| Objective:To observe the efficacy of intra-articular injection of PRP in the treatment of KOA at different times after extracorporeal shock wave therapy,to provide a better way for clinical treatment of KOA,and to clarify the internal mechanism of time difference in combined therapy affecting the efficacy of KOA through animal experiments,so as to provide experimental basis for clinical treatment.Method:1.Clinical researchA total of 60 patients with KOA who were hospitalized in Taizhou people’s Hospital from January 2022 to October 2022 were randomly divided into two groups: PRP+ESW1 group(n = 30)and PRP+ESW2 group(n = 30).Three weeks after treatment,the changes of VAS score,WOMAC score,TCM syndrome score and range of motion of knee joint were compared between the two groups before treatment,1 week after treatment,3 weeks after treatment and 3 months follow-up.2.Experimental Research32 SPF New Zealand rabbits(regardless of sex,weight 2.25 0.5kg)were randomly divided into PRP+ESW1 group(n = 8),PRP+ESW2 group(n = 8),blank control group(n = 8)and model group(n = 8).The rabbit model of KOA was made by injecting papain into the knee joint cavity.After successful modeling,PRP+ESW1 group received intra-articular injection of PRP 2 hours after extracorporeal shock wave treatment,PRP+ESW2 group received intra-articular injection of PRP 2 days after extracorporeal shock wave treatment,once a week for a total of 3 times,blank control group and model group did not take part in modeling.After the end of modeling and the last treatment,Lequesne-MG score and general observation were performed to evaluate whether the model was successful or not.At the end of the experiment,the materials were taken for general observation,HE staining was used to observe the pathological changes of rabbit knee cartilage,and ELISA method was used to determine the contents of IL-1 β,TNF-α,VEGF and TGF-β in serum.Results:1.ClinicalresearchThere was no significant difference in VAS,WOMAC,TCM syndrome score and knee joint range of motion between the two groups before treatment,but VAS,WOMAC and TCM syndrome scores in 1 week,3 weeks and 3 months after treatment in both groups were lower than those before treatment,and knee joint mobility was higher than that before treatment.The scores of VAS,WOMAC and TCM syndrome in the PRP+ESW1 group were lower than those in the PRP+ESW2 group at each time point after treatment,and the range of motion of the knee joint in the PRP+ESW1 group was higher than that in the PRP+ESW2 group,and the PRP+ESW1 group was better than the PRP+ESW2group.2.Experimental ResearchAfter treatment,the serum levels of IL-1 β,TNF α,VEGF and TGF-β in the model group were higher than those in the blank control group,PRP+ESW1group and PRP+ESW2 group,while the levels of IL-1 β,TNF α and VEGF in the PRP+ESW1 group were lower than those in the PRP+ESW2 group,and TGF-βwas higher than that in the PRP+ESW2 group,suggesting that the PRP+ESW1group was superior to the PRP+ESW2 group.There were significant differences in pairwise comparison among the four groups(P < 0.05).Gross observation of the knee: compared with the blank control group,the articular surface of the model group was rougher,the intra-articular hyperplasia was obvious,and the articular fluid was turbid;in the PRP+ESW2 group,the knee articular surface was rough,the intra-articular hyperplasia was slightly hyperplastic,and the articular fluid was slightly turbid;in the PRP+ESW1 group,the articular surface tended to be normal,the articular surface was smooth,the articular fluid was clear,and the intra-articular hyperplasia decreased significantly.HE observation: compared with the blank control group,the model group had severe chondrocyte damage and a large number of inflammatory infiltration;the PRP+ESW2 group had less chondrocyte damage and inflammatory infiltration;the RP+ESW1 group had occasional cell destruction and less inflammatory infiltration.Conclusions:Extracorporeal shock wave combined with PRP can significantly relieve knee joint pain,improve joint motion,improve joint function,reduce inflammatory response,accelerate chondrocyte repair and improve the clinical symptoms of KOA by reducing inflammatory factors,regulating the release of cytokines,accelerating chondrocyte repair,and improving the clinical symptoms of KOA.The curative effect of 2 hours interval is better than that of 2 days interval. |
