关节镜联合富血小板血浆治疗老年半月板损伤的短期疗效

doi:10.3877/cma.j.issn.1674-134X.2019.02.009

目的

关节镜手术联合富血小板血浆(PRP)治疗老年膝关节半月板损伤的疗效。

方法

选取佛山市禅城中心医院2016年7月至2017年6月期间收治的老年膝关节半月板损伤患者40例。所有入选者要求半月板损伤Stoller分级为Ⅲ级，且膝骨关节炎Keligren Lawrence分级为Ⅱ级或Ⅲ级；并排除发病前有明显外伤史、合并有交叉韧带损伤或合并外侧半月板损伤的患者。按随机数字表法分为PRP组和对照组两组，每组各20例，PRP组为关节镜联合应用PRP组；对照组为单纯关节镜治疗组。采用视觉模拟评分法(VAS评分)、膝关节Lysholm评分及西安大略和曼彻斯特大学关节炎指数(WOMAC)对术前和术后1、3、6个月随访时临床疗效、疼痛及膝关节功能进行评估。采用SPSS 13.0统计学软件分析数据，计数资料的比较采用卡方检验，同组不同时间点的比较采用重复测量因素的方差分析，组间各时间点的比较采用独立样本t检验。

结果

随访发现两组患者术后均无严重并发症出现。与治疗前比较，两组患者术后1、3、6个月的VAS评分及WOMAC评分均明显降低，而Lysholm评分明显升高；两组患者治疗后均可明显减轻疼痛，改善膝关节功能。与对照组相比，治疗后3个月、6个月PRP组患者的VAS评分、Lysholm评分及WOMAC评分的改善情况均优于对照组，差异有统计学意义(术后3个月VAS评分：t＝4.125，P<0.05；术后6个月VAS评分：t＝8.557，P<0.05；术后3个月Lysholm评分：t＝7.428，P<0.05；术后6个月Lysholm评分：t＝15.564，P<0.05；术后3个月WOMAC评分：t＝6.932，P<0.05；术后6个月WOMAC评分：t＝9.174，P<0.05)。

结论

关节镜下行老年膝关节半月板损伤修整手术联合应用PRP治疗近期疗效优良，具有一定的应用前景。

关键词: 富血小板血浆, 关节镜, 半月板, 骨关节炎

Objective

To investigate the effect of arthroscopic surgery combined platelet-rich plasma in the treatment of senile knee meniscus injury.

Methods

From July 2016 to June 2017, 40 qualified senile patients with grade Ⅱ and Ⅲ knee osteoarthritis according to Keligren Lawrence classification and grade Ⅲ knee meniscus injury according to Stoller classification in Foshan Chancheng Central Hospital were included, while the patients with a prior history of trauma, cruciate ligament injury, or lateral meniscus injury were excluded. Forty patients were randomly divided into two groups: the PRP group (n=20, arthroscopic surgery combined with PRP); and the control group (n=20, arthroscopic surgery only). The patients were followed up in postoperative one month, three months and six months. The adverse reactions of the two groups were recorded. The pain was evaluated by visual analogue scale (VAS) score, and the knee joint function was assessed with the Lysholm score and the Western Ontario and McMaster Universities (WOMAC). osteoarthritis index Data were analyzed by SPSS 13.0 statistical software. Chi-square test was used for comparison of counting data; Anova for repeated measures was used for comparison of different time points in the same group; t test for independent-samples was used for comparison of each time point between groups.

Results

No serious postoperative complication was found in both groups. At month 1, 3 and 6 after the treatment, the VAS score and WOMAC score in both groups obviously decreased compared with before treatment, while the Lysholm score obviously increased. After the treatment, the pain was relieved and knee functions were improved in both group. At month 3 and 6 after the treatment, the improvement of the VAS score, the Lysholm score and the WOMAC score of PRP group were significantly better than that of the control group(the VAS score at month 3: t=4.125, P<0.05; the VAS score at month 6: t=8.557, P<0.05; the Lysholm score at month 3: t=7.428, P<0.05; the Lysholm score at month 6: t=15.564, P<0.05; the WOMAC score at month 3: t=6.932, P<0.05; the WOMAC score at month 6: t=9.174, P<0.05).

Conclusion

Arthroscopic surgery combined with PRP therapy in the treatment of senile knee meniscus injury has an excellent recent effect, and a certain application prospect.

Key words: Platelet rich plasma, Arthroscope, Meniscus, Osteoarthritis

图1 膝关节MRI图像。图A　为冠状位影像提示膝关节内侧半月板损伤(Ⅲ级)；图B　为矢状位影像提示膝关节内侧后角半月板损伤(Ⅲ级)

图2 膝关节镜图像。图A　为术中探查见右膝内侧半月板后角撕裂，复杂严重损伤(Ⅲ型)；图B　为关节镜下半月板部分切除成形术后图像

表1 两组患者治疗前基本资料及关节功能评分比较

分组	例数	年龄[岁，(±s)]	性别(男/女)	K-L分级(2/3)	BMI[kg/m²，(±s)]
PRP组	20	62±7	4/16	12/8	29±4
对照组	20	64±8	5/15	11/9	29±4
统计值	?	t＝0.653	χ²＝0.143	χ²＝0.102	t＝0.847
P值	?	>0.05	>0.05	>0.05	>0.05

表1 两组患者治疗前基本资料及关节功能评分比较

分组	例数	年龄[岁，(±s)]	性别(男/女)	K-L分级(2/3)	BMI[kg/m²，(±s)]
PRP组	20	62±7	4/16	12/8	29±4
对照组	20	64±8	5/15	11/9	29±4
统计值	?	t＝0.653	χ²＝0.143	χ²＝0.102	t＝0.847
P值	?	>0.05	>0.05	>0.05	>0.05

表2 两组患者治疗前半月板与软骨损伤情况比较

分组	例数	内侧半月板退变性损伤分型(其他/Ⅲ型)	软骨损伤分级(其他/Ⅳ度)
PRP组	20	10/10	13/7
对照组	20	11/9	12/8
χ²值	?	0.107	0.100
P值	?	>0.05	>0.05

表2 两组患者治疗前半月板与软骨损伤情况比较

分组	例数	内侧半月板退变性损伤分型(其他/Ⅲ型)	软骨损伤分级(其他/Ⅳ度)
PRP组	20	10/10	13/7
对照组	20	11/9	12/8
χ²值	?	0.107	0.100
P值	?	>0.05	>0.05

表3 两组患者的VAS评分比较(±s)

分组	例数	治疗前	治疗后1个月	治疗后3个月	治疗后6个月	F值	P值
PRP组	20	6.8±0.7	2.7±0.9^a	1.2±0.6^a	0.9±0.5^a	15.634	<0.05
对照组	20	6.9±0.6	2.7±0.7^a	2.6±0.8^a	1.4±0.6^a	7.896	<0.05
t值	?	0.653	0.718	4.125	8.557	?	?
P值	?	>0.05	>0.05	<0.05	<0.05	?	?

表3 两组患者的VAS评分比较(±s)

分组	例数	治疗前	治疗后1个月	治疗后3个月	治疗后6个月	F值	P值
PRP组	20	6.8±0.7	2.7±0.9^a	1.2±0.6^a	0.9±0.5^a	15.634	<0.05
对照组	20	6.9±0.6	2.7±0.7^a	2.6±0.8^a	1.4±0.6^a	7.896	<0.05
t值	?	0.653	0.718	4.125	8.557	?	?
P值	?	>0.05	>0.05	<0.05	<0.05	?	?

表4 两组患者的Lysholm评分比较(±s)

分组	例数	治疗前	治疗后1个月	治疗后3个月	治疗后6个月	F值	P值
PRP组	20	48±7	78±10^a	82±10^a	93±14^a	27.638	<0.05
对照组	20	50±9	79±8^a	81±12^a	87±10^a	13.857	<0.05
t值	?	0.318	0.267	7.428	15.564	?	?
P值	?	>0.05	>0.05	<0.05	<0.05	?	?

表4 两组患者的Lysholm评分比较(±s)

分组	例数	治疗前	治疗后1个月	治疗后3个月	治疗后6个月	F值	P值
PRP组	20	48±7	78±10^a	82±10^a	93±14^a	27.638	<0.05
对照组	20	50±9	79±8^a	81±12^a	87±10^a	13.857	<0.05
t值	?	0.318	0.267	7.428	15.564	?	?
P值	?	>0.05	>0.05	<0.05	<0.05	?	?

表5 两组患者的WOMAC评分比较(±s)

分组	例数	治疗前	治疗后1个月	治疗后3个月	治疗后6个月	F值	P值
PRP组	20	59±7	28±6^*	17±4^*	16±4^*	6.936	<0.05
对照组	20	60±7	31±7^*	25±6^*	24±7^*	14.115	<0.05
t值	?	0.476	0.154	6.932	9.174	?	?
P值	?	>0.05	>0.05	<0.05	<0.05	?	?

表5 两组患者的WOMAC评分比较(±s)

分组	例数	治疗前	治疗后1个月	治疗后3个月	治疗后6个月	F值	P值
PRP组	20	59±7	28±6^*	17±4^*	16±4^*	6.936	<0.05
对照组	20	60±7	31±7^*	25±6^*	24±7^*	14.115	<0.05
t值	?	0.476	0.154	6.932	9.174	?	?
P值	?	>0.05	>0.05	<0.05	<0.05	?	?

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Analysis of short-term effect of arthroscopic surgery combined platelet-rich plasma on senile knee meniscus injury

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Analysis of short-term effect of arthroscopic surgery combined platelet-rich plasma on senile knee meniscus injury