[1]娄磊,俞光荣,倘艳锋,等.纯富血小板血浆关节腔注射联合手术治疗HeppleⅤ型距骨骨软骨损伤[J].中医正骨,2020,32(12):25-30.
　LOU Lei,YU Guangrong,TANG YanFeng,et al.Intra-articular injection of pure platelet-rich plasma combined with surgery for treatment of Hepple typeⅤosteochondral lesions of the talus[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(12):25-30.
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纯富血小板血浆关节腔注射联合手术治疗HeppleⅤ型距骨骨软骨损伤()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年12期
页码:
25-30
栏目:
临床研究
出版日期:
2020-12-20

文章信息/Info

Title:
Intra-articular injection of pure platelet-rich plasma combined with surgery for treatment of Hepple typeⅤosteochondral lesions of the talus
作者:
娄磊1; 俞光荣2; 倘艳锋1; 苏攀1; 马源1
(1.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002; 2.同济大学附属同济医院,上海 200065)
Author(s):
LOU Lei1; YU Guangrong2; TANG YanFeng1; SU Pan1; MA Yuan1
1.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China2.Tongji Hospital of Tongji University,Shanghai 200065,China
关键词:
踝损伤;  距骨;  软骨损伤;  富血小板血浆;  临床试验
Keywords:
ankle injuries;  talus;  cartilage injuries;  platelet-rich plasma;  clinical trial
摘要:
目的:观察纯富血小板血浆(pure platelet-rich plasma,P-PRP)关节腔注射联合手术治疗HeppleⅤ型距骨骨软骨损伤的临床疗效和安全性。方法:将40例HeppleⅤ型距骨骨软骨损伤患者随机分为2组,每组20例。单纯手术组采用微骨折术或松质骨植骨术治疗,联合治疗组在单纯手术组治疗的基础上联合P-PRP关节腔注射治疗。分别于术前及术后12个月记录并比较2组患者踝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分、简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分,并观察并发症发生情况。结果:①踝关节疼痛VAS评分。术前2组患者踝关节疼痛VAS评分比较,差异无统计学意义[(6.40±1.14)分,(6.20±0.52)分,t=0.712,P=0.481]; 术后12个月,联合治疗组踝关节疼痛VAS评分小于单纯手术组[(2.20±0.70)分,(3.15±0.58)分,t=3.730,P=0.001],2组患者踝关节疼痛VAS评分均小于术前(t=15.698,P=0.000; t=19.874,P=0.000)。②AOFAS踝与后足功能评分。术前2组患者AOFAS踝与后足功能评分比较,差异无统计学意义[(39.75±3.85)分,(41.20±5.28)分,t=0.993,P=0.327]; 术后12个月,联合治疗组AOFAS踝与后足功能评分大于单纯手术组[(90.45±2.31)分,(74.55±6.73)分,t=7.220,P=0.001],2组患者AOFAS踝与后足功能评分均大于术前(t=48.562,P=0.000; t=15.583,P=0.000)。③SF-36评分。术前2组患者SF-36评分比较,差异无统计学意义[(64.75±7.74)分,(64.00±7.20)分,t=0.317,P=0.753]; 术后12个月,联合治疗组SF-36评分大于单纯手术组[(90.45±1.76)分,(83.80±4.58)分,t=2.410,P=0.021],2组患者SF-36评分均大于术前(t=15.187,P=0.000; t=11.230,P=0.000)。④安全性。单纯手术组2例出现切口周围皮肤麻木,未做特殊处理,术后6个月逐渐改善; 联合治疗组1例出现关节过度增生,患者拒绝做特殊处理; 2组患者均未出现切口感染、皮肤坏死等并发症。2组并发症发生率比较,差异无统计学意义(χ2=0.000,P=1.000)。结论:采用P-PRP关节腔注射联合手术治疗HeppleⅤ型距骨骨软骨损伤,与单纯手术治疗相比,能更好地缓解踝关节疼痛、促进踝关节功能的恢复、提高患者生活质量,但两者安全性相当。
Abstract:
To observe the clinical curative effects and safety of intra-articular injection of pure platelet-rich plasma(P-PRP)combined with surgery for treatment of Hepple typeⅤosteochondral lesions of the talus(OLT).Methods:Forty patients with Hepple typeⅤOLT were enrolled in the study and were randomly divided into surgery group and combination therapy group,20 cases in each group.All patients in the 2 groups were treated with microfracture surgery or cancellous bone grafting.Moreover,the patients in combination therapy group were treated with intra-articular injection of P-PRP.The ankle pain visual analogue scale(VAS)scores,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores and short form 36 health survey questionnaire(SF-36)scores were recorded and compared between the 2 groups before the surgery and at 12 months after the surgery respectively,and the complications were observed.Results:There was no statistical difference in ankle pain VAS scores between the 2 groups before the surgery(6.40+/-1.14 vs 6.20+/-0.52 points,t=0.712,P=0.481).The ankle pain VAS scores were lower in combination therapy group compared to surgery group at 12 months after the surgery(2.20+/-0.70 vs 3.15+/-0.58 points,t=3.730,P=0.001).The ankle pain VAS scores decreased in the 2 groups at 12 months after the surgery compared to pre-surgery(t=15.698,P=0.000; t=19.874,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot function scores between the 2 groups before the surgery(39.75+/-3.85 vs 41.20+/-5.28 points,t=0.993,P=0.327).The AOFAS ankle-hindfoot function scores were higher in combination therapy group compared to surgery group at 12 months after the surgery(90.45+/-2.31 vs 74.55+/-6.73 points,t=7.220,P=0.001).The AOFAS ankle-hindfoot function scores increased in the 2 groups at 12 months after the surgery compared to pre-surgery(t=48.562,P=0.000; t=15.583,P=0.000).There was no statistical difference in SF-36 scores between the 2 groups before the surgery(64.75+/-7.74 vs 64.00+/-7.20 points,t=0.317,P=0.753).The SF-36 scores were higher in combination therapy group compared to surgery group at 12 months after the surgery(90.45+/-1.76 vs 83.80+/-4.58 points,t=2.410,P=0.021).The SF-36 scores increased in the 2 groups at 12 months after the surgery compared to pre-surgery(t=15.187,P=0.000; t=11.230,P=0.000).The skin numbness was found around the incision in 2 patients in surgery group,and the numbness was relieved at 6 months after the surgery without any special treatment.The joint hyperplasia was found in 1 patient in combination therapy group,and the special treatment was refused by the patient.No complications such as incision infection and cutaneous necrosis were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(χ2=0.000,P=1.000).Conclusion:The combination therapy of intra-articular injection of P-PRP and surgery can better relieve ankle pain,promote ankle function recovery and improve patient’s life quality compared to monotherapy of surgery in treatment of Hepple typeⅤOLT,while they are similar to each other in safety.

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备注/Memo

备注/Memo:
基金项目:洛阳市科技计划医疗卫生项目(1830004A)
通讯作者:俞光荣 E-mail:yuguangrong@tongji.edu.cn
更新日期/Last Update: 2020-12-20