases in group PRP and 55 in group HA. Patients were followed up for 12 months in group.PRP, 16 cases had 40 adverse reactions and 14 cases were 37 times in group HA. The difference was not statistically significant (P0.05). The difference was statistically significant (P0.05) between the two groups after the treatment of the two groups (P0.05). The difference was statistically significant (P0.05). There was no significant difference between 1,3,6,12 months after treatment (P0.05), and the evaluation indexes of 6,12 months after treatment in group HA were worse than that of 1,3 months, and the difference was statistically significant (P0.05). There was no statistical difference between the two groups after 1,3 months, VAS score, IKDC score and WOMAC score, but all the indexes were better than those in the 6,12 month. It is safe and effective to treat the degenerative knee cartilage by intra-articular injection of PRP, which can relieve pain, improve function and improve the quality of life. The short-term effect after treatment is not significantly different from that of HA, but the long-term effect is better than the comparative study background and purpose of the combined treatment of HA. second part PRP+HA and the only use of platelet rich plasma for the treatment of knee osteoarthritis. The exact effect of sodium hyaluronate (HA) combined with platelet rich plasma (PRP) in the treatment of knee osteoarthritis is not clear. The purpose of this article is to compare the efficacy of the PRP + HA mixture with the simple use of platelet rich plasma in the treatment of patients with knee osteoarthritis. Materials and methods were included in a group of 126 knee osteoarthritis. Patients were studied: 63 cases in group PRP+HA and group PRP. After clinical and imaging evaluation, patients received intra-articular injection of HA+PRP mixture (2mlHA+3.5mlPRP) per week or only PRP (3.5ml) for 3 weeks. Follow up in 1,3,6 and 12 months. Results: compared to patients with PRP+HA mixture and simple PRP treatment. The VAS score was significantly lower and the function of the knee (WOMAC) was obviously improved. As for VAS and WOMAC, there was no significant difference between the two groups; however, the PRP+HA mixture group had a tendency to gain a better functional score (VAS, P = 0.392; WOMAC, P = 0.082) and the.PRP+HA group found 6 failed cases and PR. There were 11 groups in the group P. And no major adverse events or complications were found in the two group. Conclusion: the combined use of PRP+HA for patients with mild and moderate knee osteoarthritis is safe and effective. Although there is no significant difference in the functional results between the two groups, the PRP+HA group has a tendency to obtain a better functional score.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R684.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李明;張長(zhǎng)青;;富血小板血漿臨床應(yīng)用及其生物材料性能[J];中國(guó)組織工程研究與臨床康復(fù);2011年08期

2 王鵬飛;時(shí)長(zhǎng)江;王玉亮;姜文學(xué);;兔富血小板血漿制備及其活性分析[J];中國(guó)組織工程研究;2013年08期

3 王鴻祥;黃留拴;陳健榮;;一種簡(jiǎn)便的收集富血小板血漿的方法探討[J];上海醫(yī)學(xué)檢驗(yàn)雜志;1989年03期

4 孫樹(shù)洋,郝軼,張風(fēng)河,孫樹(shù)征;富血小板血漿與骨修復(fù)[J];口腔頜面外科雜志;2005年03期

5 熊隆江,練克儉;富血小板血漿凝膠及其在骨科的應(yīng)用[J];中國(guó)骨與關(guān)節(jié)損傷雜志;2005年07期

6 袁霆;張長(zhǎng)青;李四波;郭尚春;曾炳芳;;富血小板血漿促進(jìn)骨修復(fù)的理論研究與臨床實(shí)踐(英文)[J];中國(guó)臨床康復(fù);2006年05期

7 張衛(wèi)兵;洪光祥;康皓;;富血小板血漿對(duì)兔骨髓間充質(zhì)干細(xì)胞增殖的作用[J];中國(guó)組織工程研究與臨床康復(fù);2008年34期

8 張洪濤;蔡道章;劉康;李青;曾毅軍;;富血小板血漿對(duì)人骨髓間充質(zhì)干細(xì)胞成骨誘導(dǎo)的影響[J];中國(guó)組織工程研究與臨床康復(fù);2009年06期

9 孫潔;張劍明;;富血小板血漿制備方法的研究進(jìn)展[J];國(guó)際口腔醫(yī)學(xué)雜志;2009年05期

10 仇建軍;張長(zhǎng)青;袁霆;曾炳芳;;富血小板血漿及所含相關(guān)因子在組織修復(fù)再生中的應(yīng)用與作用[J];中國(guó)組織工程研究與臨床康復(fù);2009年41期

相關(guān)會(huì)議論文 前10條

1 徐燕;蔣勇;;富血小板血漿對(duì)人牙周組織細(xì)胞的礦化作用影響[A];中華口腔醫(yī)學(xué)會(huì)第七屆全國(guó)口腔病理學(xué)術(shù)會(huì)議論文摘要匯編[C];2006年

2 申軍;鎮(zhèn)萬(wàn)新;;富血小板血漿的研究進(jìn)展及其在骨科的應(yīng)用[A];全國(guó)骨科臨床研究新進(jìn)展研討會(huì)暨學(xué)習(xí)班論文集[C];2006年

3 汪永躍;郭雨文;嚴(yán)玲;唐禮;程偉;;血小板活化劑對(duì)富血小板血漿中生長(zhǎng)因子濃度的影響[A];第四屆全國(guó)口腔種植學(xué)術(shù)會(huì)議論文集[C];2005年

4 袁霆;張長(zhǎng)青;陸男吉;李四波;曾炳芳;;富血小板血漿修復(fù)皮膚缺損的實(shí)驗(yàn)研究[A];第二屆華東地區(qū)骨科學(xué)術(shù)大會(huì)暨山東省第九次骨科學(xué)術(shù)會(huì)議論文匯編[C];2007年

5 陳劍;袁文;宋滇文;;富血小板血漿在骨愈合治療中的作用[A];2012年浙江省骨科學(xué)術(shù)年會(huì)論文集[C];2012年

6 袁霆;張長(zhǎng)青;曾炳芳;;富血小板血漿修復(fù)皮膚缺損的實(shí)驗(yàn)研究[A];2007年上海市醫(yī)用生物材料研討會(huì)論文匯編[C];2007年

7 孫曉雷;馬劍雄;王志剛;張華峰;馬信;;富血小板血漿聯(lián)合鈣化誘導(dǎo)對(duì)骨髓間充質(zhì)干細(xì)胞增殖和成骨活性的影響[A];天津市生物醫(yī)學(xué)工程學(xué)會(huì)第30次學(xué)術(shù)年會(huì)暨生物醫(yī)學(xué)工程前沿科學(xué)研討會(huì)論文集[C];2010年

8 徐燕;PM Bartold;V Marino;;富血小板血漿和乏血小板血漿包被的屏障膜對(duì)成骨細(xì)胞附著的影響[A];中華口腔醫(yī)學(xué)會(huì)第七屆全國(guó)口腔病理學(xué)術(shù)會(huì)議論文摘要匯編[C];2006年

9 劉中寧;王衣祥;姜婷;;富血小板血漿促進(jìn)損傷人牙髓細(xì)胞恢復(fù)和增殖的研究[A];第六次全國(guó)口腔修復(fù)學(xué)學(xué)術(shù)會(huì)議論文摘要匯編[C];2009年

10 孫曉雷;馬信龍;馬劍雄;李稚君;;富血小板血漿聯(lián)合鈣化誘導(dǎo)對(duì)骨髓間充質(zhì)干細(xì)胞增殖和成骨活性的影響[A];2009第十七屆全國(guó)中西醫(yī)結(jié)合骨傷科學(xué)術(shù)研討會(huì)論文匯編[C];2009年

相關(guān)重要報(bào)紙文章 前2條

1 李鳳元;富血小板血漿幫牙周骨再生[N];健康報(bào);2007年

2 本報(bào)記者 劉霞;用自己的血治愈自己的傷[N];科技日?qǐng)?bào);2009年

相關(guān)博士學(xué)位論文 前4條

1 郭燕慶;富血小板血漿（PRP）治療膝骨關(guān)節(jié)炎的臨床療效評(píng)價(jià)[D];山東大學(xué);2017年

2 宋揚(yáng);富血小板血漿促進(jìn)骨組織修復(fù)的實(shí)驗(yàn)研究[D];四川大學(xué);2005年

3 田學(xué)忠;硫酸鈣對(duì)骨修復(fù)的影響及硫酸鈣富血小板血漿活性支架材料的研制[D];中國(guó)人民解放軍軍醫(yī)進(jìn)修學(xué)院;2008年

4 王悅;富血小板血漿對(duì)MG63，hADSCs及hDFbs細(xì)胞生物學(xué)行為影響的實(shí)驗(yàn)研究[D];吉林大學(xué);2011年

相關(guān)碩士學(xué)位論文 前10條

1 龍玉斌;微骨折技術(shù)聯(lián)合富血小板血漿對(duì)兔膝關(guān)節(jié)軟骨損傷修復(fù)作用的實(shí)驗(yàn)研究[D];河北醫(yī)科大學(xué);2015年

2 范超勇;富血小板血漿對(duì)腦損傷合并失血性休克大鼠的腦保護(hù)作用研究[D];鄭州大學(xué);2015年

3 彭小維;溫度敏感型富血小板血漿凝膠的研究[D];南昌大學(xué);2015年

4 嚴(yán)姍姍;PRP對(duì)RA-FLS細(xì)胞遷移和侵襲的影響[D];揚(yáng)州大學(xué);2015年

5 李建武;自體富血小板血漿對(duì)兔帶真皮下血管網(wǎng)皮片移植成活率的影響[D];延安大學(xué);2016年

6 林清宇;關(guān)節(jié)熏洗劑協(xié)同富血小板血漿治療骨性關(guān)節(jié)炎的臨床研究[D];南京中醫(yī)藥大學(xué);2016年

7 陳瀟;富血小板血漿對(duì)大鼠巨噬細(xì)胞表型的影響及其機(jī)制的初步研究[D];南京醫(yī)科大學(xué);2016年

8 張軍;自體富血小板血漿對(duì)兔膝關(guān)節(jié)軟骨Ⅱ度損傷修復(fù)作用研究[D];昆明醫(yī)科大學(xué);2016年

9 楊濟(jì)榮;面部透明質(zhì)酸與富含血小板填充療法在各時(shí)間檢測(cè)點(diǎn)的動(dòng)態(tài)變化程度之比較分析[D];大連醫(yī)科大學(xué);2016年

10 羅濤;影響富血小板血漿凝膠生物效應(yīng)因素的體外實(shí)驗(yàn)研究[D];第三軍醫(yī)大學(xué);2012年

，

本文編號(hào)：1999013