一位退化性膝關節炎患者使用高濃度血小板血漿之實證照護經驗

Evidenced- Base Care of Platelet-Rich Plasma in a Knee Osteoarthritis Patient

10.6647/CN.202003_27(1).0008

張珮毓(Pei-Yu Chang)；曾萌絹(Meng-Chuan Tseng)；劉宣瑢(Hsuan-Rong Liu)

實證照護 ； 退化性膝關節炎 ； 高濃度血小板血漿 ； 玻尿酸 ； evidence- based care ； knee osteoarthritis ； platelet-rich plasma ； hyaluronic acid

彰化護理

27卷1期（2020 / 03 / 01）

49 - 61

繁體中文

退化性膝關節炎病患常因關節疼痛，導致行走不便，影響日常活動及生活品質，其治療方法除手術治療外，也有其他非手術療法可減輕膝關節疼痛並改善其身體功能活動度，關節內注射玻尿酸及高濃度血小板血漿為常見之保守性療法。因退化性膝關節炎個案拒絕手術並要求高濃度血小板血漿治療，故引發動機以實證方法搜尋相關文獻，探討退化性膝關節炎患者使用關節內注射玻尿酸及高濃度血小板血漿之成效，並應用於本文個案。實證結果發現針對中低程度退化性膝關節炎患者，使用關節內注射高濃度血小板血漿比玻尿酸更能減輕疼痛及改善身體活動功能，且副作用少，針對於高度排斥手術之患者，關節內注射高濃度血小板血漿亦是一種選擇，期能藉此案例經驗供臨床醫護人員照護退化性膝關節炎病患之參考。

Knee osteoarthritis patients often suffer from knee pain, resulting in difficulty of walking. Those symptoms could affect their daily life and quality of life. In addition to surgical treatment, non-surgical treatment could also relieve knee pain and improve physical function. Intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) are the alternative treatments used widely. The author took care of a degenerative knee osteoarthritis patient, who refused surgical treatment and requested PRP injection, which motivated the author to explore the effects between PRP and HA among patients with knee osteoarthritis. Evidenced base methodology was used and the result was also applied to the patient. The result showed intra-articular PRP was more effective for low to moderate degenerative knee osteoarthritis. PRP could reduce more knee pain and improve more physical function than HA. In addition, less adverse effects were also found. Thus, intra-articular PRP would be another choice for patients who refused surgery. We also expected this clinical case experience could provide more information to health care professionals.

1. Andia, I.,Abate, M.(2014).Knee osteoarthritis: hyaluronic acid, platelet-rich plasma or both in association?.Expert opinion on biological therapy,14(5),635-649.
2. Bellamy, N.,Buchanan, W. W.,Goldsmith, C. H.,Campbell, J.,Stitt, L. W.(1988).Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.The Journal of rheumatology,15(12),1833-1840.
3. Dai, W. L.,Zhou, A. G.,Zhang, H.,Zhang, J.(2017).Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials.Arthroscopy: The Journal of Arthroscopic & Related Surgery,33(3),659-670.
4. Dieppe, P. A.(1995).Recommended methodology for assessing the progression of osteoarthritis of the hip and knee joints.Osteoarthritis and Cartilage,3(2),73-77.
5. Dulay, G. S.,Cooper, C.,Dennison, E.(2015).Knee pain, knee injury, knee osteoarthritis & work.Best Practice & Research Clinical Rheumatology,29(3),454-461.
6. Duymus, T. M.,Mutlu, S.,Dernek, B.,Komur, B.,Aydogmus, S.,Kesiktas, F. N.(2017).Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options.Knee Surgery, Sports Traumatology, Arthroscopy,25(2),485-492.
7. Hiligsmann, M.,Cooper, C.,Arden, N.,Boers, M.,Branco, J. C.,Brandi, M. L.,Hunter, D. J.(2013).Health economics in the field of osteoarthritis: an expert's consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).Seminars in Arthritis and Rheumatism,43(3),303-313.
8. Hussain, S.,Neilly, D.,Baliga, S.,Patil, S.,Meek, R.(2016).Knee osteoarthritis: a review of management options.Scottish medical journal,61(1),7-16.
9. Kamaruzaman, H.,Kinghorn, P.,Oppong, R.(2017).Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature.BMC musculoskeletal disorders,18(1),183.
10. Kanchanatawan, W.,Arirachakaran, A.,Chaijenkij, K.,Prasathaporn, N.,Boonard, M.,Piyapittayanun, P.,Kongtharvonskul, J.(2016).Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee.Knee Surgery, Sports Traumatology, Arthroscopy,24(5),1665-1677.
11. McAlindon, T. E.,Bannuru, R. R.,Sullivan, M.,Arden, N.,Berenbaum, F.,Bierma-Zeinstra, S.,Kawaguchi, H.(2014).OARSI guidelines for the non-surgical management of knee osteoarthritis.Osteoarthritis and Cartilage,22(3),363-388.
12. Milants, C.,Bruyère, O.,Kaux, J.-F.(2017).Responders to platelet-rich plasma in osteoarthritis: a technical analysis.BioMed research international
13. Paterson, K. L.,Nicholls, M.,Bennell, K. L.,Bates, D.(2016).Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study.BMC musculoskeletal disorders,17(1),67.
14. Richards, M. M.,Maxwell, J. S.,Weng, L.,Angelos, M. G.,Golzarian, J.(2016).Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine.The Physician and sportsmedicine,44(2),101-108.
15. Sánchez, M.,Fiz, N.,Azofra, J.,Usabiaga, J.,Recalde, E. A.,Gutierrez, A. G.,Padilla, S.(2012).A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the shortterm treatment of symptomatic knee osteoarthritis.Arthroscopy: The Journal of Arthroscopic & Related Surgery,28(8),1070-1078.
16. Say, F.,Gürler, D.,Yener, K.,Bülbül, M.,Malkoc, M.(2013).Platelet-rich plasma injection is more effective than hyaluronic acid in the treatment of knee osteoarthritis.Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca,80(4),278-283.
17. Unver, B.,Ertekin, Ö.,Karatosun, V.(2014).Pain, fear of falling and stair climbing ability in patients with knee osteoarthritis before and after knee replacement: 6 month follow-up study.Journal of back and musculoskeletal rehabilitation,27(1),77-84.
18. Vaquerizo, V.,Plasencia, M. Á.,Arribas, I.,Seijas, R.,Padilla, S.,Orive, G.,Anitua, E.(2013).Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial.Arthroscopy: The Journal of Arthroscopic & Related Surgery,29(10),1635-1643.
19. Walker, L. C.,Clement, N. D.,Bardgett, M.,Weir, D.,Holland, J.,Gerrand, C.,Deehan, D. J.(2018).The WOMAC score can be reliably used to classify patient satisfaction after total knee arthroplasty.Knee Surgery, Sports Traumatology, Arthroscopy,26(11),3333-3341.
20. Zhang, H. F.,Wang, C. G.,Li, H.,Huang, Y. T.,Li, Z. J.(2018).Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis.Drug design, development and therapy,12,445-453.
21. 行政院衛生福利部（2018年4月27日）‧105年住院人次統計‧取自https://dep.mohw.gov.tw/DOS/cp-3745-39015-113.html