中国修复重建外科杂志

中国修复重建外科杂志

富血小板血浆辅助前交叉韧带重建治疗的临床疗效分析

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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(P>0.05),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(P<0.05),术后 3 个月试验组各评分均优于对照组(P<0.05),术后 12 个月两组比较差异均无统计学意义(P>0.05)。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;χ2=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。

Objective To investigate the clinical outcomes of autologous platelet rich plasma (PRP) for anterior cruciate ligament (ACL) reconstruction. Methods Between August 2014 and August 2016, 42 patients with ACL ruptures who underwent arthroscopic ACL reconstruction were randomly divided into 2 groups: 21 patients received graft soaked with PRP (trial group) and 21 patients received routine graft in ACL reconstruction (control group). Because 6 patients failed to be followed up, 17 patients of trial group and 19 of control group were enrolled in the study. There was no significant difference in gender, age, body mass index, side, injury reason, disease duration, Kellgren-Lawrence grade, and preoperative visual analogue scale (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) activity scores between 2 groups (P>0.05). VAS score, Lysholm score, and IKDC activity scores were used to evaluate pain and function at 3 and 12 months postoperatively. Further, second arthroscopy and MRI examination were performed at 12 months postoperatively. Results The patients in both groups were followed up 3 to 12 months with an average of 9.83 months. The VAS score, Lysholm score, and IKDC activity scores were significantly improved at 3 and 12 months after operation in 2 groups (P<0.05), and the scores of trial group were significantly better than those of control group at 3 months (P<0.05), but no significant difference was found between 2 groups at 12 months (P>0.05). No complications of effusion, infection, and allergy were observed in 2 groups during follow-up. MRI showed good position of ACL grafts and good signal quality of the graft in the majority of the cases. However, mixed hyperintense and presence of synovial fluid at the femoral bone-tendon graft interface were found in 3 patients of trial group and 4 patients of control group, indicating poor remodeling ligamentation. MRI score was 3.53±1.13 in trial group and was 3.21±0.92 in control group, showing no significant difference (t=0.936,P=0.356). The second arthroscopy examination showed ligament remodeling score was higher in trial group than control group (t=3.248,P=0.014), but no significant difference was found in synovial coverage score and the incidence of cartilage repair (t=2.190,P=0.064;χ2=0.090,P=0.764). Conclusion PRP application in allograft ACL reconstruction can improve knee function and relieve pain after operation, which may also accelerate graft remodeling.

关键词: 富血小板血浆; 前交叉韧带重建; 自体腘绳肌移植物; 关节镜

Key words: Platelet rich plasma; anterior cruciate ligament reconstruction; hamstring autograft; arthroscopy

引用本文: 纪庆明, 杨育晖, 陈昊, 耿玮峥, 董航, 于庆巍. 富血小板血浆辅助前交叉韧带重建治疗的临床疗效分析. 中国修复重建外科杂志, 2017, 31(4): 410-416. doi: 10.7507/1002-1892.201611056 复制

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