富血小板血浆联合关节镜治疗Ⅲ度半月板损伤膝关节功能恢复时间的影响因素分析

doi:10.3969/j.issn.1000-8535.2024.06.017

摘要/Abstract

摘要： 目的探讨富血小板血浆（PRP）联合关节镜治疗Ⅲ度半月板损伤患者的临床疗效,及其对膝关节功能恢复时间的影响。方法选取2021年2月—2022年2月南方医科大学南方医院增城院区骨科收治的Ⅲ度半月板损伤患者45例,采用随机数字法分为观察组22例与对照组23例,对照组患者在关节镜下行半月板成形术,观察组在对照组基础上给予PRP治疗。观察两组患者术后恢复时间、治疗效果及并发症发生情况;比较两组治疗前和治疗后1、3、6个月膝关节功能、疼痛情况。结果利用观察组患者自体全血制备的PRP,其血小板的回收率、红细胞留存率、白细胞留存率分别为（91.00±9.27）%、（0.29±0.12）%、（29.98±6.68）%,PRP制备质量稳定、可控。观察组联合PRP治疗术与关节镜手术治疗后恢复时间均短于对照组,观察组治疗有效率高于对照组（P<0.05）。经重复方差测量分析,两组美国特种外科医院膝关节评分系统（HSS）评分、西安大略大学和麦克马斯特大学骨关节炎指数（WOMAC）评分、视觉模拟疼痛评分法（VAS）交互（F_交互=1.869、F_交互=1.482、F_交互=2.193）比较差异均有统计学意义（P<0.05）;与对照组治疗后1、3、6个月比较,观察组HSS评分升高,WOMAC评分、VAS评分下降（P<0.05）;观察组并发症总发生率4.55%低于对照组30.43%（χ²=5.156、P=0.023）。结论对于Ⅲ度半月板损伤患者,采用PRP联合关节镜手术治疗可帮助患者消炎止痛、加快疗效、加快膝关节功能的恢复,缩短其恢复的时间,效果良好,且安全性较高。

关键词: 富血小板血浆, 关节镜, Ⅲ度半月板损伤, 膝关节功能恢复

Abstract: Objective To investigate the clinical effect of platelet rich plasma（PRP）combined with arthroscopy treatment on patients with third degree meniscus injury,and its impact on the recovery time of knee joint function．Methods From February 2021 to February 2022,45 patients with III-degree meniscal injuries admitted to the Department of Orthopedics,Zengcheng district,Nanfang Hospital of Southern Medical University were selected and divided into an observation group of 22 cases and a control group of 23 cases using the random number method．Patients in the control group received menisplasty under arthroscopy,and the observation group was given PRP treatment on the basis of the control group．The postoperative recovery time,treatment effects and complications of the two groups of patients were observed;the knee joint function and pain of the two groups before treatment and 1,3,and 6 months after treatment were compared．Results The platelet recovery rate,red blood cell retention rate,and white blood cell retention rate of PRP prepared from the autologous whole blood of patients in the observation group were（91.00±9.27）%,（0.29±0.12）%,and（29.98±6.68）% respectively．The PRP preparation quality is stable and controllable．The recovery time after combined PRP treatment and arthroscopic surgery in the observation group was shorter than that in the control group,and the treatment effectiveness of the observation group was higher than that of the control group（P<0.05）．After repeated measures of variance analysis,the comparison of American Hospital for Special Surgery（HSS）Knee Scoring System,Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）,and visual analogue pain scales（VAS）interacted(F_Interaction=1.869,F_interaction=1.482,F_interaction=2.193),the differences were statistically significant（P<0.05）．Compared with the control group 1,3,and 6 months after treatment,the HSS score of the observation group increased,and the WOMAC score,VAS score decreased（P<0.05）;the total incidence of complications in the observation group was 4.55%,lower than that in the control group（30.43%,χ²=5.156,P=0.023）．Conclusions For patients with III-degree meniscal injuries,PRP combined with arthroscopic surgery can help reduce inflammation and pain,speed up the curative effect,accelerate the recovery of knee joint function,and shorten the recovery time．It has good effects and is relatively safe．

Key words: platelet-rich plasma, arthroscopic treatment, third degree meniscus injury, knee joint function recovery

潘芹, 李小丹, 伍星. 富血小板血浆联合关节镜治疗Ⅲ度半月板损伤膝关节功能恢复时间的影响因素分析[J]. 广州医药, 2024, 55(6): 673-679.

PAN Qin, LI Xiaodan, WU Xing. Analysis of influencing factors on the recovery time of knee joint function in the treatment of third-degree meniscus injury with platelet rich plasma combined with arthroscopy[J]. Guangzhou Medical Journal, 2024, 55(6): 673-679.

参考文献

[1] 李石旦,张倩婷,王绍川,等.1318例半月板损伤患者的流行病学特征[J].中华骨与关节外科杂志,2023,16(2):159-163.
[2] 李青天. 关节镜联合小针刀松解膝内侧副韧带浅层治疗退行性膝关节内侧半月板损伤的临床效果[J].内蒙古中医药,2021,40(5):117-119.
[3] 蔡超. 关节镜联合PRP治疗对膝关节半月板损伤患者临床疗效、疼痛及关节功能的影响研究[J].四川解剖学杂志,2020,28(3):29-30.
[4] 胡争波,李文虎,袁艾东,等.富血小板血浆治疗慢性半月板损伤的前期疗效观察[J].中华关节外科杂志(电子版),2019,13(1):33-38.
[5] 李燕,赵海龙,李伟,等.MRI对运动性半月板损伤的诊断及术后康复效果的评估[J].影像科学与光化学,2022,40(3):675-679.
[6] EVERHART J,CAVENDISH P A,EIKENBERRY A,et al.Platelet-rich plasma reduces failure risk for isolated meniscal repairs but provides no benefit for meniscal repairs with anterior cruciate ligament reconstruction[J].Am J Sports Med,2019,47(8):1789-1796.
[7] GRIFFIN J W,HADEED M M,WERNER B C,et al.Platelet-rich plasma in meniscal repair:Does augmentation improve surgical outcomes?[J].Clin Orthop Relat Res,2015,473(5):1665-1672.
[8] BRAUN H J,KIM H J,CHU C R,et al.The effect of platelet-rich plasma formulations and blood products on human synoviocytes[J].Am J Sports Med,2014,42(5):1204-1210.
[9] 孙仕华,郑建平,潘昊.实用临床骨外科学[M].长春:吉林科学技术出版社,2012.
[10] 李晓光. McMurray试验[J].中国矫形外科杂志,2010,18(2):123.
[11] 吴建伟,陈浩鹏,张天一,等.关节镜联合富血小板血浆治疗老年半月板损伤的短期临床效果评价[J].中国医刊,2020,55(12):1331-1334.
[12] 何健,甄小伟.MIPO技术与髓内钉固定对胫腓骨骨折患者HSS评分、疼痛介质及血清PINP、MMP-9水平的影响[J].川北医学院学报,2021,36(11):1428-1431,1454.
[13] 陈国华,邵建赟,何健,等.成人大骨节病膝关节生物力学测量与 WOMAC 评分的多重回归分析[J].中华地方病学杂志,2018,37(3):186-191.
[14] 魏东,陈翔,顾晓东,等.关节镜手术联合富血小板血浆治疗半月板损伤的Meta分析[J].中国骨伤,2021,34(9):879-886.
[15] 杨春生. 关节镜下半月板成形术联合膝关节功能锻炼治疗半月板损伤的效果[J].中国误诊学杂志,2020,15(9):397-399.
[16] 谢博多,文学,张志强,等.针灸辅助关节镜联合富血小板血浆治疗半月板损伤临床观察[J].山东中医杂志,2022,41(6):638-643.
[17] 王昌. 关节镜下半月板成形术联合PRP应用于膝关节半月板损伤患者治疗的临床疗效观察[J].智慧健康,2021,7(23):69-71.
[18] 马维理,陈国奋.PRP联合关节镜半月板成形术治疗老年膝关节半月板损伤的疗效及对患者关节功能的影响[J].海南医学,2021,32(1):68-71.
[19] 史昱晖,陶天奇,朱立帆,等.富血小板血浆对半月板损伤患者炎症及关节功能的影响[J].中华关节外科杂志(电子版),2020,14(3):329-333.
[20] 仇建军,邹翰林,张磊,等.富血小板血浆修复半月板损伤的研究进展[J].国际骨科学杂志,2021,42(5):305-309.
[21] 左秀芹,尹飒飒,谢惠敏,等.富血小板血浆在肌骨修复领域应用的适用性与相关规范[J].中国组织工程研究,2021,25(20):3239-3245.
[22] BENNELL K L,HUNTER D J,PATERSON K L.Platelet-rich plasma for the management of hip and knee osteoarthritis[J].Curr Rheumatol Rep,2017,19(5):24.
[23] 姜云虎,张喜久,李基新,等.基于Sirt1/FoxO1通路探讨体外冲击波联合富血小板血浆治疗膝关节骨性关节炎大鼠软骨损伤的作用机制[J].国际生物医学工程杂志,2023,46(5):427-432.
[24] 唐凤娟,叶致宇,刘思佳,等.富血小板血浆联合三氧大自血疗法辅助关节镜治疗膝关节骨性关节炎的效果[J].临床和实验医学杂志,2023,22(8):854-858.
[25] 马小松,李朋斌,邬良平.关节镜下微骨折联合富血小板血浆治疗膝关节骨性关节炎的临床疗效分析[J].中外医疗,2023,42(9):49-53.
[26] 吴驷东,杨杰,徐扬.自体富血小板血浆联合关节镜下清理术治疗半月板损伤合并膝关节炎的疗效[J].检验医学与临床,2023,20(20):3090-3094.
[27] 卢立坤,杨雷.骨痛灵酊外敷联合富血小板血浆膝关节腔注射对半月板损伤术后康复的临床疗效观察[J].中医外治杂志,2023,32(2):35-37.
[28] 叶培,王立晖,臧学慧.富血小板血浆联合髓芯减压治疗早期膝关节自发性骨坏死的疗效[J].广州医药,2022,53(1):45-49.