基于超声动态监测的富血小板血浆与玻璃酸钠治疗膝骨关节炎对比研究

Comparative Study on the Treatment of Knee Osteoarthritis with Platelet-Rich Plasma and Sodium Hyaluronate Based on Ultrasonic Dynamic Monitoring

摘要: 目的：本研究旨在通过超声动态监测，系统评估富血小板血浆(platelet-rich plasma, PRP)相较于玻璃酸钠(sodium hyaluronate, SH)在膝关节骨关节炎(knee osteoarthritis, KOA)软骨修复中的潜在疗效，揭示其时间依赖性的生物学效应。方法：采用前瞻性随机对照设计，纳入2024年1月~2025年1月包头市中心医院收治的KOA患者90例，通过计算机生成的随机序列进行分组分配(PRP组与SH组各45例)。两组均接受超声引导下关节腔内注射治疗。主要结局指标包括：疼痛视觉模拟评分(visual analogue scale, VAS)和骨关节炎指数(Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC)。超声定量参数：关节间隙宽度及髁间沟软骨厚度。评估节点设置为基线、治疗后10周、20周、30周，采用重复测量方差分析处理纵向数据，评估人员对分组信息设盲。结果：1) 两组人口学资料及观察指标均衡可比(P > 0.05)。2) VAS评分：PRP组呈现持续曲线，30周降幅达56.9% (54.60→23.80)，SH组的逆向变化(Δ = 27.73, 95% CI 25.12~30.34; P < 0.001)。WOMAC评分：PRP组30周时率47.3%，而SH组出现4.6%的恶化(P < 0.001)。3) 关节间隙宽度：组间差异无统计学意义(P = 0.271)，但PRP组30周时维持基线水平(2.57 ± 0.36 mm)，SH组出现进行性狭窄(Δ = −0.19 mm)。4) 髁间沟软骨厚度：PRP组30周时较基线增厚11.2% (1.97→2.19 mm)，高于SH组的进行性变薄(P < 0.001)，差异在20周后具统计学性。结论：1) PRP组在疼痛缓解(VAS)和功能(WOMAC)方面呈现持续增效趋势，提示PRP具有的长期疗效。2) PRP组髁间沟软骨厚度在20周后呈现软骨厚度增加(30周较基线增厚11.2%，P < 0.001)，SH组则持续变薄(−9.6%)，提示PRP可能通过促进软骨厚度增加而延缓结构破坏，具有潜在的结构修复效应。此外，为保证测量结果的可靠性，本研究对超声测量进行信度分析(ICC = 0.87)，显示测量具有较高一致性。所有测量均在固定的关节角度(膝关节屈曲30˚)下进行，并统一测量位置(髁间沟中央)，由同一名经验丰富的技师操作，以最大限度减少偏倚。

Abstract: Objective: This study aimed to systematically evaluate the potential efficacy of platelet-rich plasma (PRP) versus sodium hyaluronate (SH) in cartilage repair for knee osteoarthritis (KOA) through dynamic ultrasound monitoring, and to reveal its time-dependent biological effects. Methods: A prospective randomized controlled design was adopted, enrolling 90 KOA patients admitted to Baotou Central Hospital from January 2024 to January 2025. Patients were assigned to groups (45 cases in the PRP group and 45 cases in the SH group) using a computer-generated random sequence. Both groups received ultrasound-guided intra-articular injection therapy. The primary outcome measures included the Visual Analogue Scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Ultrasound quantitative parameters included joint space width and intercondylar groove cartilage thickness. Assessment time points were set at baseline, 10 weeks, 20 weeks, and 30 weeks after treatment. Repeated-measures analysis of variance was used to process longitudinal data, and assessors were blinded to group allocation. Results: 1) The demographic data and observation indicators of the two groups were balanced and comparable (P > 0.05). 2) VAS score: The PRP group showed a continuous decreasing trend, with a reduction of 56.9% at 30 weeks (from 54.60 to 23.80), while the SH group exhibited a reverse change (Δ = 27.73, 95% CI 25.12~30.34; P < 0.001). For the WOMAC score, the PRP group achieved a reduction rate of 47.3% at 30 weeks, whereas the SH group showed a 4.6% deterioration (P < 0.001). 3) Joint space width: There was no statistically significant difference between the two groups (P = 0.271). However, the PRP group maintained the baseline level at 30 weeks (2.57 ± 0.36 mm), while the SH group showed progressive narrowing (Δ = −0.19 mm). 4) Intercondylar groove cartilage thickness: At 30 weeks, the cartilage thickness in the PRP group increased by 11.2% compared with the baseline (from 1.97 mm to 2.19 mm), which was higher than the progressive thinning observed in the SH group (P < 0.001). The difference became statistically significant after 20 weeks. Conclusion: 1) The PRP group showed a continuous trend of efficacy improvement in pain relief (VAS) and function (WOMAC), suggesting that PRP has long-term therapeutic effects. 2) The intercondylar groove cartilage thickness in the PRP group increased after 20 weeks (11.2% thicker at 30 weeks compared with the baseline, P < 0.001), while the SH group showed continuous thinning (−9.6%). This suggests that PRP may delay structural damage by promoting an increase in cartilage thickness, exhibiting a potential structural repair effect. In addition, to ensure the reliability of measurement results, this study conducted a reliability analysis of ultrasound measurements (ICC = 0.87), showing high consistency of the measurements. All measurements were performed at a fixed joint angle (30˚ knee flexion) and at a unified measurement position (the center of the intercondylar groove) by the same experienced technician to minimize bias.