先日の テレビで PRP ( Platelet rich plasmaの略)が 膝や肉離れに有効であるという
番組が放送されました。
ご覧になられたかたも多いと思います。


通常のPRPの関節内注射に関する文献も紹介したいと思います。

無作為化対照試験;エビデンスレベル1の文献です。

股関節OAに対する超音波エコーガイド下のPRPとヒアルロン酸の単体及び組合せ注射

Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis

Dante Dallari,*y MD, Cesare Stagni,y MD, and Gianluca Giavaresi,§ MD

2016  Am J Sports Med

●背景

『関節内PRP注射の効果は、膝chondroplasty及びOA(変形性関節症)において評価されている;しかしながら、股関節 変形性関節症におけるその有効性についてのエビデンスはほとんど存在しない。』

BACKGROUND:
The effectiveness of intra-articular platelet-rich plasma (PRP) injections has been evaluated in knee chondroplasty and osteoarthritis (OA); however, little evidence of its efficacy in hip OA exists.



●目的 

『股関節OAにおいて、自家PRP、ヒアルロン酸(HA)、または両方の組み合わせ(PRP+HA)の治療効果を比較すること。』

PURPOSE:
To compare the therapeutic efficacy of autologous PRP, hyaluronic acid (HA), or a combination of both (PRP+HA) in hip OA.



方法
18歳から65歳までの 変形性股関節症を有する 外来手術を行なった患者さんを VAS scoreが20以上の患者を集めた
WOMAC score HHS score VAS scoreで臨床成績を評価した。


METHODS:
Patients aged between 18 and 65 years who were treated with outpatient surgery and who had hip OA and pain intensity at baseline of >20 on a 100-mm visual analog scale (VAS) were recruited for this study. Exclusion criteria were extensive surgery; presence of excessive deformities; or rheumatic, infective, cardiovascular, or immune system disorders. The primary outcome measure was a change in pain intensity as assessed by the VAS at 2, 6, and 12 months after treatment. Secondary outcome measures were the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and concentration of growth factors in PRP and their correlation with clinical outcomes. Clinical outcomes were evaluated by assessors and collectors blinded to the type of treatment administered.



結果

百十一人の患者さんをランダムに 3群に分けた 3回週の  PRP単独  PRPとヒアルロン酸  ヒアルロン酸のみ  を注射した
PRP単独群のが  VAS スコア が最も低かった。(すなわち 疼痛緩和が最も効果的であった)

WOMAC スコアは 2ヶ月と6ヶ月で 他の群よりも良好であった/

疼痛緩和と 生活の質の改善において、有意な改善が達成された。

RESULTS:
A total of 111 patients were randomly assigned to 3 groups and received 3 weekly injections of either PRP (44 patients), PRP+HA (31 patients), or HA (36 patients). At all follow-ups, the PRP group had the lowest VAS scores. In particular, at 6-month follow-up, the mean VAS score was 21 (95% CI, 15-28) in the PRP group, 35 (95% CI, 26-45) in the PRP+HA group, and 44 (95% CI, 36-52) in the HA group (P < .0005 [PRP vs HA] and P = .007 [PRP vs PRP+HA]; F = 0.663). The WOMAC score of the PRP group was significantly better at 2-month follow-up (mean, 73; 95% CI, 68-78) and 6-month follow-up (mean, 72; 95% CI, 67-76) but not at 12-month follow-up. A significant, "moderate" correlation was found between interleukin-10 and variations of the VAS score (r = 0.392; P = .040). Significant improvements were achieved in reducing pain and ameliorating quality of life and functional recovery.





●結語を抜粋します。

『結果は、関節内PRP注射が、股関節OAを有する患者らにおいて、関連される副作用を伴わず、有意な臨床改善を提供することを示唆した。他のテストされた治療と比較したときの利点は、最大12ヶ月まで有意に安定していた。HAにPRPの追加は、疼痛症状において有意な改善を導かなかった。』


Abstract
BACKGROUND:
The effectiveness of intra-articular platelet-rich plasma (PRP) injections has been evaluated in knee chondroplasty and osteoarthritis (OA); however, little evidence of its efficacy in hip OA exists.



STUDY DESIGN:
Randomized controlled trial; Level of evidence, 1.




CONCLUSION:
Results indicated that intra-articular PRP injections offer a significant clinical improvement in patients with hip OA without relevant side effects. The benefit was significantly more stable up to 12 months as compared with the other tested treatments. The addition of PRP+HA did not lead to a significant improvement in pain symptoms.