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

[1]	Hussain SM, Neilly DW, Baliga S, et al. Knee osteoarthritis: a review of management options[J]. Scott Med J, 2016, 61(1)：7-16.
[2]	Sharma L, Song J, Dunlop D, et al. Varus and valgus alignment and incident and progressive knee osteoarthritis[J]. Ann Rheum Dis, 2010, 69(11): 1940-1945.
[3]	Englund M, Roemer FW, Hayashi D, et al. Meniscus pathology, osteoarthritis and the treatment controversy[J]. Nat Rev Rheumatol, 2012, 8(7): 412-419.
[4]	Primorac D, Molnar V, Rod E, et al. Knee osteoarthritis: a review of pathogenesis and state-of-the-art non-operative therapeutic considerations[J]. Genes (Basel), 2020, 11(8): 854. doi: 10.3390/genes11080854.
[5]	Sun H, Zhou L, Li F, et al. Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: a systematic review and meta-analysis[J]. J Knee Surg, 2017, 30(2): 158-165.
[6]	Katz JN, Brownlee SA, Jones MH. The role of arthroscopy in the management of knee osteoarthritis[J]. Best Pract Res Clin Rheumatol, 2014, 28(1): 143-156.
[7]	O'connell B. Wragg NM, Wilson SL. The use of PRP injections in the management of knee osteoarthritis[J]. Cell Tissue Res, 2019, 376(2): 143-152.
[8]	Sharma L, Song J, Felson DT, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis[J]. JAMA, 2001, 286(2): 188-195.
[9]	Englund M, Guermazi A, Lohmander LS. The meniscus in knee osteoarthritis[J]. Rheum Dis Clin North Am, 2009，35(3): 579-590.
[10]	Thorlund JB, Juhl CB, Roos EM, et al. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms[J]. BMJ, 2015, 350(19): h2747. doi: 10.1136/bmj.h2747.
[11]	Khan M, Khanna V, Adili A, et al. Knee osteoarthritis: when arthroscopy can help[J]. Pol Arch Intern Med, 2018, 128(2): 121-125.
[12]	Michael JW, Schlüter-Brust K, Epidemiology ET, et al. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee[J]. Dtsch Arztebl Int, 2010, 107(9): 152-162.
[13]	Raeissadat SA, Rayegani SM, Hassanabadi H, et al. Knee osteoarthritis injection choices: platelet-rich plasma (PRP) versus hyaluronic acid (a one-year randomized clinical trial)[J]. Clin Med Insights Arthritis Musculoskelet Disord, 2015, 8: 1-8.
[14]	Dai WL, Zhou AG, Zhang H, et al. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials[J]. Arthroscopy, 2017, 33(3): 659-670.e1.
[15]	Cook CS, Smith PA. Clinical update: why PRP should be your first choice for injection therapy in treating osteoarthritis of the knee[J]. Curr Rev Musculoskelet Med, 2018, 11(4): 583-592.

[1]	许银峰, 盛璞义, 余世明, 张阳春. 偏心性髋臼旋转截骨术治疗发育性髋关节发育不良[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 568-574.
[2]	刘鹏, 罗天, 许珂媛, 邓红美, 李瑄, 唐翠萍. 八段锦对膝关节炎疗效的初步步态分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 590-595.
[3]	苏介茂, 齐岩松, 王永祥, 魏宝刚, 马秉贤, 张鹏飞, 魏兴华, 徐永胜. 关节镜手术在早中期膝骨关节炎治疗的应用进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 646-652.
[4]	谢佳乐, 李琦, 芦升升, 姜劲松. 内侧膝骨关节炎伴胫股关节冠状半脱位的手术治疗[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 653-657.
[5]	庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[6]	李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[7]	王冰, 孙海宁, 于秀淳, 周珂, 翟凯, 苗族康. 膝骨关节炎的活动衬垫型单髁置换疗效与假体生存率[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 337-345.
[8]	张江礼, 刘金辉, 潘西庆, 刘光源, 范虓. 全膝关节置换应用智能辅助手术导航系统治疗膝骨关节炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 346-351.
[9]	王振宇, 张洪美, 荆琳, 何名江, 闫奇. 膝骨关节炎相关炎症因子与血浆代谢物间的因果关系及中介效应[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 467-473.
[10]	李亚龙, 王星童, 申传安. 异体富血小板血浆在创面修复中的临床应用进展[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 541-545.
[11]	赵芊, 李亚坤, 李智. 同种异体富血小板血浆临床应用的研究进展[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(04): 364-367.
[12]	庹晓晔, 冯光. 复杂胸壁重建策略[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(03): 276-276.
[13]	苏永涛, 王春雷, 徐广琪, 关中正, 焦伟, 隋颖. 胫骨骨膜牵张术联合富血小板血浆对治疗糖尿病足溃疡的疗效观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(03): 238-244.
[14]	高广涵, 张耀南, 石磊, 王林, 王飞, 郑子天, 王鸿禹, 郭民政, 薛庆云. 膝骨关节炎患者前交叉韧带功能影像学影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 301-307.
[15]	罗斯敏, 周苗苗, 石绮屏. 肥胖脂肪代谢及肠道微生物群异常与骨关节炎关系的研究进展[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 200-205.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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