Birinci Karpometakarpal Eklem Osteoartritinin Tedavisi: Kortikosteroid ile Platelet Zengin Plazma – Randomize Karşılaştırmalı Çalışma

Year 2019, , 143 - 151, 22.03.2019

Mehmet Emin Şimşek

https://doi.org/10.17098/amj.542222

Abstract

Amaç: İleri yaş erkek ve kadınların birinci parmağın
karpometakarpal (KMK) eklem artrozu %35,8 sıklıkta görülmektedir. Çalışmamızda
elde 1. parmak karpometakarpal eklem artrozunda kortikosteroid ve platelet
zengin plazma (PZP) enjeksiyonunun klinik ve fonksiyonel sonuçlar üzerinde
etkisinin karşılaştırılması amaçlanmıştır.

Materyal ve Metot: Bu çalışmada Ekim
2016 – Mart 2018 tarihleri arasında kliniğimize başvuran, elde 1.
karpometakarpal eklemde osteoartrit tanısı konulan ve daha önce diğer
konservatif tedavi yöntemlerinden fayda görmeyen, Eaton- Littler sınıflamasına
göre evre 2 ve en az 24 hafta takip edilmiş olan 58 hasta prospektif çalışmaya
dahil edildi. 1.,2.,3. ve 6. aylarda Dreiser ve VAS skorları ile
değerlendirilerek sonuçlar istatistiksel olarak karşılaştırıldı.

Bulgular: Grupların enjeksiyon öncesi VAS ve
Dreiser skorları arasında istatistiksel olarak anlamlı fark yoktu (sırası ile
p=0,211 ve p=0,239). Her iki grubun kendi içinde enjeksiyon öncesi ile
4.,8.,12. ve 24. haftalardaki klinik skorları arasındaki fark istatistiksel
olarak anlamlı olup, VAS ve Dreiser skorlarında düzelme istatistiksel anlamlı
düzeyde olduğu tespit edildi (p <0,001). 24. Haftada her iki grup VAS ve
Dreiser skoru sonuçlarında düzelme olduğu ve iki grubun klinik sonuçlarının
benzer olduğu görülmüştür. 24. Haftada ağrı ve fonksiyonel iyileşme miktarı her
ne kadar azalmış olsada enjeksiyon öncesi döneme göre istatistiksel olarak VAS
ve Dreiser skorlarında anlamlı düşüş mevcuttur (p<0,05). 

Sonuç: PZP ve steroid enjeksiyonları karşılaştırıldığında 24.
haftada Dreiser skoru ile elde edilen el fonksiyonlarında iyileşme ve VAS
skoruna göre elde edilen ağrı derecesinde azalmanın her iki yöntem için benzer
olduğu ve aralarında istatistiksel olarak anlamlı fark olmadığı tespit
edilmiştir. Elimizdeki veriler değerlendirildiğinde, PRP’ nin birinci KMK eklem
osteoartritinde etkinliği gösterilmiş olsa da; hazırlık sürecinin zor ve
maliyetin daha fazla olması, kit temini güçlüğü gibi zorluklar sebebiyle
steroid tedavisinin yerini alması zor görünmektedir.

Keywords

karpometakarpal eklem, osteoartrit, platelet zengin plazma, kortikosteroid

Treatment of the First Carpometacarpal Joint Osteoarthritis: Corticosteroid Versus Platelet Rich Plasma – A Randomized Comparative Study

Abstract

Objectives: The prevalence of arthrosis of the thumb
carpometacarpal (CMC) joint is 35.8% in older males and females. In our study,
it was aimed to compare the effect of corticosteroid and platelet-rich plasma
(PRP) injection on the clinical and functional results in arthrosis of the
first carpometacarpal joint of the hand.

Materials and Methods: 58 patients who presented to our clinic between October
2016 - March 2018 and were diagnosed with osteoarthritis of the first
carpometacarpal joint of the hand, who did not previously benefit from other
conservative treatment methods, who were stage 2 according to the Eaton-Littler
classification and followed-up for at least 24 weeks were enrolled in this
prospective study. Dreiser and VAS scores at months 1, 2, 3 and 6 were
evaluated and the results were statistically compared.

Results: There was no statistically significant difference between the groups in
terms of pre-injection VAS and Dreiser scores (p=0.211 and p=0.239,
respectively). The difference between the clinical scores before the injection
and at weeks 4, 8, 12 and 24 within each group was statistically significant,
wherein the improvement in VAS and Dreiser scores was at a statistically
significant level (p<0.001). It was observed that both groups exhibited an
improvement in VAS and Dreiser scores and the clinical results of the two
groups were similar at week 24. Although the amount of functional improvement
and pain had decreased at week 24, VAS and Dreiser scores exhibited a
statistically significant decrease in comparison to the pre-injection period
(p<0.05).

Conclusion: Comparing PRP and steroid injections, it was observed
that the improvement in hand functions according to the Dreiser score and the
decrease in the level of pain according to the VAS score at week 24 were
similar in both methods, and there was no statistically significant difference
between them. In the light of current data, although the efficacy of PRP has
been proven in osteoarthritis of the first CMC joint, replacing the steroid
treatment with PRP seems difficult due to drawbacks such as the challenging
preparation period, higher costs and difficulty of supplying the kits.

Keywords

carpometacarpal joint, osteoarthritis, platelet rich plasma, corticosteroid

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