观察富血小板血浆(PRP)注射治疗慢性半月板损伤的临床疗效。

选择2016年1月至2017年10月韶关市第一人民医院收治的35例病程大于6个月的慢性半月板损伤患者采用压痛点注射PRP治疗。每周注射1次，每次每膝2 ml，共3～6次，首次注射后膝关节制动3周，随访3～6个月，采用Lysholm评分、视觉模拟痛评分(VAS)、半月板旋转试验(McMurray试验)、MRI影像Stoller损伤分级评估疗效、观察并发症发生率。Lysholm评分、VAS评分结果采用重复测量数据的方差分析，McMurray试验、MRI影像等计数资料采用χ²检验进行统计分析。

共有35例37膝47个半月板，年龄24～71岁，平均(56±13)岁；病程6～112个月，平均(48±33)个月。本组病例在其治疗前及首次治疗后1月、2月、3月膝关节Lysholm评分分别为(65.1±4.8)、(68.8±5.1)、(71.6±4.8)、(72.5±4.9)，差异有统计学意义(F ＝1968.5，P < 0.01)；治疗前、治疗后3个月膝关节痛VAS评分分别为(4.3±0.9)、(2.4±0.8)，差异有统计学意义(F ＝72.22，P < 0.01)；治疗前膝关节McMurray试验阳性、可疑阳性、阴性分别为41、6、0，治疗3个月后分别为6、11、30，差异有统计学意义(χ²＝57.53，P < 0.01)；半月板损伤按Stoller分度，治疗前0、Ⅰ、Ⅱ、Ⅲ度分别为0、4、36、7例，治疗3个月后为6、26、11、4例，差异有统计学意义(χ²＝36.25，P < 0.01)，总有效率为74.47%(35/47)。在并发症方面，共有10.81%(4/37)；MRI提示膝关节内积液增加，但无特殊不适；另有8.51%(4/47)；出现注射深后处疼痛，经热敷处理后缓解；均未见针道感染。

PRP治疗可促进膝关节慢性半月板损伤愈合，能缓解疼痛，改善体征，提高生活质量，具有较好的治疗效果，值得推广应用；使用时注意注射方法和技巧，避免并发症。

To observe the clinical efficacy of platelet rich plasma (PRP) injection in the treatment of chronic meniscus injury.

From January 2016 to October 2017, a total of 35 patients with chronic meniscus injury, which courses were more than 6 months, were treated with PRP injection in Shaoguan Hospital Affiliated to Southern Medical University. Their knee joints were immobilized for three weeks after the first injection and followed up for three to six months. Lysholm score, visual analogue pain score (VAS), meniscus rotation test (McMurray test), Stoller injury grading of MR images were used to evaluate the efficacy. The incidence of complications was also observed. Lysholm score and visual analogue pain score (VAS) were analyzed by variance analysis of repeated measurements. The counting data of McMurray test and MRI image were analyzed by chi-square test.

There were 35 patients with 37 knees and 47 meniscuses, aged from 24 to 71 years, (56±13)years on average. Course of disease were six to 112 months, average (48±33) months. The Lysholm knee score was (65.1±4.8), (68.8±5.1), (71.6±4.8), (72.5±4.9)respectively before treatment, and one month, two months, three months after the first injection; the difference was statistically significant(F=1 968.5, P <0.01). The VAS scores of knee joint were (4.3±0.9), (3.9±0.4), (2.9±0.6)and (2.4±0.8)respectively. The difference was statistically significant (F=72.2, P <0.01). As to frequency of positive, suspicious positive and negative knee joint McMurray test, the cases were 41, six and zero before the treatment; and six, 11, 30 cases after the treatment respectively. the difference was statistically significant(χ²=57.53, P< 0.01). In addition, the Stoller-graduation, stage zero, I, II and III were zero, four, 36, and seven cases respectively before the treatment; six, 26, 11, and four cases respectively after the treatment at three months; the difference was statistically significant(χ²=36.25, P < 0.01). The total effective rate of meniscus chronic injury showed by MRI was 74.47% (35/47). Although there were 10.81% (4/37) knees accompanying with increment of joint effusion showing in MRI, but without special discomfort to patients; the incidence of deep pain was 8.51% (4/47) after PRP injection, which was relieved by heat treatment. No needle injecting tract infection was observed.

PRP treatment can promote the healing of knee meniscus chronic injury, relieve pain, improve symptoms, improve the quality of life, which has an excellent therapeutic effect; complications should be avoided.