富血小板血浆联合手术治疗膝骨关节炎复合半月板损伤

doi:10.3877/cma.j.issn.1674-134X.2021.03.019

目的

观察富血小板血浆联合胫骨高位截骨、关节镜清理治疗复合内侧半月板损伤的内翻性膝骨关节炎的临床疗效。

方法

回顾性分析浙江大学医学院附属第二医院骨科2016年6月至2019年6月收治的12例复合内侧半月板损伤的内翻性膝骨关节炎，采用膝关节镜清理、半月板成型，胫骨高位截骨调整力线，纠正膝关节内翻，富血小板血浆分别于术中，术后2周和术后4周关节腔注射治疗膝骨关节炎。在术前、术后1月、3月、6月、1年和2年记录疼痛视觉模拟评分(VAS)，特种外科医院(HSS)膝关节评分。计量资料采用t检验，不同时间点分析采用单因素重复测量数据方差分析。

结果

本组患者共12例，其中男性5例，女性7例，术前胫骨近端内侧角(MPTA)(81.6±2.2)°，股胫角(FTA)(185.7±2.4)°，股骨远端外侧角(LDFA)(88.4±1.9)°，VAS评分(3.9±1.1)，HSS评分(52.8±6.5)。术后MPTA(93.2±2.9)°，FTA(172.8±2.3)°，患者术后各时间点VAS评分(F＝4.79，P<0.001)和HSS评分(F＝2.01，P＝0.02)逐渐改善。

结论

通过富血小板血浆和胫骨高位截骨、关节镜清理联合治疗复合内侧半月板损伤的内翻性膝骨关节炎具有良好的临床效果，缓解患者的疼痛，改善膝关节功能。

关键词: 富血小板血浆, 膝内翻, 骨关节炎, 截骨术, 半月板损伤

Objective

To observe the effect of treatment for the varus knee osteoarthritis with the medial meniscus injury by platelet rich plasma (PRP) combined with high tibial osteotomy (HTO) and arthroscopy.

Methods

Retrospective analysis of 12 cases of varus knee osteoarthritis with the medial meniscus injury treated by PRP combined with HTO and arthroscopy between June 2016 and June 2019. PRP was injected at the time of operation, two weeks and four weeks after operation. Visual analogue scale (VAS) and Hospital for Special Surgery (HSS) knee score were recorded at the time of operation, one month, three months, six months, one year and two years after operation. The t test was used for measurement data, and repeated measurement data variance was used for analysis of different time points.

Results

There were 12 patients (five males and seven females). preoperative MPTA was (81.6±2.2)°, femorotibial angle (FTA) was (185.7±2.4)°, lateral distal femoral angle (LDFA) was (88.4+ 1.9)°, VAS score was (3.9±1.1) and HSS score was (52.8±6.5). Postoperative medial proximal tibial angle (MPTA) was (93.2±2.9)° and FTA was (172.8±2.3)°. The VAS score (F=4.79, P<0.001)and HSS score(F=2.01, P=0.02) were improved significantly after operation.

Conclusion

The combination treatment of PRP, HTO and arthroscopy for the varus knee osteoarthritis with the medial meniscus injury has been confirmed, which reduces the pain of patients, improve the function of the knee joint.

Key words: Platelet rich plasma, Genu varum, Osteoarthritis, Osteotomy, Meniscus injury

表1 膝关节力线角度[°，n＝12，(±s)]

	MPTA	FTA
术前	81.6±2.2	185.7±2.4
术后6月	93.2±2.9	172.8±2.3
t值	-11.46	13.26
P值	<0.001	<0.001

表1 膝关节力线角度[°，n＝12，(±s)]

	MPTA	FTA
术前	81.6±2.2	185.7±2.4
术后6月	93.2±2.9	172.8±2.3
t值	-11.46	13.26
P值	<0.001	<0.001

表2 VAS评分和HSS膝关节评分[n＝12，(±s)]

时间点	VAS评分	HSS膝关节评分
术前	3.9±1.1	52.8±6.5
术后1月	2.2±1.1^a	56.2±7.4^b
术后3月	1.6±0.9^a	67.4±6.1^a
术后6月	1.1±0.7^a	80.9±4.6^a
术后1年	0.9±0.7^a	85.3±5.5^a
术后2年	0.8±0.7^a	86.3±6.3^a
F值	4.79	2.01
P值	<0.001	0.02

表2 VAS评分和HSS膝关节评分[n＝12，(±s)]

时间点	VAS评分	HSS膝关节评分
术前	3.9±1.1	52.8±6.5
术后1月	2.2±1.1^a	56.2±7.4^b
术后3月	1.6±0.9^a	67.4±6.1^a
术后6月	1.1±0.7^a	80.9±4.6^a
术后1年	0.9±0.7^a	85.3±5.5^a
术后2年	0.8±0.7^a	86.3±6.3^a
F值	4.79	2.01
P值	<0.001	0.02

图1 典型病例术前X线片。图A为双下肢全长片，示左膝内翻畸形；图B为左膝正侧位片，示内侧间室骨质增生，间隙稍狭窄

图2 典型病例术前MRI，示左膝内侧膝骨关节炎、软骨退变损伤、内侧半月板损伤

图3 典型病例术中关节镜监视下在半月板成形后给予膝关节腔注射富血小板血浆

图4 典型病例术后3个月X线片。图A为双下肢全长片，示左膝内翻畸形纠正；图B为左膝正侧位片，示截骨位置良好，内固定稳定

图5 典型病例术后6月X线片。图A为双下肢全长片，示左膝力线良好，无再发异常；图B为左膝正侧位片，示截骨端骨性愈合

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Platelet rich plasma combined with surgery for treatment of knee osteoarthritis with meniscus injury

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Platelet rich plasma combined with surgery for treatment of knee osteoarthritis with meniscus injury