Regarding the treatment of knee osteoarthritis, Liu Peilai, director of joint and sports medicine at Qilu Hospital of Shandong University, advocates step-by-step treatment, so that patients can have more choices, not just the option of "changing knees". At the same time, Liu Peilai advocated that knee osteoarthritis needs precise treatment and should choose a treatment plan that suits you based on the patient's own situation, such as age, gender, weight, occupation, etc.
Today, let Liu Pei talk about what he understands about the ladder treatment of knee osteoarthritis and the application of PRP in the treatment of knee osteoarthritis.
Liu Peilai accepted an online interview with orthopedics
Regarding knee osteoarthritis, he always insisted on step-by-step treatment
According to Epidemiological survey , the incidence of knee osteoarthritis in the elderly in my country is 16-17%, higher than that of the hands (4-5%) and hip joints (6%). Faced with many patients with knee osteoarthritis, Liu Peilai has always adhered to the concept of step-by-step treatment.
He believes that knee osteoarthritis is developing in stages, so treatment also requires step-by-step treatment, and accurate treatment is carried out for different stages of the disease, different manifestations, and individual conditions of the patients. "For example, based on the patient's age, gender, weight, and nature of work, whether it is physical or mental labor, and combined with the lesion stage of knee osteoarthritis, whether it is early, middle or late stage, and whether there are any abnormalities in the joint position," said Liu Peilai's daily work
Liu Peilai introduced that step-by-step treatment includes conservative treatment, restorative treatment, arthroscopic treatment, knee protection surgery and total knee replacement. Among them, conservative treatment includes basic treatment and drug treatment. Weight control, muscle training, auxiliary braces and physical therapy are basic treatments. Drug treatment mainly involves taking NSAIDs drugs, as well as chronic drugs that relieve joint pain and inflammatory swelling.
PRP (rich in platelet plasma) is a repairing treatment method for knee osteoarthritis, and has the characteristics of little trauma and good efficacy. Arthroscopy can be used to perform minimally invasive surgeries such as joint cleaning, meniscus injury and free bodies. HTO and UKA are knee protection surgery, both of which are the most commonly used surgical methods for ladder treatment of knee osteoarthritis. Compared with knee replacement, knee protection surgery retains the ligaments of the knee joint, and this treatment method protects joint function the most naturally. In the ladder treatment of
, he believes that it is worth promoting
Liu Pei once said that a theory and a technology are recognized by peers, accepted by patients, and achieved good results. This is good medical skills and good technology. In the treatment of knee osteoarthritis, there is a technology that not only achieves minimally invasiveness and precision, but also has excellent efficacy and lasts for a long time. It is PRP technology.
PRP, which is rich in platelet plasma, refers to an autologous plasma preparation containing platelet , growth factor , protein and other components extracted from the patient's autologous whole blood through centrifugation.
Liu Peilai in New York Beth Israel Joint and Sport Center Communication and learning
Liu Peilai summarized the main role of PRP, which mainly includes the following aspects:
1. Promote tissue repair and regeneration
Liu Peilai emphasized that PRP is rich in a variety of growth factors, such as platelets. Derivative growth factors (PDGF), epidermal growth factor (EGF), vascular endothelial cell growth factor (VEGF), insulin-like growth factor (IGF), fibroblast growth factor (FGF), etc. After activation, these growth factors can accelerate the differentiation of stromal stem cells, promote the proliferation of osteoblasts and fibroblasts and , accelerate the synthesis of fibrin and extracellular matrix, and facilitate tissue regeneration and repair.
2. Reduce inflammatory response
"PPR can reduce the secretion of inflammatory factors and reduce the inflammatory response of surrounding tissues, thereby achieving the effect of relieve pain."Liu Peilai said that PRP contains a large number of growth factors, which can compete to inhibit the inflammatory response pathway, reduce the synthesis of inflammatory factors and enzymes, reduce the concentration of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and metalloproteinase, and exert the role of anti-inflammatory .
During his study and exchange at the University of Oxford in the UK, Liu Peilai and Jonh O’Connor, one of the inventors of the Oxford activity platform, Group photo
3. Improve the intra-articular environment
PRP stimulates synovial cells to secrete endogenous hyaluronic acid by releasing a variety of biologically active factors, which plays the role of lubricate joints, nourishes cartilage, and relieves pain. Liu Peilai said that platelets in PRP can also secrete antibacterial peptide , which has a certain anti-infective effect.
" Injection of PRP is a safe and effective treatment method for the treatment of knee osteoarthritis. It can not only reduce the inflammatory factors and synovial fluid in arthritis, significantly reduce pain and improve clinical function, but also reduce the risk of adverse events . "In Liu Pei's view, PRP plays a very important role in the treatment of knee osteoarthritis.
PRP has unique advantages in treating knee osteoarthritis
Knee is the joint with the largest weight bearing and the most exercise in the human body, and is also the part with the earliest degeneration and most damage in the human body. Therefore, many elderly people suffer from knee osteoarthritis. PRP has unique advantages in treating knee osteoarthritis, so Liu Peilai suggests that as long as patients with early and mid-stage knee osteoarthritis who meet the PRP indications can make Use PRP technology.
Liu Peilai attended a knee protection academic conference in South Korea
Regarding the unique advantages of PRP, Liu Peilai expressed the following points:
. Adapt to the large number of patients, and has good effect on early and mid-stage knee osteoarthritis. It significantly reduces patients' pain, improves joint mobility, and improves patients' quality of life.
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Liu Peilai participated in the free knee protection clinic
. Safety: PRP originates from autologous blood and has high safety. Generally, it will not cause immune response or spread diseases.
"Clinical Practice Guidelines for the Treatment of Knee Osteoarthritis with PRP (2018 Edition)" pointed out that "For patients with knee osteoarthritis, injection of PRP in joint cavity will not increase the incidence of adverse events, such as infection, local redness, swelling and pain". et al. ".
. Convenient: The joint cavity injection operation is simple and convenient, the treatment time is short, and it does not affect normal walking after treatment, and it is easy for patients to accept it.
for the treatment of knee osteoarthritis, PRP must be used in standardized manner
In recent years, PRP has been increasingly used in clinical practice, especially in the field of treating knee osteoarthritis, which has attracted widespread attention. "PRP has achieved specific efficacy in the treatment of knee osteoarthritis, but in clinical applications, there is a lack of unified norms and standards. "Liu Peilai said that the following issues need to be paid attention to in clinical applications of PRP:
1. Selection of leukocyte-rich PRP and leukocyte-poor PRP
Due to different product sets and preparation methods, the components of the prepared PRP cells vary, among which the number of leukocytes is an important measurement standard. According to the concentration of leukocytes, PRP can be divided into leukocyte-poor PRP and leukocyte-poor PRP. Different types of PRP will have different effects on cell regeneration and tissue healing.
Liu Peilai pointed out that leukocyte-poor PRP is more suitable for the treatment of osteoarthritis, while leukocyte-rich PRP is more suitable for chronic tissue damage, Achilles tendonitis , fractures and trauma. Because leukocyte- function is to kill foreign bacteria and tissues indiscriminately, the result after killing is the release of free radical , and the secretion of other interleukin-6 and tumor necrosis inflammatory factors. These inflammatory factors will aggravate the occurrence of inflammation, so leukocyte-poor PRP is the first choice for the treatment of osteoarthritis, and leukocyte-rich PRP cannot be selected.
Liu Peilai in Canada Western Ontario University Hospital Learn to communicate
2. Optimal concentration of platelets
"It is not that the more platelets, the better the effect of treating knee osteoarthritis, because the binding sites of cell membrane receptors are limited, and the binding sites of platelet growth factors are also limited. Too many platelets cannot play a role. On the contrary, it will inhibit the growth factors from playing a role in proliferation and repair." So Liu Peilai emphasized that the higher the concentration of platelets, the better, and it is best to control the concentration between 2-4 times, because this concentration can better stimulate cell proliferation and synthesis of hyaluronic acid .
3. Avoid using hormones and anesthetics
Liu Pei emphasized that when using PRP to treat knee osteoarthritis, it is necessary to avoid using hormones and anesthetics. Because hormones and anesthetics promote the degradation of soft tissues, they are not conducive to cartilage synthesis. "In clinical practice, it is not recommended to treat osteoarthritis by injecting hormones multiple times. One injection is enough during the acute inflammation period." Liu Peilai believes that in the treatment of knee osteoarthritis, the use of PRP and blocking needle should be avoided.
4. Before extracting PRP, stop taking NSAIDs drugs
NSAIDs drugs are commonly used by most patients with knee osteoarthritis. They have anti-inflammatory and analgesic effects, but this drug can also inhibit the function of platelets, while PRP uses the repair function of platelets, so the opposite effect of the two. Taking NSAIDs drugs will reduce the efficacy of PRP and significantly reduce the effect of growth factors.
Liu Peilai took a photo with the students in the knee protection study class to take a photo
5. The frequency of injection of PRP
"It is recommended to inject PRP once every 7-10 days." Liu Peilai pointed out that the average lifespan of platelets is 5-9 days, so the frequency of recommended dose of PRP is exactly within the metabolic time of platelets. In clinical practice, it is once every 7-10 days, three times in a row. Generally speaking, the patient's symptoms will be significantly relieved and the efficacy can last for one year. PRP can be injected again the second year to continue the previous treatment effect. Then and so on.
Due to the effectiveness, safety and simplicity of PRP in the treatment of osteoarthritis, Liu Peilai is very optimistic about its development prospects and believes that it will be accepted by more patients. Liu Peilai also emphasized that the indication for PRP is mild and moderate knee osteoarthritis. If there is severe knee osteoarthritis, it is recommended to undergo relevant evaluation for knee protection surgery or total knee replacement.
Conclusion
Understanding what the patient is anxious about, worrying about what the patient is worried about, thinking about what the patient is thinking. This idea of focusing on patients always guides Liu Peilai's way of practicing medicine. In the future, he will continue to stick to his philosophy: step-by-step treatment of knee osteoarthritis; continue to advocate minimally invasive, precise, and low-risk treatment strategies, so as to truly benefit the majority of patients suffering from osteoarthritis.
The doctor is a kind person, and the doctor is kind. We can always believe that a doctor is willing to put in time and effort to cure diseases and save lives. As an orthopedic doctor, he will not forget his original intention and internalize the treatment concept into a practical guide, and gradually move away from the road to the treatment of knee osteoarthritis.
Expert resume
Liu Peilai
Medical doctor, chief physician, professor, doctoral supervisor
Director of the Department of Joint and Sports Medicine, Deputy Director of Orthopedics,
Member of the Standing Committee of the Bone Joint Protection and Health Branch of the Qilu Hospital of Shandong University
Member of the Joint Surgery Professional Committee of the Chinese Research Hospital Society and Deputy Leader of the Joint Protection and Orthopedics Group
Deputy Leader of the Rehabilitation Group of the Orthopedics Branch of the Chinese Medical Association
Chinese Medical Education Association Orthopedics Standardized Training Shandong Base Chairman
Director of the Joint and Sports Medicine Department and Deputy Director of Orthopedics Department
Shandong Province Rehabilitation Medicine Chairman of the Society's Bone and Joint Professional Committee
Deputy Chairman of the Orthopedic Science Branch of Shandong Medical Association and Head of the Rehabilitation Group
Vice Chairman of the Orthopedic Surgery Branch of Shandong Medical Association
Vice Chairman of the Orthopedic Surgery Branch of Shandong Medical Association
Vice Chairman of the Orthopedic Surgery Branch of Shandong Medical Association
Secondary of the Shandong Provincial Knee Arthritis Ladder Treatment Committee
SICOT Standing Committee of the First Committee of the Youth Committee of the Ministry of China
Currently undertakes 4 national and provincial scientific research projects, publishes 13 SCI papers, and participates in the editing of 3 monographs as deputy editor or editor, and mainly translates 3 foreign orthopedic tutorials, 1 national invention patent and 9 utility model patents
Editorial Committee of the Fourth Editorial Committee of the 4th Editorial Committee of " Practical Orthopedic Magazine ", "Knee" Surgery&Related Research, " Journal of Shandong University ", "Chinese Journal of Bone and Joint", "Chinese Tissue Engineering Research", and other journals reviewed
