富血小板血浆辅助前交叉韧带重建治疗的临床疗效分析

发布时间：2018-04-16 12:37

本文选题：富血小板血浆 + 前交叉韧带重建　；参考：《中国修复重建外科杂志》2017年04期

【摘要】：目的探讨自体富血小板血浆(platelet rich plasma,PRP)辅助前交叉韧带(anterior cruciate ligament,ACL)重建治疗的临床疗效。方法 2014年8月—2016年8月选择符合标准的ACL断裂需行韧带重建手术患者42例,随机分为PRP治疗组(试验组)及非PRP治疗组(对照组),每组21例;因随访过程中6例失访,故最终试验组和对照组纳入研究例数分别为17例和19例。两组患者性别、年龄、体质量指数、侧别、损伤原因、病程、Kellgren-Lawrence分级及术前疼痛视觉模拟评分(VAS)、Lysholm评分、国际膝关节文献委员会(IKDC)评分等一般资料比较差异均无统计学意义(P0.05),具有可比性。试验组采用自体PRP辅助ACL重建治疗,对照组单纯行常规ACL重建治疗。术后采用VAS评分、Lysholm评分及IKDC评分评估膝关节疼痛及功能状态,并于术后12个月进行MRI及关节镜二次探查。结果两组患者均获随访,随访时间3~12个月,平均9.83个月。术后3、12个月两组VAS评分、Lysholm评分及IKDC评分均较术前显著改善(P0.05),术后3个月试验组各评分均优于对照组(P0.05),术后12个月两组比较差异均无统计学意义(P0.05)。随访期间两组患者膝关节均未见显著渗液、感染或过敏反应等并发症。膝关节MRI复查示所有患者ACL移植物走行良好,位置佳;少数患者(试验组3例、对照组4例)可见重建移植物呈混杂信号或腱-骨界面存在积液,提示移植物愈合程度欠佳。试验组和对照组MRI评分分别为(3.53±1.13)分和(3.21±0.92)分,差异无统计学意义(t=0.936,P=0.356)。9例患者行关节镜二次探查显示,试验组韧带重塑评分优于对照组(t=3.248,P=0.014),而两组滑膜覆盖评分及软骨修复发生率比较差异无统计学意义(t=2.190,P=0.064;χ~2=0.090,P=0.764)。结论 PRP辅助膝关节ACL重建治疗能够缓解早期术后关节疼痛、改善关节功能,并能有效促进移植物韧带重塑。
[Abstract]:Objective to investigate the clinical effect of autologous platelet rich plasma-assisted anterior cruciate ligamentum reconstruction (ACLR).Methods from August 2014 to August 2016, 42 patients with ACL rupture needed ligamentous reconstruction were randomly divided into PRP treatment group (experimental group) and non- treatment group (control group, 21 cases, each group, 21 cases).So the final trial group and control group included 17 cases and 19 cases respectively.Sex, age, body mass index, side type, cause of injury, course of disease and preoperative visual analogue score of pain and visual analogue score (VASA) and Lysholm score were analyzed in both groups.There was no significant difference in general data such as IKDC score between the International knee Joint Literature Committee and so on, which was comparable.The experimental group was treated with autologous PRP plus ACL reconstruction, while the control group was treated with conventional ACL reconstruction alone.The pain and function of knee joint were evaluated by VAS score, Lysholm score and IKDC score. MRI and arthroscopy were performed 12 months after operation.Results the two groups were followed up for 3 ~ 12 months with an average of 9.83 months.At 3 and 12 months after operation, the VAS scores and IKDC scores in the two groups were significantly improved compared with those before operation (P 0.05). At 3 months after operation, the scores in the trial group were better than those in the control group (P 0.05). There was no significant difference between the two groups at 12 months after operation (P 0.05).During the follow-up period, no significant effusion, infection or allergic reaction were found in the knee joint of the two groups.MRI examination of knee joint showed that the ACL graft was in good position in all patients and a few patients (3 in the experimental group and 4 in the control group) showed mixed signals or accumulated fluid in the tendin-bone interface, suggesting that the graft healing degree was not good.The MRI scores of the test group and the control group were 3.53 卤1.13 and 3.21 卤0.92, respectively. There was no significant difference between the two groups.The score of ligamentum remodeling in the experimental group was better than that in the control group. However, there was no significant difference in the score of synovial covering and the incidence of cartilage repair between the two groups, and there was no significant difference between the two groups in the score of synovial covering and the incidence of cartilage repair.Conclusion PRP combined with ACL reconstruction of knee joint can relieve early postoperative joint pain, improve joint function and promote remodeling of graft ligament.
【作者单位】：吉林大学中日联谊医院骨科;
【基金】：吉林大学研究生创新基金资助项目(2016219)~~
【分类号】：R687.4

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