[1]王勇,张宇,刘英,等.富血小板血浆关节腔注射在关节镜下微骨折术治疗距骨骨软骨损伤中的应用[J].中医正骨,2022,34(05):6-12.
　WANG Yong,ZHANG Yu,LIU Ying,et al.Application of intra-articular injection of platelet-rich plasma in arthroscopic microfracture surgery for treatment of osteochondral lesion of the talus[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(05):6-12.
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富血小板血浆关节腔注射在关节镜下微骨折术治疗距骨骨软骨损伤中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年05期
页码:
6-12
栏目:
临床研究
出版日期:
2022-05-20

文章信息/Info

Title:
Application of intra-articular injection of platelet-rich plasma in arthroscopic microfracture surgery for treatment of osteochondral lesion of the talus
作者:
王勇; 张宇; 刘英; 张文举; 徐善强; 李平; 何凯元
(四川省骨科医院,四川 成都 610041)
Author(s):
WANG Yong; ZHANG Yu; LIU Ying; ZHANG Wenju; XU Shanqiang; LI Ping; HE Kaiyuan
Sichuan Province Orthopedic Hospital,Chengdu 610041,Sichuan,China
关键词:
距骨;  软骨疾病;  关节成形术; 软骨下;  关节镜检查;  富血小板血浆;  注射; 关节内
Keywords:
talus;  cartilage diseases;  arthroplasty; subchondral;  arthroscopy;  platelet-rich plasma;  injections; intra-articular
摘要:
目的:探讨富血小板血浆(platelet-rich plasma,PRP)关节腔注射在关节镜下微骨折术治疗距骨骨软骨损伤(osteochondral lesion of the talus,OLT)中的应用价值。方法:回顾性分析36例OLT患者的病例资料,其中采用关节镜下微骨折术联合PRP关节腔注射治疗19例(联合治疗组),单纯采用关节镜下微骨折术治疗17例(手术治疗组)。比较2组患者治疗前、治疗后6个月、治疗后12个月踝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、足与踝关节结局评分(foot and ankle outcome score,FAOS)、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及软骨下骨骨髓水肿体积。结果:①踝关节疼痛VAS评分。时间因素和分组因素存在交互效应(F=12.291,P=0.003); 2组患者踝关节疼痛VAS评分总体比较,组间差异无统计学意义,即不存在分组效应(F=2.617,P=0.137); 治疗前后不同时间点踝关节疼痛VAS评分的差异有统计学意义,即存在时间效应(F=354.262,P=0.000); 2组患者踝关节疼痛VAS评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致[联合治疗组:(5.74±1.27)分,(1.94±0.64)分,(0.76±0.25)分,F=532.326,P=0.000; 手术治疗组:(5.47±1.05)分,(3.21±0.74)分,(1.64±0.23)分,F=70.097,P=0.000]; 治疗前,2组患者踝关节疼痛VAS评分比较,差异无统计学意义(t=0.833,P=0.424); 治疗后6个月、12个月,联合治疗组踝关节疼痛VAS评分均低于手术治疗组(t=3.634,P=0.005; t=3.627,P=0.005)。②FAOS。时间因素和分组因素存在交互效应(F=7.269,P=0.004); 2组患者FAOS总体比较,组间差异有统计学意义,即存在分组效应(F=3.473,P=0.006); 治疗前后不同时间点FAOS的差异有统计学意义,即存在时间效应(F=856.830,P=0.000); 2组患者FAOS随时间变化均呈上升趋势,但2组的上升趋势不完全一致[联合治疗组:(61.27±3.68)分,(87.81±5.19)分,(97.64±2.43)分,F=630.157,P=0.000; 手术治疗组:(60.42±4.82)分,(79.70±7.14)分,(91.12±3.70)分,F=240.758,P=0.000]; 治疗前,2组患者FAOS比较,差异无统计学意义(t=0.421,P=0.683); 治疗后6个月、12个月,联合治疗组FAOS均高于手术治疗组(t=5.846,P=0.000; t=5.420,P=0.000)。③AOFAS踝与后足评分。时间因素和分组因素不存在交互效应(F=0.666,P=0.461); 2组患者AOFAS踝与后足评分总体比较,组间差异无统计学意义,即不存在分组效应(F=1.377,P=0.286); 治疗前后不同时间点AOFAS踝与后足评分的差异有统计学意义,即存在时间效应(F=1 033.580,P=0.000); 2组患者AOFAS踝与后足评分随时间变化均呈上升趋势,但2组的上升趋势不完全一致[联合治疗组:(66.93±5.99)分,(88.19±7.87)分,(98.43±6.67)分,F=498.276,P=0.000; 手术治疗组:(65.44±4.82)分,(86.47±8.44)分,(94.12±5.09)分,F=413.547,P=0.000]; 治疗前、治疗后6个月,2组患者AOFAS踝与后足评分比较,组间差异均无统计学意义(t=0.460,P=0.655; t=0.640,P=0.536); 治疗后12个月,联合治疗组AOFAS踝与后足评分高于手术治疗组(t=2.400,P=0.037)。④软骨下骨骨髓水肿体积。时间因素和分组因素存在交互效应(F=13.723,P=0.002); 2组患者软骨下骨骨髓水肿体积总体比较,组间差异无统计学意义,即不存在分组效应(F=2.256,P=0.164); 治疗前后不同时间点软骨下骨骨髓水肿体积的差异有统计学意义,即存在时间效应(F=383.914,P=0.000); 2组患者软骨下骨骨髓水肿体积随时间变化均呈下降趋势,但2组的下降趋势不完全一致[联合治疗组:(1.01±0.43)cm3,(0.30±0.17)cm3,(0.12±0.09)cm3,F=204.682,P=0.000; 手术治疗组:(0.93±0.37)cm3,(0.52±0.29)cm3,(0.38±0.11)cm3,F=137.510,P=0.000]; 治疗前,2组患者软骨下骨骨髓水肿体积比较,差异无统计学意义(t=0.760,P=0.465); 治疗后6个月、12个月,联合治疗组软骨下骨骨髓水肿体积均小于手术治疗组(t=2.825,P=0.018; t=4.012,P=0.002)。结论:在关节镜下微骨折术治疗OLT中应用PRP关节腔注射,有利于减轻软骨下骨骨髓水肿、缓解踝关节疼痛、改善踝关节功能。
Abstract:
Objective:To explore the applied value of intra-articular injection of platelet-rich plasma(PRP)in arthroscopic microfracture surgery for treatment of osteochondral lesion of the talus(OLT).Methods:The medical records of 36 OLT patients were analyzed retrospectively.Nineteen patients were treated with arthroscopic microfracture surgery and intra-articular injection of PRP(combination therapy group),while the others with arthroscopic microfracture surgery alone(surgical therapy group).The ankle pain visual analogue scale(VAS)score,foot and ankle outcome score(FAOS),American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and subchondral bone marrow edema(SBME)volume measured before the treatment and at 6 and 12 months after the treatment were compared between the 2 groups.Results:①There was interaction between time factor and group factor in ankle pain VAS score(F=12.291,P=0.003).There was no statistical difference in ankle pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=2.617,P=0.137).There was statistical difference in ankle pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=354.262,P=0.000).The ankle pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(combination therapy group:5.74±1.27,1.94±0.64,0.76±0.25 points,F=532.326,P=0.000; surgical therapy group:5.47±1.05,3.21±0.74,1.64±0.23 points,F=70.097,P=0.000).There was no statistical difference in ankle pain VAS scores between the 2 groups before the treatment(t=0.833,P=0.424); while the ankle pain VAS scores were lower in combination therapy group compared to surgical therapy group at 6 and 12 months after the treatment(t=3.634,P=0.005; t=3.627,P=0.005).②There was interaction between time factor and group factor in FAOS(F=7.269,P=0.004).There was statistical difference in FAOSs between the 2 groups in general,in other words,there was group effect(F=3.473,P=0.006).There was statistical difference in FAOSs between different timepoints before and after the treatment,in other words,there was time effect(F=856.830,P=0.000).The FAOSs presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(combination therapy group:61.27±3.68,87.81±5.19,97.64±2.43 points,F=630.157,P=0.000; surgical therapy group:60.42±4.82,79.70±7.14,91.12±3.70 points,F=240.758,P=0.000).There was no statistical difference in FAOSs between the 2 groups before the treatment(t=0.421,P=0.683); while the FAOSs were higher in combination therapy group compared to surgical therapy group at 6 and 12 months after the treatment(t=5.846,P=0.000; t=5.420,P=0.000).③There was no interaction between time factor and group factor in AOFAS ankle-hindfoot score(F=0.666,P=0.461).There was no statistical difference in AOFAS ankle-hindfoot scores between the 2 groups in general,in other words,there was no group effect(F=1.377,P=0.286).There was statistical difference in AOFAS ankle-hindfoot scores between different timepoints before and after the treatment,in other words,there was time effect(F=1 033.580,P=0.000).The AOFAS ankle-hindfoot scores presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(combination therapy group:66.93±5.99,88.19±7.87,98.43±6.67 points,F=498.276,P=0.000; surgical therapy group:65.44±4.82,86.47±8.44,94.12±5.09 points,F=413.547,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot scores between the 2 groups before the treatment and at 6 months after the treatment(t=0.460,P=0.655; t=0.640,P=0.536); while the AOFAS ankle-hindfoot scores were higher in combination therapy group compared to surgical therapy group at 12 months after the treatment(t=2.400,P=0.037).④There was interaction between time factor and group factor in SBME volume(F=13.723,P=0.002).There was no statistical difference in SBME volume between the 2 groups in general,in other words,there was no group effect(F=2.256,P=0.164).There was statistical difference in SBME volume between different timepoints before and after the treatment,in other words,there was time effect(F=383.914,P=0.000).The SBME volume presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(combination therapy group:1.01±0.43,0.30±0.17,0.12±0.09 cm(3),F=204.682,P=0.000; surgical therapy group:0.93±0.37,0.52±0.29,0.38±0.11 cm(3),F=137.510,P=0.000).There was no statistical difference in SBME volume between the 2 groups before the treatment(t=0.760,P=0.465); while the SBME volume was smaller in combination therapy group compared to surgical therapy group at 6 and 12 months after the treatment(t=2.825,P=0.018; t=4.012,P=0.002).Conclusion:Application of intra-articular injection of PRP in arthroscopic microfracture surgery is helpful to reduce SBME,relieve ankle pain and improve ankle function in treatment of OLT.

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(收稿日期:2021-12-26 本文编辑:吕宁)

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备注/Memo

备注/Memo:
基金项目:四川省医学会骨科(尚安通)专项科研课题(2021SAT18) 通讯作者:张宇 E-mail:zhangyudoc@126.com
更新日期/Last Update: 1900-01-01