Abstract:

Objective　To investigate the effect of different concentrations of platelet-rich plasma combined with quadricep muscle training in cartilage repair of knee osteoarthritis. Methods　A total of 114 patients with cartilage repair of knee osteoarthritis treated in Shaanxi Rehabilitation Hospital from June 2022 to December 2023 were retrospectively selected as the study objects. According to different platelet-rich plasma concentrations, the patients were divided into three groups, 38 cases in each group. There were 23 males and 15 females in group A, aged (59.38±3.61) years, with a course of disease of (4.15±0.59) years, 22 cases of left knee and 16 cases of right knee, Kellgren-Lawrence (K-L) classification: 27 cases of grade Ⅱ and 11 cases of grade Ⅲ. There were 24 males and 14 females in group B, aged (60.11±3.64) years, with a course of disease of (4.18±0.62) years, 23 cases of left knee and 15 cases of right knee, K-L classification: 29 cases of grade Ⅱ and 9 cases of grade Ⅲ. There were 21 males and 17 females in group C, aged (59.94±3.62) years, with a course of disease of (4.17±0.60) years, 30 cases of left knee and 8 cases of right knee, K-L classification: 30 cases of grade Ⅱ and 8 cases of grade Ⅲ. All the three groups were treated with quadricep muscle training, and on the basis of this, different concentrations of platelet-rich plasma were injected into the knee joint. The platelet-rich plasma concentration in group A was 900 to 1 500×10⁹/L, 1 500 to 1 800×10⁹/L in group B, and 1 800 to 2 100×10⁹/L in group C. All the three groups were treated for 6 weeks. The knee function [Western Ontario and McMaster University Osteoarthritis Index (WMOAC)] and inflammatory factors and oxidative stress indexes [interleukin-17 (IL-17), Toll-like receptor 4 (TLR4), nitric oxide (NO), oxidized low density lipoprotein (ox-LDL), and glutathione peroxidase (GSH-Px)] before and after treatment and the occurrence of adverse reactions during treatment were compared among the 3 groups. Independent sample t test, paired t test, ANOVA, and χ² test were used. Results　After treatment, the scores of pain, limitation of daily living, and stiffness of the WMOAC in the 3 groups were lower than those before treatment (all P<0.05); the above scores of group B were lower than those of groups A and C [(6.39±1.52) points vs. (18.52±2.61) points and (18.54±2.63) points, (60.23±5.21) points vs. (79.46±7.12) points and (79.48±7.10) points. (4.32±0.61) points vs. (7.82±1.12) points and (7.85±1.14) points] (all P<0.05). After treatment, the levels of IL-17, TLR4, NO, and ox-LDL in the 3 groups were lower than those before treatment, and the GSH-Px level was higher than that before treatment (all P<0.05); the levels of IL-17, TLR4, NO, and ox-LDL in group B were lower than those in groups A and C [(3.22±0.43) ng/L vs. (4.51±0.57) ng/L and (4.53±0.59) ng/L, (9.78±1.21) μg/L vs. (13.25±1.95) μg/L and (13.27±1.97) μg/L, (83.52±6.72) μmol/L vs. (102.14±8.74) μmol/L and (102.18±8.79) μmol/L, (10.62±0.87) nmol/L vs. (12.15±1.34) nmol/L and (12.17±1.36) nmol/L], and the GSH-Px level was higher than those in groups A and C [(247.39±18.72) mg/L vs. (195.37±15.41) mg/L and (196.11±15.43) mg/L] (all P<0.05). During the treatment period, there was no statistically significant difference in the total incidence of adverse reactions among the 3 groups (P>0.05). Conclusion　Different concentrations of platelet-rich plasma combined with quadricep muscle training for cartilage repair of knee osteoarthritis can achieve good repair effects, and the treatment effect of platelet-rich plasma concentration of 1 500-1 800×10⁹/L is the best, which can reduce the patients' pain, improve the function of knee joint, reduce the levels of inflammatory factors and oxidative stress in the body, and is safe.

Key words:

Platelet-rich plasma, Quadricep muscle training, Knee osteoarthritis, Cartilage repair, Knee joint function, Inflammatory factors,  , Oxidative stress

摘要：

目的　探讨不同浓度富血小板血浆联合股四头肌训练在膝关节骨性关节炎软骨修复中的应用效果。方法　选取2022年6月至2023年12月陕西省康复医院收治的114例膝关节骨性关节炎软骨修复患者作为研究对象。根据富血小板血浆浓度，将患者分为A组、B组、C组，各38例。A组男23例，女15例；年龄（59.38±3.61）岁；病程（4.15±0.59）年；患膝部位：左膝22例，右膝16例；Kellgren-Lawrence（K-L）分级：Ⅱ级27例，Ⅲ级11例。B组男24例，女14例；年龄（60.11±3.64）岁；病程（4.18±0.62）年；患膝部位：左膝23例，右膝15例；K-L分级：Ⅱ级29例，Ⅲ级9例。C组男21例，女17例；年龄（59.94±3.62）岁；病程（4.17±0.60）年；患膝部位：左膝30例，右膝8例；K-L分级：Ⅱ级30例，Ⅲ级8例。3组均采用股四头肌训练治疗，并在此基础上采用不同浓度富血小板血浆治疗（膝关节注射）。A组富血小板血浆浓度（900～1 500）×10⁹/L，B组（1 500～1 800）×10⁹/L，C组（1 800～2 100）×10⁹/L。3组均持续治疗6周。比较3组治疗前后膝关节功能［西安大略和麦克马斯特大学骨关节炎指数（WMOAC）］、炎症因子及氧化应激指标［白细胞介素-17（IL-17）、Toll样受体4（TLR4）、一氧化氮（NO）、氧化低密度脂蛋白（ox-LDL）、谷胱甘肽过氧化物酶（GSH-Px）］，治疗期间不良反应发生情况。采用独立样本t检验、配对t检验、方差分析和χ²检验。结果　治疗后，3组WMOAC中疼痛、日常生活受限程度及僵硬情况评分均低于治疗前（均P<0.05）；B组上述评分均低于A、C组［（6.39±1.52）分比（18.52±2.61）分、（18.54±2.63）分，（60.23±5.21）分比（79.46±7.12）分、（79.48±7.10）分，（4.32±0.61）分比（7.82±1.12）分、（7.85±1.14）分］（均P<0.05）；3组IL-17、TLR4、NO及ox-LDL水平均低于治疗前，GSH-Px水平高于治疗前（均P<0.05）；B组IL-17、TLR4、NO及ox-LDL水平均低于A、C组［（3.22±0.43）ng/L比（4.51±0.57）ng/L、（4.53±0.59）ng/L，（9.78±1.21）μg/L比（13.25±1.95）μg/L、（13.27±1.97）μg/L，（83.52±6.72）μmol/L比（102.14±8.74）μmol/L、（102.18±8.79）μmol/L，（10.62±0.87）nmol/L比（12.15±1.34）nmol/L、（12.17±1.36）nmol/L］，GSH-Px水平高于A、C组［（247.39±18.72）mg/L比（195.37±15.41）mg/L、（196.11±15.43）mg/L］（均P<0.05）。治疗期间，3组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　不同浓度富血小板血浆联合股四头肌训练应用于膝关节骨性关节炎软骨修复效果良好，富血小板血浆浓度（1 500～1 800）×10⁹/L治疗效果较好，可减轻患者疼痛，改善膝关节功能，减少炎症反应，降低氧化应激水平，安全性较好。

关键词:

富血小板血浆, 股四头肌训练, 膝关节骨性关节炎, 软骨修复, 膝关节功能, 炎症因子, 氧化应激