本文選題：富血小板血漿 + 膝骨關(guān)節(jié)炎　； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)對(duì)不同濃度的富血小板血漿治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的安全有效性分析,評(píng)價(jià)富血小板血漿治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的臨床療效,并探討富血小板血漿治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的臨床使用濃度。方法:選取符合納入、排除標(biāo)準(zhǔn)病例101例,將納入病例按隨機(jī)數(shù)字表法先隨機(jī)分為對(duì)照組及實(shí)驗(yàn)組,然后實(shí)驗(yàn)組再次通過(guò)隨機(jī)數(shù)字表法隨機(jī)分為A、B、C、D組。各組均口服依托考昔片,每日一次,每次一片基礎(chǔ)治療。對(duì)照組患者予膝關(guān)節(jié)腔內(nèi)注射2ml玻璃酸鈉注射液。實(shí)驗(yàn)組予注射2ml富血小板血漿,其中A組富血小板血漿濃度(900-1500)×10~9/L,B組富血小板血漿濃度(1200-1500)×10~9/L,C組富血小板血漿濃度(1500-1800)×10~9/L,D組富血小板血漿濃度(1800-2100)×10~9/L,膝關(guān)節(jié)注射治療以5次為一個(gè)療程。治療前及治療后3、6、9個(gè)月時(shí)回訪(fǎng)病人,按照WOMAC骨關(guān)節(jié)炎指數(shù)評(píng)分、IKDC評(píng)分、VAS視覺(jué)疼痛評(píng)分評(píng)定關(guān)節(jié)功能并根據(jù)《中醫(yī)病癥診斷療效標(biāo)準(zhǔn)》評(píng)價(jià)治療有效率(以WOMAC評(píng)分為評(píng)價(jià)指標(biāo))。治療前及治療完成后均行肝腎功等相關(guān)檢查,以評(píng)估富血小板血漿治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的臨床安全性。并通過(guò)不同濃度分組觀(guān)察,探索富血小板血漿應(yīng)用于膝關(guān)節(jié)骨性關(guān)節(jié)炎的臨床適宜濃度。結(jié)果:對(duì)照治療后3個(gè)月隨訪(fǎng)時(shí)顯效率為14.29%,有效率為59.52%(綜合有效率為73.81%),對(duì)照組終末隨訪(fǎng)時(shí)綜合有效率為28.57%;實(shí)驗(yàn)組治療后3個(gè)月隨訪(fǎng)時(shí)顯效率為22.03%,有效率為61.02%(綜合有效率為83.05%),實(shí)驗(yàn)組終末綜合有效率為55.93%。對(duì)照組和治療組患者治療VAS評(píng)分明顯下降(3.98±1.26及3.27±1.70),終末隨訪(fǎng)較前上升(5.29±1.44及4.06±1.63),但低于治療前,對(duì)照組及實(shí)驗(yàn)組在治療后各隨訪(fǎng)時(shí)間點(diǎn)實(shí)驗(yàn)組VAS評(píng)分均優(yōu)于對(duì)照組。治療前后各組WOMAC評(píng)分治療后3個(gè)月下降最明顯(31.05±6.55及29.44±5.63),終末隨訪(fǎng)對(duì)照組與治療前無(wú)明顯差異(44.02±11.60),實(shí)驗(yàn)組低于治療前(35.98±9.16),隨訪(fǎng)過(guò)程中實(shí)驗(yàn)組評(píng)分均低于對(duì)照組。治療前后各組IKDC評(píng)分治療后3個(gè)月改善最明顯(64.05±11.14及68.64±9.82),終末隨訪(fǎng)對(duì)照組與治療前無(wú)明顯差異(55.43±15.59),實(shí)驗(yàn)組低于治療前(60.58±8.68),隨訪(fǎng)過(guò)程中實(shí)驗(yàn)組評(píng)分均優(yōu)于對(duì)照組。不同實(shí)驗(yàn)組間VAS評(píng)分,以C組下降最明顯,治療后3個(gè)月時(shí)為(2.35±1.06),治療后9個(gè)月為(3.53±1.42);WOMAC評(píng)分以C組改善效果最滿(mǎn)意,治療后第3、6、9個(gè)月分別為(27.71±5.46、24.94±7.68、35.59±7.98);IKDC評(píng)分WOMAC評(píng)分以C組改善效果最滿(mǎn)意,治療后第3、6、9個(gè)月分別為(73.94±9.42、66.06±7.17、65.59±8.99)。不良反應(yīng)患者注射富血小板血漿中白細(xì)胞、紅細(xì)胞高于不發(fā)生不良反應(yīng)患者(40.17±8.65×10~9/L和24.31±5.72×10~9/L;3.81±1.59×1012/L和1.92±1.07×1012/L)。結(jié)論:關(guān)節(jié)腔注射玻璃酸鈉及富血小板血漿均能有效改善膝骨性關(guān)節(jié)炎患者的臨床癥狀。后者通過(guò)修復(fù)軟骨、消除炎癥療效優(yōu)于前者。不同血小板濃度的富血小板血漿對(duì)膝骨性關(guān)節(jié)炎患者的療效在一定程度上呈劑量依賴(lài),最適宜血小板濃度應(yīng)為(1500-1800)×10~9/L。治療前后血常規(guī)、肝腎功等檢查結(jié)果正常,無(wú)感染、血栓等并發(fā)癥,少量不良反應(yīng)的發(fā)生可能是由過(guò)多的白細(xì)胞及紅細(xì)胞引起,但可迅速自行緩解。因此自體富血小板血漿關(guān)節(jié)腔注射治療膝骨性關(guān)節(jié)炎安全有效。
[Abstract]:Objective: To evaluate the efficacy of platelet rich plasma in the treatment of osteoarthritis of the knee joint, evaluate the clinical efficacy of platelet rich plasma in the treatment of osteoarthritis of the knee joint, and discuss the clinical concentration of platelet rich plasma in the treatment of osteoarthritis of the knee joint. Method: select the standard cases 10 to exclude the standard cases. 1 cases were randomly divided into the control group and the experimental group according to the random number table method. Then the experimental group was randomly divided into A, B, C, and D group by random digital table method. Each group was taken orally Etoricoxib Tablets, once a day, a piece of basic treatment. The control group was injected with 2ml Sodium Hyaluronate Injection in the knee joint cavity. The experimental group was given the injection of 2m. L rich platelet plasma, of which platelet rich plasma concentration (900-1500) x 10~9/L, platelet rich plasma concentration in group B (1200-1500) x 10~9/L, platelet rich plasma concentration (1500-1800) x 10~9/L in group C, platelet rich plasma concentration (1800-2100) x 10~9/L in D group, and 5 times for knee joint injection therapy, before and after treatment, and 3,6,9 months after treatment. The patients were interviewed, according to the WOMAC Osteoarthritis Index score, the IKDC score, the VAS visual pain score to evaluate the joint function and to evaluate the treatment efficiency according to the standard of TCM syndrome diagnosis (the evaluation index of the WOMAC score). The liver and kidney functions were performed before and after the treatment to evaluate the platelet rich plasma for the treatment of the knee joint. Clinical safety of arthrosis. And through the observation of different concentration groups, the clinical suitable concentration of platelet rich plasma used in osteoarthritis of the knee joint was explored. Results: the effective rate was 14.29%, the effective rate was 59.52% (comprehensive effective rate 73.81%) at 3 months after the control treatment, and the comprehensive effective rate was 28.57% at the end of the follow-up group, and the experimental group was 28.57%. After 3 months of follow-up, the effective rate was 22.03% and the effective rate was 61.02% (comprehensive effective rate 83.05%). The final comprehensive efficiency of the experimental group was significantly decreased (3.98 + 1.26 and 3.27 + 1.70) in the 55.93%. control group and the treatment group (3.98 + 1.26 and 3.27 + 1.70), and the final follow-up was higher (5.29 + 1.44 and 4.06 + 1.63) than before (5.29 + 1.44 and 4.06 + 1.63), but lower than the control group and the experimental group before the treatment. The VAS scores in the experimental group were better than those in the control group after the treatment. The 3 months after treatment were the most obvious (31.05 + 6.55 and 29.44 + 5.63) after treatment. There was no significant difference between the control group and the control group (44.02 + 11.60), and the experimental group was lower than before treatment (35.98 + 9.16). The scores of the experimental group were lower than those of the experimental group. Before and after treatment, the improvement of IKDC score was the most obvious (64.05 + 11.14 and 68.64 + 9.82) after treatment, and no significant difference between the control group and before treatment (55.43 + 15.59), and the experimental group was lower than before treatment (60.58 + 8.68). The score of the experimental group was better than the control group. The VAS score between the different experimental groups was the most obvious in the C group, and the treatment was the most obvious in the C group. 3 months after treatment (2.35 + 1.06) and 9 months after treatment (3.53 + 1.42), WOMAC score was most satisfactory in group C, 3,6,9 months after treatment was (27.71 + 5.46,24.94 + 7.68,35.59 + 7.98), WOMAC score of IKDC score was most satisfactory in C group, and (73.94 + 9.42,66.06 + 7.17,65.59 + 8.99) after treatment, respectively. Patients with good reaction were injected with leukocytes in platelet rich plasma, and red blood cells were higher than those without adverse reactions (40.17 + 8.65 x 10~9/L and 24.31 + 5.72 x 10~9/L; 3.81 + 1.59 x 1012/L and 1.92 + 1012/L). Conclusion: intraarticular injection of sodium hyaluronate and platelet rich plasma can effectively improve the clinical symptoms of patients with knee osteoarthritis. The effect of platelet rich plasma on osteoarthritis of the knee is dose-dependent to a certain extent by repairing the cartilage. The most suitable platelet concentration should be (1500-1800) the blood routine before and after the treatment of (1500-1800) x, liver and kidney work and other complications, such as no infection, thrombosis and other complications. The occurrence of adverse reactions may be caused by too many leucocytes and red cells, but it can be relieved quickly and spontaneously. Therefore, autologous platelet rich plasma injection is safe and effective in the treatment of osteoarthritis of the knee.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R684.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 潘雪;王偉鋼;;膝骨關(guān)節(jié)炎中醫(yī)證型與常見(jiàn)臨床指標(biāo)之間的關(guān)系研究[J];風(fēng)濕病與關(guān)節(jié)炎;2016年11期

2 吳驍;檀亞軍;咸杰;何本祥;;富血小板血漿修復(fù)膝關(guān)節(jié)骨關(guān)節(jié)炎[J];中國(guó)組織工程研究;2016年42期

3 李浩煒;敬勝偉;張靜;王輝;鄧靈芝;;密集型銀質(zhì)針治療膝骨性關(guān)節(jié)炎的臨床療效研究[J];甘肅科技;2016年17期

4 袁林;郭燕慶;于洪波;于泓;呂慧利;李偉;滿(mǎn)振濤;孫水;;富血小板血漿治療Ⅱ-Ⅲ期膝骨關(guān)節(jié)炎的療效評(píng)價(jià)[J];中華關(guān)節(jié)外科雜志(電子版);2016年04期

5 潘紅娟;王雅麗;呂爽;劉鐵梅;;富血小板血漿制備方法穩(wěn)定性的研究[J];中國(guó)實(shí)驗(yàn)診斷學(xué);2016年06期

6 周祝興;邱冰;;富血小板血漿治療骨關(guān)節(jié)炎的研究進(jìn)展[J];貴州醫(yī)藥;2016年04期

7 梁大偉;衛(wèi)小春;魏壘;;富血小板血漿在肌肉骨骼疾病中的應(yīng)用[J];中華關(guān)節(jié)外科雜志(電子版);2016年02期

8 李艷秋;劉金鳳;張?zhí)焓?張海鑫;徐云;;富血小板纖維蛋白體外釋放生長(zhǎng)因子相關(guān)因素的研究[J];中國(guó)口腔種植學(xué)雜志;2016年01期

9 侯靖釗;包洪衛(wèi);肖海祥;王海紅;葉金松;;骨髓PRP關(guān)節(jié)腔內(nèi)注射治療膝骨性關(guān)節(jié)炎效果觀(guān)察[J];交通醫(yī)學(xué);2016年01期

10 王一帆;木彬;李代斌;李小峰;;銀質(zhì)針療法在慢性軟組織損傷性疼痛中的應(yīng)用研究[J];遼寧中醫(yī)藥大學(xué)學(xué)報(bào);2016年01期

相關(guān)碩士學(xué)位論文 前3條

1 李心竹;富血小板血漿促牙髓干細(xì)胞/內(nèi)皮祖細(xì)胞共培養(yǎng)物體外成牙本質(zhì)、成血管的實(shí)驗(yàn)研究[D];南方醫(yī)科大學(xué);2014年

2 沈鵬飛;膝關(guān)節(jié)滑液中IL-1β，IL-6含量與骨性關(guān)節(jié)炎關(guān)系的研究[D];南京中醫(yī)藥大學(xué);2009年

3 陳慶真;膝骨性關(guān)節(jié)炎中醫(yī)證候規(guī)范化的研究[D];廣州中醫(yī)藥大學(xué);2008年

，

本文編號(hào)：1940701