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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 141 -146. doi: 10.3877/cma.j.issn.1674-134X.2023.01.021

临床经验

富血小板血浆对膝软骨损伤术后功能康复的影响
贾星海1, 张超1, 林岩1,†()   
  1. 1. 221000　徐州矿务集团总医院
  • 收稿日期:2021-01-11 出版日期:2023-02-01
  • 通信作者: 林岩

Effect of platelet-rich plasma on functional rehabilitation after knee cartilage injury surgery

Xinghai Jia1, Chao Zhang1, Yan Lin1,†()   

  1. 1. Xuzhou Mining Group General Hospital, Xuzhou 221000, China
  • Received:2021-01-11 Published:2023-02-01
  • Corresponding author: Yan Lin
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贾星海, 张超, 林岩. 富血小板血浆对膝软骨损伤术后功能康复的影响[J]. 中华关节外科杂志(电子版), 2023, 17(01): 141-146.

Xinghai Jia, Chao Zhang, Yan Lin. Effect of platelet-rich plasma on functional rehabilitation after knee cartilage injury surgery[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 141-146.

目的

探讨自体富血小板血浆(PRP)关节腔内注射辅助手术治疗对膝关节软骨损伤患者功能康复的影响。

方法

回顾性分析徐州矿务集团总医院膝关节软骨损伤患者106例(2017年1月至2018年3月)临床资料，接受微骨折术联合PRP治疗者计为研究组(n＝53)，接受微骨折术联合玻璃酸钠治疗者计对照组(n＝53)。比较两组治疗前及治疗后3、6、9个月视觉模拟评分(VAS)、日本骨科协会评分(JOA)、特种外科医院膝关节(HSS)功能评分、炎性因子水平及不良反应。

结果

治疗后3、6、9个月两组VAS评分较治疗前降低，且研究组低于对照组(F时间＝34.842，F组别＝23.766，F交互＝15.591，均为P<0.05)。治疗后3、6、9个月两组JOA评分较治疗前增高，且研究组高于对照组(F时间＝69.734，F组别＝44.069，F交互＝28.318，均为P<0.05)。治疗后3、6、9个月两组HSS评分较治疗前增高，且研究组高于对照组(F时间＝61.012，F组别＝48.338，F交互＝25.443，均为P<0.05)。治疗后研究组血清白介素(IL)-6、肿瘤坏死因子-α(TNF-α)水平明显低于治疗前(t＝64.233、42.920，均为P<0.05)，且研究组明显低于对照组(t＝12.576、8.324，均为P<0.05)。研究组不良反应发生率(5.7%)低于对照组(18.9%)(χ2＝4.296，P<0.05)。

结论

采取PRP关节腔内注射辅助手术治疗膝关节软骨损伤，可有效减轻患者疼痛程度，改善其关节功能，且安全性较高。

关键词: 膝关节损伤, 软骨, 注射，关节内, 功能康复, 富血小板血浆
Objective

To investigate the effect of intra articular injection of autologous platelet-rich plasma (PRP) as an adjuvant surgical treatment on functional recovery in patients with knee cartilage injury.

Methods

A retrospective analysis of the clinical data of 106 patients with knee cartilage injury in Xuzhou Mining Group General Hospital (January 2017 to March 2018) was conducted. The patients who received microfracture surgery combined with PRP treatment were assigned in the study group (n=53), while those who received microfracture surgery combined with sodium hyaluronate treatment were assigned in the control group (n=53). The visual analogue scale (VAS), Japanese Orthopaedic Association(JOA) scores, the Hospital for Special Surgery (HSS) knee joint function scores, inflammatory factor levels, and adverse reactions were compared between the two groups before and in three, six, and nine months after treatment.

Results

The VAS scores of the two groups in three, six, and nine months after treatment were lower than those before treatment, and the study group were lower than the control group (Ftime=34.842, Fgroup=23.766, F interaction=15.591, all P<0.05). Three, six, and nine months after treatment, the JOA scores in the two groups were higher than those before treatment, and the study group was higher than the control group (Ftime=69.734, Fgroup=44.069, F interaction=28.318, all P <0.05). Three, six, and nine months of treatment, the HSS scores of the two groups were higher than those before treatment, and the study group was higher than the control group (Ftime=61.012, Fgroup=48.338, F interaction=25.443, all P <0.05). The levels of serum interleukin (IL) -6 and tumor necrosis factor (TNF)-α in the study group after treatment were significantly lower than those before the treatment(t=64.233、42.920, both P<0.05), and levels of IL-6 and TNF-α in the study group were lower than the control group (t=12.576, 8.324, both P<0.05). The incidence of adverse reactions in the study group (5.7%) was lower than that in the control group (18.9%)(χ2=4.296, P<0.05).

Conclusion

Intraarticular injection of PRP as an adjunctive surgical treatment for knee cartilage injury can effectively alleviate pain and improve joint function.

Key words: Knee injuries, Cartilage, Injections, intraarticular, Functional rehabilitation, Platelet rich plasma
表1 两组一般资料比较
Table 1 Comparison of general informations between two groups
资料Information 研究组Study group 对照组Control group 统计值Statistical value P值
例数Case number 53 53    
性别Gender[例(%)]        
男 30(56.6) 33(62.3) χ2＝0.352 >0.05
女 23(43.4) 20(37.7)
年龄[岁，(±s)]Age (39.1±7.9) (38.8±8.1) t＝0.161 >0.05
病程[月，(±s)]Course of disease (11.2±2.9) (11.0±3.0) t＝0.379 >0.05
致伤原因Causes of injury        
挤压伤 2(3.8) 1(1.9)    
交通事故 11(20.7) 14(26.4) χ2＝0.745 >0.05
运动损伤 40(75.5) 38(71.7)    
患侧Affected side[例(%)]        
左膝 25(47.2) 27(50.9) χ2＝0.151 >0.05
右膝 28(52.8) 26(49.1)
损伤分级[例(%)]Injury classification        
Ⅱ级 17(32.1) 21(39.6)    
Ⅲ级 20(37.7) 19(35.9) χ2＝0.757 >0.05
Ⅳ级 16(30.2) 13(24.5)    
表2 两组VAS评分比较[分，(±s)]
Table 2 Comparison of VAS scores between the two groups
组别Group 例数Case number 治疗前Before treatment 治疗后After treatment
3个月three months 6个月six months 9个月nine months
研究组Study group 53 7.1±1.1 3.9±1.0* 3.4±0.8* 3.0±0.6*
对照组Control group 53 7.1±1.1 4.6±1.0* 4.1±0.8* 3.5±0.7*
F值   时间：34.842，组别：23.766，交互：15.591
P值   时间：0.001，组别：<0.001，交互：<0.001
表3 两组JOA评分比较[分，(±s)]
Table 3 Comparison of JOA scores between the two groups
组别Group 例数Case number 治疗前Before treatment 治疗后After treatment
3个月three months 6个月six months 9个月nine months
研究组Study group 53 38±4 75±5* 78±7* 87±7*
对照组Control group 53 38±4 70±5* 72±6* 82±6*
F值     时间：69.734，组别：44.069，交互：28.318
P值     时间：<0.001，组别：<0.001，交互：<0.001
表4 两组HSS评分比较[分，(±s)]
Table 4 Comparison of HSS scores between the two groups
组别Group 例数Case number 治疗前Before treatment 治疗后After treatment
3个月three months 6个月six months 9个月nine months
研究组Study group 53 41±5 66±8* 80±8* 80±8*
对照组Control group 53 41±5 62±7* 74±8* 75±7*
F值     时间：61.012，组别：48.338，交互：25.443
P值     时间：<0.001，组别：<0.001，交互：<0.001
表5 两组治疗前后血清IL-6和TNF-α水平[ng/L，(±s)]
Table 5 Serum levels of IL-6 and TNF-α in the two groups before and after treatment
组别Group 例数Case number IL-6 t值 P值
治疗前Before treatment 治疗后After treatment
研究组Study group 53 181±20 80±11* 64.233 <0.001
对照组Control group 53 180±22 110±14* 55.341 <0.001
t值   1.325 41.242    
P值   >0.05 <0.001    
组别Group 例数Case number TNF-α t值 P值
治疗前Before treatment 治疗后After treatment
研究组Study group 53 95±12 58±8* 42.920 <0.001
对照组Control group 53 95±13 71±9* 34.631 <0.001
t值   0.135 33.373    
P值   >0.05 <0.001    
表6 两组不良反应比较[例(%)]
Table 6 Comparison of adverse reactions between the two groups
组别Group 例数Case number 关节肿胀Joint swelling 关节红热Joint redness and heat 关节疼痛Joint pain 过敏Allergy 总发生率Total incidence
研究组Study group 53 1(1.9) 1(1.9) 1(1.9) 0(0) 3(5.7)
对照组Control group 53 3(5.7) 4(7.5) 2(3.8) 1(1.9) 10(18.9)
χ2值           4.296
P值           0.038
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