[1]胡海旗,黄凯.关节镜下清理钻孔减压联合富血小板血浆关节内注射治疗早期膝骨关节炎的临床研究[J].中医正骨,2025,37(09):40-50.
　HU Haiqi,HUANG Kai.A clinical study of arthroscopic debridement and drilling decompression combined with intra-articular injection of platelet-rich plasma for treatment of early-stage knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(09):40-50.
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关节镜下清理钻孔减压联合富血小板血浆关节内注射治疗早期膝骨关节炎的临床研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年09期
页码:
40-50
栏目:
临床研究
出版日期:
2025-09-20

文章信息/Info

Title:
A clinical study of arthroscopic debridement and drilling decompression combined with intra-articular injection of platelet-rich plasma for treatment of early-stage knee osteoarthritis
作者:
胡海旗; 黄凯
(浙江省立同德医院,浙江 杭州 310012)
Author(s):
HU Haiqi; HUANG Kai
Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China
关键词:
骨关节炎; 膝;  富含血小板血浆;  注射; 关节内;  关节镜检查;  软骨; 关节;  随机对照试验专题
Keywords:
osteoarthritis; knee;  platelet-rich plasma;  injections; intra-articular;  arthroscopy;  cartilage; articular;  randomized controlled trials as topic
摘要:
目的:观察关节镜下清理钻孔减压联合富血小板血浆(platelet-rich plasma,PRP)关节内注射治疗早期膝骨关节炎(knee osteoarthritis,KOA)的临床疗效和安全性。方法:将2023年1月至2024年1月收治的74例早期(Kellgren-LawrenceⅠ～Ⅱ级)KOA患者随机分为联合组和关节镜组,每组37例。2组均采用关节镜下清理钻孔减压术治疗; 联合组在此基础上,分别于关节镜下清理钻孔减压术结束时、术后第2周、术后第4周各进行1次PRP关节内注射治疗。分别于治疗前和治疗结束后1个月、6个月、12个月,评定患者的膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分和Lysholm膝关节评分; 治疗前和治疗结束后12个月,采用MRI评估膝关节软骨损伤情况; 观察记录2组患者治疗及随访期间并发症的发生情况。结果:①一般情况。联合组1例失访,关节镜组2例失访、1例主动要求退出试验。②膝关节疼痛VAS评分。2组膝关节疼痛VAS评分均随时间呈降低趋势(F=288.267,P=0.000; F=148.047,P=0.000); 治疗前、治疗结束后1个月,2组膝关节疼痛VAS评分比较,组间差异均无统计学意义; 治疗结束后6个月、12个月,联合组膝关节疼痛VAS评分均低于关节镜组(t=3.266,P=0.002; t=3.849,P=0.000)。③Lysholm疼痛评分和爬楼评分。2组Lysholm疼痛评分和爬楼评分均随时间呈升高趋势(疼痛评分:F=76.645,P=0.000; F=39.235,P=0.000; 爬楼评分:F=38.059,P=0.000; F=16.262,P=0.000); 治疗前、治疗结束后1个月,2组Lysholm疼痛评分和爬楼评分比较,组间差异均无统计学意义; 治疗结束后6个月、12个月,联合组Lysholm疼痛评分和爬楼评分均高于关节镜组(疼痛评分:t=0.010,P=0.030; t=3.366,P=0.010; 爬楼评分:t=2.164,P=0.034; t=3.289,P=0.002)。④Lysholm肿胀评分。2组 Lysholm肿胀评分均随时间呈升高趋势(F=15.174,P=0.000; F=6.075,P=0.001); 治疗前、治疗结束后1个月、治疗结束后6个月,2组Lysholm肿胀评分比较,组间差异均无统计学意义; 治疗结束后12个月,联合组Lysholm肿胀评分高于关节镜组(t=2.740,P=0.008)。⑤Lysholm交锁评分和不稳定评分。Lysholm交锁评分、不稳定评分随时间变化总体均呈升高趋势(F=130.344,P=0.000; F=523.814,P=0.000)。联合组Lysholm交锁评分、不稳定评分均高于关节镜组(F=5.125,P=0.024; F=10.910,P=0.001)。⑥Lysholm跛行评分、下蹲评分、支撑评分。Lysholm跛行评分随时间变化总体呈先升高后轻微降低的趋势(F=22.127,P=0.000),Lysholm下蹲评分、支撑评分随时间变化总体均呈升高趋势(F=29.375,P=0.000; F=37.650,P=0.000)。2组Lysholm跛行评分、下蹲评分、支撑评分总体比较,组间差异均无统计学意义。⑦膝关节软骨损伤情况。治疗结束后12个月,联合组26例、关节镜组15例软骨损伤程度较治疗前减轻,2组均未出现软骨损伤程度加重的情况。联合组的软骨损伤改善率优于关节镜组(χ2=5.692,P=0.017)。⑧并发症发生情况。2组患者均未发生神经血管损伤、感染等并发症。结论:关节镜下清理钻孔减压联合PRP关节内注射,可有效减轻早期KOA患者的膝关节疼痛症状、改善膝关节功能、促进损伤软骨修复,疗效优于单纯关节镜下清理钻孔减压治疗,而且具有较高的安全性。
Abstract:
Objective:To observe the clinical efficacy and safety of arthroscopic debridement and drilling decompression combined with intra-articular injection of platelet-rich plasma(PRP)in treatment of early-stage knee osteoarthritis(KOA).Methods:Seventy-four patients with early-stage KOA(Kellgren-Lawrence gradedⅠ-Ⅱ)recruited from January 2023 to January 2024 were randomized into combination group and arthroscopy group,with 37 ones in each group.All patients in the 2 groups were treated with arthroscopic debridement and drilling decompression,moreover,the ones in combination group were further treated with intra-articular injection of PRP at the end of the arthroscopic procedure and at postoperative week 2 and 4,respectively.The outcome measures including knee pain visual analogue scale (VAS)score and Lysholm knee score were assessed before the treatment,at 1,6,and 12-month post-treatment,respectively,and the knee cartilage damage was evaluated by MRI before the treatment and at 12-month post-treatment,respectively.Furthermore,the complications were observed and recorded throughout the treatment and follow-up periods in the 2 groups.Results:①General information.One patient was lost to follow-up in combination group,while,2 ones were lost to follow-up,and 1 withdrew from the trial in arthroscopy group.②Knee pain VAS score.The knee pain VAS score presented a decreasing trajectory over time in the 2 groups(F=288.267,P=0.000; F=148.047,P=0.000).In addition,the knee pain VAS score was not significantly different between the 2 groups before the treatment and at 1-month post-treatment,respectively,while,at 6 and 12-month post-treatment,it was lower in combination group compared to arthroscopy group(t=3.266,P=0.002; t=3.849,P=0.000).③Lysholm pain and stair-climbing subscores.The Lysholm pain and stair-climbing subscores presented an increasing trajectory over time in the 2 groups(pain subscore:F=76.645,P=0.000; F=39.235,P=0.000; stair-climbing subscore:F=38.059,P=0.000; F=16.262,P=0.000).In addition,the Lysholm pain and stair-climbing subscores were not significantly different between the 2 groups before the treatment and at 1-month post-treatment,respectively,while,at 6 and 12-month post-treatment,the both were higher in combination group compared to arthroscopy group(pain subscore:t=0.010,P=0.030; t=3.366,P=0.010; stair-climbing subscore:t=2.164,P=0.034; t=3.289,P=0.002).④Lysholm swelling subscore.The Lysholm swelling subscore presented an increasing trajectory over time in the 2 groups(F=15.174,P=0.000; F=6.075,P=0.001).In addition,the Lysholm swelling subscore was not significantly different between the 2 groups before the treatment,at 1 and 6-month post-treatment,respectively,while,at 12-month post-treatment,it was higher in combination group compared to arthroscopy group(t=2.740,P=0.008).⑤Lysholm locking and instability subscores.The Lysholm locking and instability subscores presented an increasing trajectory over time in the 2 groups in general(F=130.344,P=0.000; F=523.814,P=0.000),and they were higher in combination group compared to arthroscopy group(F=5.125,P=0.024; F=10.910,P=0.001).⑥Lysholm subscores for limping,squatting,and supporting.The Lysholm subscore for limping showed a biphasic trajectory of initial increase followed by a slight decrease,whereas the Lysholm subscores for squatting and supporting exhibited an increaseing trend over time in the 2 groups in general(F=22.127,P=0.000; F=29.375,P=0.000; F=37.650,P=0.000).However,these three subscores were not significantly different between the 2 groups in general.⑦Knee cartilage damage.At 12-month post-treatment,the knee cartilage damage was improved in 26 patients in combination group and 15 ones in arthroscopy group,with no patients experienced worsened cartilage damage in the 2 groups.The improvement rate of cartilage damage was higher in combination group compared to arthroscopy group(χ2=5.692,P=0.017).⑧Complications.No patients experienced neurovascular injuries or infections in the 2 goups.Conclusion:Arthroscopic debridement and drilling decompression combined with intra-articular injection of PRP can effectively alleviate knee pain,improve knee function,and promote the repair of damaged cartilage in patients with early-stage KOA.Its therapeutic efficacy is superior to that of arthroscopic debridement and drilling decompression alone,and it demonstrates a high safety profile.

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通讯作者:黄凯 E-mail:zjhzhuangkai@163.com
更新日期/Last Update: 1900-01-01