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

doi:10.3969/j.issn.1000-8535.2022.01.009

广州医药 ›› 2022, Vol. 53 ›› Issue (1): 45-49.DOI: 10.3969/j.issn.1000-8535.2022.01.009

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

叶培, 王立晖, 臧学慧

华南理工大学附属第六医院骨科(佛山 528200)

收稿日期:2021-07-12 出版日期:2022-01-20 发布日期:2022-04-12
通讯作者: 臧学慧,E-mail:114965815@qq.com
基金资助:
佛山市医学类科技攻关项目(1920001001280,1920001001814)

Effect of platelet-rich plasma combined with core decompression in the treatment of early spontaneous osteonecrosis of the knee

YE Pei, WANG Lihui, ZANG Xuehui

Orthopedic Department, The Sixth Affiliated Hospital, South China University of Technology, Foshan 528200, China

Received:2021-07-12 Online:2022-01-20 Published:2022-04-12

摘要/Abstract

摘要： 目的探讨富血小板血浆(platelet-rich plasma, PRP)联合髓芯减压治疗早期膝关节自发性骨坏死(spontaneous osteonecrosis of the knee, SONK)的临床疗效。方法回顾性分析我院2015年6月—2020年6月收治Koshino分期为Ⅰ、Ⅱ期的SONK患者,按治疗方法不同分为单纯髓芯减压组(对照组 21例)和PRP注射+髓芯减压组(PRP组 22例),比较2组患者治疗前、后1月、3月、6月、12月的VAS评分、WOMAC评分,评估术前和随访时膝关节功能,并观察记录有无并发症。结果 43例患者术后随访12～62个月,2组患者治疗后均无切口感染、关节感染、深静脉血栓等并发症。2组患者术前VAS评分、WOMAC评分比较无统计学意义(P>0.05);VAS评分、WOMAC评分在术后1、3、6 、12月较术前比较差异均有统计学意义(P<0.05);与对照组相比,PRP组术后3、6、12月的VAS评分降低(P＜0.05),PRP组在术后6、12月的WOMAC评分改善(P＜0.05)。PRP组、对照组的总体有效率分别为90.48%(19/21)、77.27%(17/22),差异有统计学意义(P＜0.05)。在完成治疗12个月后至今的随访中,对照组共有6例患者、PRP组仅2例患者行单髁置换。结论富血小板血浆联合髓芯减压治疗早期SONK,安全有效,临床疗效优于单纯髓芯减压术。

关键词: 富血小板血浆, 髓芯减压, 自发性骨坏死, 膝关节

Abstract: Objective To investigate the clinical effect of platelet-rich plasma(PRP) combined with core decompression in the treatment of early spontaneous osteonecrosis of the knee(SONK). Methods A retrospective analysis of SONK patients with Koshino stage I and Ⅱ admitted to our hospital from June 2015 to June 2020 was carried out. According to the different treatment methods, patients were divided into core decompression group (control group, 21 patients), and knee joint cavity PRP injection combined with core decompression group (PRP group, 22 patients). The VAS scores and WOMAC scores before treatment, 1, 3, 6 and 12 months after surgery were compared between the two groups to assess the knee joint function, and observed whether there were complications. Results Forty-three patients were followed up for 12 to 62 months after the operation. After treatment, the two groups had no complications such as wound infection, joint infection, or deep vein thrombosis. The preoperative VAS score and WOMAC score of the two groups were not significantly different (P>0.05);compared with those before the operation, VAS score and WOMAC score were significantly different at 1, 3, 6, and 12 months after the operation (P<0.05); compared with the control group, the VAS score of the PRP group was significantly reduced at 3, 6, and 12 months after surgery (P<0.05), and the WOMAC score of the PRP group was significantly improved at 6 and 12 months after surgery (P<0.05). The overall effective rates of the PRP group and the control group were 90.48% (19/21) and 77.27% (17/22) respectively, and the difference between the two groups was statistically significant (P<0.05). In the follow-up 12 months after the completion of the treatment, 6 patients in the control group and 2 patients in the PRP group underwent unicondylar replacement. Conclusion The combination of platelet-rich plasma and core decompression in the treatment of early SONK was safe and effective, and the clinical effect was better than that of core decompression only.

Key words: platelet-rich plasma, core decompression, spontaneous osteonecrosis, knee joint

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.

YE Pei, WANG Lihui, ZANG Xuehui. Effect of platelet-rich plasma combined with core decompression in the treatment of early spontaneous osteonecrosis of the knee[J]. Guangzhou Medical Journal, 2022, 53(1): 45-49.

参考文献

[1] AHLBACK S, BAUER G C, BOHNE W H. Spontaneous osteonecrosis of the knee[J]. Arthritis Rheum, 1968,11(6):705-733.
[2] DEIE M, OCHI M, ADACHI N, et al. Artificial bone grafting[calcium hydroxyapatite ceramic with an interconnected porous structure (IP-CHA)] and core decompression for spontaneous osteonecrosis of the femoral condyle in the knee[J]. Knee Surg Sports Traumatol Arthrosc, 2008,16(8):753-758.
[3] 刘新光, 郭万首. 自发性膝关节骨坏死的治疗进展[J]. 中华骨与关节外科杂志, 2015,8(4):363-366.
[4] KON E, FILARDO G, DELCOGLIANO M, et al. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper's knee[J]. Injury, 2009,40(6):598-603.
[5] 中国医疗保健国际交流促进会骨科分会, 邢丹, 余楠生, 等. 关节腔注射富血小板血浆治疗膝骨关节炎的临床实践指南(2018年版)[J]. 中华关节外科杂志(电子版), 2018(4):444-448.
[6] WU W, CHEN F, LIU Y, et al. Autologous injectable tissue-engineered cartilage by using platelet-rich plasma: experimental study in a rabbit model[J]. J Oral Maxillofac Surg, 2007,65(10):1951-1957.
[7] 王浩浩, 张民, 席刚, 等. 膝关节自发性骨坏死的保膝治疗研究进展[J]. 实用骨科杂志, 2020,26(12):1127-1131.
[8] FORST J, FORST R, HELLER K D, et al. Spontaneous osteonecrosis of the femoral condyle: causal treatment by early core decompression[J]. Arch Orthop Trauma Surg, 1998,117(1-2):18-22.
[9] AKGUN I, KESMEZACAR H, OGUT T, et al. Arthroscopic microfracture treatment for osteonecrosis of the knee[J]. Arthroscopy, 2005,21(7):834-843.
[10] DAI W L, ZHOU A G, ZHANG H, et al. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a Meta-analysis of randomized controlled trials[J]. Arthroscopy, 2017,33(3):659-670.
[11] BELK J W, KRAEUTLER M J, HOUCK D A, et al. Platelet-richplasma versus hyaluronic acid for knee osteoarthritis: a systematic review and Meta-analysis of randomized controlled trials[J]. Am J Sports Med, 2021,49(1):249-260.
[12] CHEN Z, WANG C, YOU D, et al. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a Meta-analysis[J]. Medicine, 2020,99(11):e19388.

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

Effect of platelet-rich plasma combined with core decompression in the treatment of early spontaneous osteonecrosis of the knee

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