小針刀、玻尿酸和高濃度血小板血漿三合一療法治療膝關節炎療效觀察

The Efficacy of Triple Therapy with Acupotomy, Hyaluronic Acid, and Platelet-Rich Plasma in Combination with Subsequent Oral Hyaluronic Acid for Moderate Knee Osteoarthritis

蔡德祥(Der-Shiang Tsai) ； 高宗桂(Tsung-Kuei Kao)

《中醫藥研究論叢》 23卷2期 (2020/09) Pp. 15-33

https://doi.org/10.6516/TJTCM.202009_23(2).0002

摘要

背景：玻尿酸、高濃度血小板血漿和小針刀三合一療法對膝關節炎的療效仍然未知。此篇研究目的在探討三合一療法對三種單獨療法的療效比較。方法：選取院內膝關節門診60位病患，共分四組，採用關節內玻尿酸注射15位，小針刀療法15位，高濃度血小板血漿關節內注射15位和上述三種合併療法（三合一療法）15位。治療後，四組開始服用玻尿酸共12個月，觀察治療後一個月、三個月、六個月和十二個月疼痛視覺類比量表（VAS）和西安大略和麥馬斯特大學骨性關節炎指數（WOMAC）臨床評量。結果：四組治療後第一個月、第三個月、第六個月和第十二個月，VAS緩解疼痛和WOMAC功能恢復，都有明顯療效且具統計意義（p＜0.05）。三合一療法組個別與單純治療的玻尿酸注射組、高濃度血小板血漿組和小針刀組比較，於第一個月、第三個月、第六個月和第十二個月，在VAS緩解疼痛和WOMAC功能恢復方面都有明顯療效且具統計意義（p＜0.05）。經一年的追蹤發現，四組治療後口服玻尿酸可維持療效長達一年。結論：三合一療法後續口服玻尿酸治療退化性膝關節炎比起單獨療法更有明顯的療效，惟更進一步嚴謹的雙盲研究值得期待。

關鍵字

膝關節炎 ； 小針刀 ； 玻尿酸 ； 高濃度血小板血漿 ； VAS ； WOMAC

並列摘要

Background: The exact outcome of combined use (triple therapy) with intra-articular hyaluronic acid (HA) injection, intra-articular platelet-rich plasma (PRP) injection and acupotomy (ACUP) in the treatment of moderate knee osteoarthritis remains unclear. The goal of the paper was to compare the efficacy of triple therapy with those of a cohort of patients treated with ACUP, HA and PRP only. Methods: A total of 60 subjects with knee osteoarthritis, stage 3 were enrolled: 15 cases in HA group, 15 cases in PRPgroup, 15 cases in ACUP group and 15 cases in triple therapy group (HA+PRP+ACUP). After clinical evaluation, patients received a weekly HA injection of HA for 3 times in HA group, PRP for 1 time in HA group, a weekly acupotomy in ACUP group for 3 times, and combined use in triple therapy group. All 4 groups subsequently received self rehabilitation and healthy food nutrition (oral HA). Clinical outcomes were evaluated using Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire at baseline and after 1,3,6 and 12 months. Results: The study showed that all 4 groups have significant improvement at 1, 3, 6 and 12 month after therapy (p＜0.05, respectively). In addition, triple therapy group had significant reduction in VAS score and WOMAC function activity score at 1, 3, 6, 12 month when compared to ACUP, HA, and PRP group respectively (p＜0.05). Oral hyaluronic acid maintained the effect till one year in all four group was observed. Conclusion: The findings of the study support the use of triple therapy as an effective treatment for moderate knee osteoarthritis when compared to other three group. Further rigorously designed and well-controlled RCTs with long-term follow-up are warranted.

並列關鍵字

Knee osteoarthritis ； Acupotomy ； Hyaluronic acid ； Platelet-rich plasma ； VAS ； WOMAC

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