[1]高文香,王明君,李晓峰,等.关节镜下微骨折术联合富血小板血浆与纤维蛋白凝胶覆盖微骨折创面治疗膝骨关节炎软骨退变缺损[J].中医正骨,2019,31(11):21-25.
　GAO Wenxiang,WANG Mingjun,LI Xiaofeng,et al.Arthroscopic microfracture surgery combined with microfractured wound surface coverage with platelet rich plasma and fibrin gels for treatment of degenerative cartilage defects in patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(11):21-25.
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关节镜下微骨折术联合富血小板血浆与纤维蛋白凝胶覆盖微骨折创面治疗膝骨关节炎软骨退变缺损()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年11期
页码:
21-25
栏目:
临床研究
出版日期:
2019-11-20

文章信息/Info

Title:
Arthroscopic microfracture surgery combined with microfractured wound surface coverage with platelet rich plasma and fibrin gels for treatment of degenerative cartilage defects in patients with knee osteoarthritis
作者:
高文香; 王明君; 李晓峰; 李鹏; 杨鑫; 王鸿雁; 邹春雨; 郝军; 王冬
(河南省洛阳正骨医院/河南省骨科医院,河南 郑州 450016)
Author(s):
GAO Wenxiang; WANG Mingjun; LI Xiaofeng; LI Peng; YANG Xin; WANG Hongyan; ZOU Chunyu; HAO Jun; WANG Dong
Luoyang Orthopedic-Traumatological Hospital,Zhengzhou 450016,Henan,China
关键词:
骨关节炎; 膝;  软骨;  关节成形术;  软骨下;  富血小板血浆;  纤维蛋白;  凝胶;  关节镜检查;  临床试验
Keywords:
osteoarthritis; knee;  cartilage;  arthroplasty; subchondral;  platelet-rich plasma;  fibrin;  gels;  arthroscopy;  clinical trial
摘要:
目的:观察关节镜下微骨折术联合富血小板血浆(platelet rich plasma,PRP)与纤维蛋白凝胶覆盖微骨折创面治疗膝骨关节炎(knee osteoarthritis,KOA)软骨退变缺损的临床疗效和安全性。方法:将符合要求的KOA软骨退变缺损患者随机纳入联合组或微骨折组。联合组先于关节镜下在软骨缺损处软骨下骨行微骨折术,然后用PRP与凝血酶填充微骨折处理后的软骨缺损处,最后用纤维蛋白凝胶进行封口处理。微骨折组仅进行微骨折处理。术前及术后随访时,测定患者上下10级楼梯后的膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分,测量同一位置软骨退变缺损面积,测定患者的西安大略和麦克马斯特大学(Western Ontario and McMaster Universities,WOMAC)骨关节炎指数。观察治疗及随访期间的并发症发生情况。结果:共纳入32例患者,联合组和微骨折组各16例。所有患者均获得随访,随访时间10～15个月,中位数12个月。治疗及随访期间均未出现并发症。治疗前2组患者的膝关节疼痛VAS评分比较,差异无统计学意义[(6.67±1.05)分,(6.60±1.30)分,t=0.155,P=0.878]; 末次随访时2组患者的膝关节疼痛VAS评分均较治疗前降低(t=10.990,P=0.000; t=5.641,P=0.000),联合组的评分低于微骨折组[(2.13±1.25)分,(3.38±1.43)分,t=-2.221,P=0.035]。治疗前2组患者的软骨退变缺损面积比较,差异无统计学意义[(2.91±0.70)cm2,(2.57±0.68)cm2,t=1.354,P=0.187]; 末次随访时2组患者的软骨退变缺损面积均较治疗前减小(t=6.688,P=0.000; t=2.772,P=0.015),联合组的软骨退变缺损面积小于微骨折组[(1.18±0.74)cm2,(1.83±0.76)cm2,t=-2.241,P=0.022]。治疗前2组患者的WOMAC骨关节炎指数比较,差异无统计学意义[(108.27±12.89)分,(106.87±13.11)分,t=0.295,P=0.770]; 末次随访时2组患者的WOMAC骨关节炎指数均较治疗前减小(t=17.318,P=0.000; t=17.760,P=0.000),联合组的WOMAC骨关节炎指数小于微骨折组[(24.69±12.53)分,(36.57±14.97)分,t=-2.354,P=0.026]。结论:关节镜下微骨折术联合PRP与纤维蛋白凝胶覆盖微骨折创面,可修复KOA软骨退变缺损,减轻膝关节疼痛症状、改善膝关节功能,安全性较高,疗效优于单纯微骨折术治疗。
Abstract:
Objective:To observe the clinical curative effects and safety of arthroscopic microfracture surgery combined with microfractured wound surface coverage with platelet rich plasma(PRP)and fibrin gels(FG)for treatment of degenerative cartilage defects in patients with knee osteoarthritis(KOA).Methods:Thirty-two patients with KOA and degenerative cartilage defects were enrolled in the study and were randomly divided into combination group and microfracture group,16 cases in each group.The patients in combination group were treated with arthroscopic microfracture surgeries on subchondral bones,and their cartilage defects were filled with PRP and thrombin and were sealed with FG; while the patients in microfracture group were merely treated with arthroscopic microfracture surgeries.The knee pain visual analogue scale(VAS)scores were measured after the patients went up and down 10 stairs,and the area of degenerative cartilage defects and the Western Ontario and McMaster Universities(WOMAC)osteoarthritis index were measured through the preoperative and postoperative follow-up respectively.Moreover,the complication incidences were observed and compared between the 2 groups during the treatment and follow-up period.Results:All patients in the 2 groups were followed up for 10-15 months with a median of 12 months.No complications were found in the 2 groups during the treatment and follow-up period.There was no statistical difference in knee pain VAS scores between the 2 groups before the treatment(6.67+/-1.05 vs 6.60+/-1.30 points,t=0.155,P=0.878).The knee pain VAS scores decreased at last follow-up compared to pretreatment in the 2 groups(t=10.990,P=0.000; t=5.641,P=0.000),and were lower in combination group compared to microfracture group(2.13+/-1.25 vs 3.38+/-1.43 points,t=-2.221,P=0.035).There was no statistical difference in the area of degenerative cartilage defect between the 2 groups before the treatment(2.91+/-0.70 vs 2.57+/-0.68 cm(2),t=1.354,P=0.187).The area of degenerative cartilage defect decreased at last follow-up compared to pretreatment in the 2 groups(t=6.688,P=0.000; t=2.772,P=0.015),and was less in combination group compared to microfracture group(1.18+/-0.74 vs 1.83+/-0.76 cm(2),t=-2.241,P=0.022).There were no statistical difference in WOMAC osteoarthritis index between the 2 groups before the treatment(108.27+/-12.89 vs 106.87+/-13.11 points,t=0.295,P=0.770).The WOMAC osteoarthritis index decreased at last follow-up compared to pretreatment in the 2 groups(t=17.318,P=0.000; t=17.760,P=0.000),and was lower in combination group compared to microfracture group(24.69+/-12.53 vs 36.57+/-14.97 points,t=-2.354,P=0.026).Conclusion:The combination therapy of arthroscopic microfracture surgery and microfractured wound surface coverage with PRP and FG can repair degenerative cartilage defect,relieve the knee pain and improve the knee function in patients with KOA,meanwhile,it has high safty and its curative effect is better than that of monotherapy of arthroscopic microfracture surgery.

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备注/Memo

备注/Memo:
基金项目:河南省重点中医学科(专科)学术带头人培养项目(2015ZY03008)(收稿日期:2019-08-06 本文编辑:李晓乐)
更新日期/Last Update: 2019-11-10