创伤外科杂志2024，Vol.26Issue(9) ：686-691.DOI:10.3969/j.issn.1009-4237.2024.09.008

凝胶型富血小板血浆联合关节镜下微骨折术对距骨骨软骨损伤的临床疗效

Clinical efficacy of gel-based platelet-rich plasma combined with arthroscopic microfracture surgery in the treatment of osteochondral injuries of the talus

陈学明 张兴飞 张宇轩 佘昶
创伤外科杂志2024，Vol.26Issue(9) ：686-691.DOI:10.3969/j.issn.1009-4237.2024.09.008
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凝胶型富血小板血浆联合关节镜下微骨折术对距骨骨软骨损伤的临床疗效

Clinical efficacy of gel-based platelet-rich plasma combined with arthroscopic microfracture surgery in the treatment of osteochondral injuries of the talus

陈学明 1张兴飞 1张宇轩 1佘昶2
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作者信息

  • 1. 无锡市第九人民医院(苏州大学附属无锡九院)足踝外科,江苏 无锡 214000
  • 2. 苏州大学附属第二医院骨科,江苏 苏州 215004
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摘要

目的 探讨凝胶型富血小板血浆(PRP)联合关节镜下微骨折术(AMS)对距骨骨软骨损伤(OLT)的早期疗效.方法 前瞻性研究2020年2月-2022年2月无锡市第九人民医院足踝外科收治的踝关节创伤后OLT患者45例,男性28例,女性17例;年龄18～43岁,平均28.0岁;病程17～32个月,平均23.0个月.按随机数字表法分为玻璃酸钠联合组(22例)、PRP联合组(23例).玻璃酸钠联合组行玻璃酸钠(2 mL,注射,术后1次/周,共治疗6周)联合AMS治疗,PRP联合组行凝胶型PRP(3 mL,注射,术后1次/周,共治疗6周)联合AMS治疗.比较治疗前及治疗后6个月两组患者骨髓水肿(BME)程度、VAS、踝关节活动度(ROM)、美国足踝关节外科协会(AOFAS)评分,并统计并发症发生情况.结果 治疗后6个月PRP联合组软骨下骨BME体积(0.37±0.11)cm3、VAS(2.0±0.6)分低于玻璃酸钠联合组(0.46±0.15)cm3、(3.1±1.0)分(P＜0.05);PRP 联合组跖屈 ROM、背伸 ROM(25.49±3.72)°、(15.43±2.54)°大于玻璃酸钠联合组(22.88±2.83)°、(13.57±2.03)°(P＜0.05);PRP 联合组疼痛、功能、对线及 AOFAS 总分[(34.7±5.6)分、(39.8±7.4)分、(7.7±1.6)分、(87.2±4.8)分高于玻璃酸钠联合组(29.7±5.9)分、(32.1±4.4)分、(6.0±1.5)分、(80.6±5.1)分(P＜0.05);PRP联合组跖屈软骨修复组织观察评分(35.4±8.2)分低于玻璃酸钠联合组(42.3±9.5)分(P＜0.05).PRP联合组踝关节功能优良率87.0％(20/23)高于玻璃酸钠联合组54.5％(12/22)(P＜0.05).PRP联合组并发症发生率(8.7％,2/23)低于玻璃酸钠联合组(36.4％,8/22),差异有统计学意义(P＜0.05).结论 凝胶型PRP联合AMS治疗距骨骨软骨损伤,可改善患者的足、踝关节功能,缓解BME及疼痛,增加踝关节ROM,减少并发症.

Abstract

Objective To investigate the early clinical effect of gel-based platelet-rich plasma(PRP)combined with arthroscopic microfracture surgery(AMS)in managing osteochondral injuries of the talus(OLT).Methods A total of 45 patients with post-traumatic OLT admitted to Wuxi Ninth People's Hospital from Feb.2020 to Feb.2022 were prospectively selected,including 28 males and 17 females aged 18-43(mean 28.0)years.The course of injuries was 17-32(mean 23.0)months.All the patients received AMS and according to the random num-ber table,22 cases were injected with sodium hyaluronate(2 mL once a week for 6 weeks postoperatively,SH joint group)and 23 were injected with PRP(3 mL once a week for 6 weeks postoperatively,PRP joint group).The de-gree of bone marrow edema(BME),VAS,ankle range of motion(ROM),and American Association of Foot and An-kle Surgery(AOFAS)scores before and 6 months after treatment were recorded,as well as complications.Results At 6 months after treatment,compared with the SH joint group,the PRP joint group showed much smaller BME at the subchondral bone(cm3,0.37±0.11 vs.0.46±0.15)and VAS(2.0±0.6 vs.3.1±1.0,both P＜0.05);much lar-ger metatarsal flexion ROM(25.49°±3.72° vs.22.88°±2.83°)and dorsiflexion ROM(15.43°±2.54° vs.13.57°±2.03°,both P＜0.05);much higher AOFAS scores of pain(34.7±5.6 vs.29.7±5.9),function(39.8±7.4 vs.32.1±4.4),alignment(7.7±1.6 vs.6.0±1.5)and total scores(87.2±4.8 vs.80.6±5.1,all P＜0.05);and much lower scores by Magnetic Resonance Observation of Cartilage Repair Tissue(35.4±8.2 vs.42.3±9.5,P＜0.05).Moreover,the good-to-excellent rate of the ankle joint function was much higher in the PRP joint group(87.0％,20/23 vs.54.5％,12/22,P＜0.05),and the incidence of complications was much lower(8.7％,2/23 vs.36.4％,8/22,P＜0.05).Conclusion For patients with OLT,gel-based PRP joint with AMS can improve the foot and ankle joint function,relieve BME and pain,increase ankle ROM,and reduce complications.

关键词

距骨骨软骨损伤/富血小板血浆/关节镜下微骨折术/骨髓水肿/疼痛/踝关节功能

Key words

Osteochondral lesions of the talus/Platelet rich plasma/Arthroscopic microfracture surgery/Bone marrow edema/Pain/Ankle function

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出版年

2024
创伤外科杂志
第三军医大学,大坪医院,野战外科研究所

创伤外科杂志

CSTPCD
影响因子：1.017
ISSN：1009-4237
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