氨基葡萄糖联合PRP及HA治疗退变性膝关节疼痛的疗效分析

Therapeutic Effect of Glucosamine Combined with PRP and HA in the Treatment of Degenerative Knee Pain

摘要: 背景：近年来随着中国人口的老年化，退变性膝关节疼痛患者呈现明显增长趋势，以围绝经期女性患者最为多见；目前保守治疗退变性膝关节疼痛患者方式较多，除手术外，最为常见的保守治疗方式有抗炎镇痛药、氨基葡萄糖、软骨素、糖皮质激素、透明质酸、降钙素及富血小板血浆等；由于长期口服抗炎镇痛药对胃黏膜损伤较大，药效作用时间短，目前临床上对于围绝经女性，保守治疗最为常用的治疗方式为口服氨基葡萄糖、关节腔注射透明质酸及富血小板血浆等，这些治疗方式中哪一种效果更为显著，单一用药还是联合用药，目前还缺乏一定的临床治疗依据，这值得我们共同探讨。目的：探讨富血小板血浆及透明质酸联合氨基葡萄糖治疗围绝经期女性患者退变性膝关节疼痛的疗效分析，为临床中治疗早期膝关节疼痛提供更好的参考依据。方法：纳入利川市人民医院2019年6月至2022年6月因膝关节疼痛并符合纳入标准的150例女性患者，按照患者不同的治疗方式分为5组：A组，口服氨基葡萄糖；B组，关节腔注射透明质酸(HA)；C组，关节腔注射富血小板血浆(PRP)；D组，口服氨基葡萄糖 + 关节腔注射HA；E组，口服氨基葡萄糖 + 关节腔注射PRP；治疗2周、4周、6周及8周后分别对五组一般情况、患肢WOMAC评分、Lysholm评分及步态参数评估进行测量对比；结果五组保守治疗方式均有效；联合用药组(D、E)较单一用药组(A, B, C)治疗效果明显；联合用药组中，E组口服氨基葡萄糖 + PRP关节腔注射能长期效缓解膝关节疼痛，患肢膝关节WOMAC评分、Lysholm评分及步态参数评估均优于其他治疗组。结论：联合应用口服氨基葡萄糖 + PRP关节腔注射或HA关节腔注射，治疗膝关节疼痛效果均优于膝关节单一用药组，在联合用药组中，口服氨基葡萄糖 + PRP关节腔注射，治疗退变性膝关节疼痛远期效果更为明显，为临床中治疗早期KOA患者膝关节疼痛提供了新的治疗依据。

Abstract: Background: In recent years, with the aging of the Chinese population, the patients with degenerative knee pain have shown a significant increase trend, and perimenopausal women are the most common patients. At present, there are many conservative treatment methods for patients with degenerative knee pain. Besides surgery, the most common conservative treatment methods include anti-inflammatory analgesics, glucosamine, chondroitin, glucocorticoid, hyaluronic acid, calcitonin and platelet-rich plasma. As long-term oral anti-inflammatory and analgesic drugs can cause greater damage to gastric mucosa and have a short time of action, currently, the most commonly used conservative treatment for perimenopausal women is oral glucosamine, joint cavity injection of hyaluronic acid and platelet-rich plasma, etc. Which of these treatment methods has the more significant effect, single drug or combined drug? At present, there is still a lack of clinical treatment basis, which is worth discussing together. Objective: To explore the therapeutic effect of platelet-rich plasma and hyaluronic acid combined with glucosamine in the treatment of degenerative knee pain in perimenopausal female patients, and to provide a better reference for the treatment of early knee pain. Methods 150 female patients with knee pain who met the inclusion criteria in the Lichuan People’s Hospital from June 2019 to June 2022 were enrolled and divided into 5 groups according to different treatment methods: Group A, oral glucosamine; Group B was injected with hyaluronic acid (HA). In group C, platelet-rich plasma (PRP) was injected into joint cavity; Group D, oral glucosamine + joint cavity injection HA; Group E, oral glucosamine + joint cavity injection PRP; After 2, 4, 6 and 8 weeks of treatment, the general condition, WOMAC score, Lysholm score and gait parameter evaluation of the five groups were measured and compared respectively. Results: All five groups of conservative treatment were effective. The effect of combination therapy group (D, E) was more obvious than that of single therapy group (A, B, C). In the combined treatment group, the joint injection of glucosamine + PRP in the E group could relieve knee pain in a long-term manner, and the WOMAC score, Lysholm score and gait parameter evaluation of the affected knee joint were better than those of other treatment groups. Conclusion: Combined use of oral glucosamine + PRP articular injection or HA articular injection for the treatment of knee pain is better than that of single medication group for the knee joint. In the combined medication group, oral glucosamine + PRP articular injection for the treatment of degenerative knee pain is more effective in the long term. It provides a new basis for the clinical treatment of knee pain in patients with early KOA.