富血小板血浆在镜下前交叉韧带重建中的短期临床疗效分析

发布时间：2018-06-03 02:08

  本文选题：前交叉韧带撕裂 + 富血小板血浆　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:探讨膝关节镜下富血小板血浆应用于前交叉韧带重建术的临床疗效及其对ACL腱骨愈合的促进作用。方法:64例前交叉韧带断裂的患者通过膝关节镜下行前交叉韧带重建术,随机分成两组:A组(采用自体半腱肌和股薄肌重建ACL,在股骨隧道侧注射1ml生理盐水)33例,B组(采用自体半腱肌和股薄肌重建ACL,在股骨隧道侧注射1mlPRP)31例。两组术后的康复训练方案相同。术后1、3、6、12月定期门诊随访并指导功能锻炼。结果:64例患者均获得随访,平均随访时间为12.6±1.7个月。经随访发现,A组IKDC评分从术前的26.1±6.0提高到术后12个月的90.1±5.4(p=0.000);Lysholm评分从术前的42.3±6.9提高到术后12个月的91.9±3.9(p=0.000);VAS评分从术前的4.7±1.5降到术后12个月的1.1±1.3(p=0.000)。B组IKDC评分从术前的28.3±6.3提高到术后12个月的91.7±5.2(p=0.0000);Lysholm评分从术前的44.6±5.5提高到术后12个月的92.5±3.6(p=0.0000);VAS评分从术前的5.1±1.6降到术后12个月的1.2±1.2(p=0.0000)。AB两组间的评分均无显著性差异(p0.05)。而术后12月的CT显示,A组股骨隧道直径由术前7.2±0.05 mm的扩大到术后的9.4±0.09mm,B组则由术前的7.1±0.06mm扩大到术后的8.55±0.14mm。B组骨隧道的扩大率明显低于A组(19.4±18.0%vs29.7±13.2%,p=.005)。术后1年的MRI显示,A 组移植韧带有 9.1%(3/33)为 Ⅰ 型,54.5%(18/33)为 Ⅱ 型,36.4%(12/33)为 Ⅲ型;B 组移植韧带有 48.4%(15/31)为 Ⅰ 型,38.7%(12/31)为 Ⅱ型,12.9%(4/31)为Ⅲ型。B组Ⅰ型移植韧带显著多于A组(p=0.0005),Ⅲ型显著低于A组(p=0.03)。所有患者在术中及术后均无并发症发生。结论:膝关节镜下前交叉韧带重建术中应用PRP治疗前交叉韧带损伤能改善膝关节功能,可避免前交叉韧带骨隧道扩大,临床短期疗效满意。
[Abstract]:Objective: to investigate the clinical effect of platelet-rich plasma in anterior cruciate ligament reconstruction (ACL) under knee arthroscopy and its promoting effect on ACL tendon bone healing. Methods 64 patients with anterior cruciate ligament rupture underwent anterior cruciate ligament reconstruction under knee arthroscopy. They were randomly divided into two groups: group A (using autogenous semitendinosus muscle and gracilis muscle to reconstruct ACLs) and group B (33 cases of femoral tunnel side treated with 1ml normal saline) (autogenous semitendinosus muscle and gracilis muscle were used to reconstruct ACLs and 1mlPRP)31 cases were injected into femur tunnel side). The rehabilitation training program was the same between the two groups. The patients were followed up regularly for 12 months to guide functional exercise. Results all 64 cases were followed up, the average follow-up time was 12.6 卤1.7 months. The IKDC score of group A was increased from 26.1 卤6.0 before operation to 90.1 卤5.4p0.000m at 12 months after operation from 42.3 卤6.9 before operation to 91.9 卤3.9p0.000 after operation from 4.7 卤1.5 before operation to 28.3 卤6.3 before operation in 1.1 卤1.3(p=0.000).B group. At 12 months after operation, the Lysholm score increased from 44.6 卤5.5 to 92.5 卤3.6 after operation, and decreased from 5.1 卤1.6 before operation to 1.2 卤1.2(p=0.0000).AB at 12 months postoperatively. There was no significant difference between the two groups (p 0.05). 12 months after operation, the diameter of femoral tunnel in group A expanded from 7.2 卤0.05mm before operation to 9.4 卤0.09mm in group B from 7.1 卤0.06mm before operation to 8.55 卤0.14mm.B after operation. The rate of expansion of bone tunnel in group A was significantly lower than that in group A (19.4 卤18.0%vs29.7 卤13.2mm). One year after the operation, MRI showed that there were 9.1% of the grafted ligaments in group A (9.1% 33) as type 鈪，

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