关节镜清理联合富血小板血浆治疗创伤性踝关节炎
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湖北民族大学附属民大医院

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风湿性疾病发生与干预湖北省重点实验室(湖北民族大学 PT022222)


Arthroscopic debridement combined with platelet-rich plasma in the treatment of post-traumatic osteoarthritis
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The First Affiliated Hospital of Harbin Medical University

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Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic Diseases(Hubei Minzu University)

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    摘要:

    目的 探讨关节镜清理联合富血小板血浆(platelaet-rich plasma,PRP)治疗创伤性踝关节炎(post-traumatic osteoarthritis,PTOA)的临床疗效及安全性。方法 回顾性分析2019年2月至 2021年2月本院收治的41例PTOA患者的临床资料。依据医患沟通结果,23例采用关节镜联合PRP(PRP组),18例采用关节镜联合透明质酸(hyaluronate acid ,HA)(HA组)。比较两组围手术期、随访及检验、影像学资料。结果 两组均顺利完成手术,术中无严重并发症。PRP组手术时间、切口愈合情况、术中出血量及平均住院天数与HA组比较均无显著差异(P>0.05)。两组患者均获12个月以上随访,HA组完全负重活动时间于PRP组无明显差异(P> 0.05)。随时间推移,两组VAS评分均显著减少(P<0.05),而AOFAS评分显著增加(P<0.05)。术前及术后6月,两组间上述指标无明显差异(P>0.05),术后12月差异有统计学意义(P<0.05)。踝背伸-跖屈ROM无显著变化(P>0.05)。检验方面,与术前相比,两组患者CRP、IL-6、TNF-a均显著减少(P<0.05)。术前及术后6月,两组间上述指标无明显差异(P>0.05),术后12月有显著差异(P< 0.05)。影像方面,与术前相比,术后6月两组距骨倾角、外侧胫骨远端机械角及Kellgren-Lawrence 踝关节骨关节炎分期无明显变化(P> 0.05)。相应时间点,两组间的上述指标也无明显差异(P>0.05)。术后12月,两组间 Kellgren-Lawrence 踝关节骨关节炎分期的差异有统计学意义(P<0.05)。而距骨倾斜角、外侧胫骨远端机械角均无统计学意义(>0.05)。结论 PRP组可减轻关节疼痛,改善关节功能,临床疗效显著,安全性高。

    Abstract:

    Objective To explore the clinical efficacy and safety of arthroscopic debridement combined with platelet-rich plasma (PRP) in the treatment of post-traumatic osteoarthritis (PTOA). Methods The clinical data of 41 patients with PTOA treated in our hospital from February 2019 to February 2021 were analyzed retrospectively. According to the results of doctor-patient communication, 23 cases were treated with arthroscopy combined with PRP (PRP group) and 18 cases with arthroscopy combined with hyaluronic acid (HA group).The perioperative period, follow-up, examination and imaging data of the two groups were compared. Results The operation was completed successfully in both groups and there were no serious complications during the operation.There was no significant difference in operation time, incision healing, intraoperative blood loss and average hospital stay between PRP group and HA group.Patients in both groups were followed up for more than 12 months. There was no significant difference in the time of complete weight-bearing activity between HA group and PRP group.With the passage of time, the VAS score decreased significantly, while the AOFAS score increased significantly in both groups.There was no significant difference in the above-mentioned indexes between the two groups before and 6 months after operation (P > 0.05), but there was significant difference 12 months after operation (P < 0.05).There was no significant change in ROM from dorsal ankle extension to metatarsal flexion.In terms of examination, compared with those before operation, CRP, IL-6 and TNF-a decreased significantly in both groups (P < 0.05).There was no significant difference in the above-mentioned indexes between the two groups before and 6 months after operation (P > 0.05), but there was significant difference 12 months after operation (P < 0.05).In terms of imaging, there was no significant change in talus inclination angle, lateral tibial distal mechanical angle and Kellgren-Lawrence ankle osteoarthritis stage between the two groups 6 months after operation.There was no significant difference in the above-mentioned indexes between the two groups at the corresponding time point (P > 0.05).12 months after operation, there was significant difference in the stage of KellgrenLawrence ankle osteoarthritis between the two groups (P < 0.05).The tilt angle of talus and the mechanical angle of distal tibia were not statistically significant (> 0.05). Conclusion PRP group can relieve joint pain and improve joint function. It has remarkable clinical effect and high safety.

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  • 收稿日期:2022-11-30
  • 最后修改日期:2023-03-13
  • 录用日期:2023-05-06
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