自体富血小板血浆治疗退变性半月板撕裂的疗效

doi:10.3877/cma.j.issn.1674-134X.2025.04.015

目的

探讨关节腔注射自体富血小板血浆（PRP）治疗退变性半月板撕裂的临床疗效。

方法

选取2021年5月至2023年8月期间因膝关节疼痛于盐城市第一人民医院骨科门诊就诊的患者，经过MRI诊断为半月板撕裂，且无明确外伤史。按照随机数法分为PRP组（27例），透明质酸（HA）组（27例）和对照组（27例），共计81例。所有患者均拒绝关节镜手术治疗。每组患者每周接受1次关节腔注射治疗，三组分别注射PRP 5 ml、HA 2.5 ml、生理盐水5 ml，连续3周。三组患者治疗后采取相同的康复方案，记录所有患者治疗前、后1、3和6个月时的视觉模拟疼痛评分（VAS）、Lysholm评分和膝关节损伤与骨关节炎评分（KOOS），采取重复测量方差分析进行对比。记录随访过程中的不良事件发生情况。治疗后6个月时复查膝关节MRI，评估治疗前、后的半月板Stoller分度，采取卡方检验分析半月板的修复情况。

结果

所有参与本次研究的患者均完成随访。治疗前三组患者在年龄、性别、患侧、BMI值和随访时间方面没有显著差异。治疗前三组患者的VAS、Lysholm和KOOS评分比较差异均无统计学意义（均为P>0.05），治疗后三组患者VAS评分均低于治疗前，Lysholm和KOOS评分均高于治疗前，且治疗后1、3、6个月PRP组VAS评分（4.2±1.2、2.6±1.0、2.0±1.1）均低于HA组（5.2±1.0、4.5±1.3、3.2±1.1）和对照组（5.7±1.4、4.93±1.2、4.4±1.2），差异有统计学意义（F=10.966、29.388、30.721，均为P<0.01）。治疗后1、3、6个月PRP组Lysholm评分（75.6±4.5、79.6±4.2、85.1±5.3）均高于HA组（69.3±4.6、73.8±4.1、79.1±4.5）和对照组（64.8±3.6、68.9±5.3、70.4±4.3），差异有统计学意义（F=45.504、36.868、67.314，均为P<0.001）。治疗后3个月和6个月PRP组KOOS评分均高于HA组和对照组，差异有统计学意义（均为P<0.05）。三组患者均未出现膝关节感染等严重不良事件情况。PRP组的半月板修复率（66.7%）明显高于HA组（40.7%）和对照组（19.2%）（χ²=15.738，P=0.015）。

结论

退变性半月板撕裂患者采取关节腔注射PRP治疗能够缓解疼痛，改善膝关节功能，同时促进半月板撕裂的修复，临床疗效较为满意。

关键词: 膝损伤, 半月板, 富血小板血浆, 透明质酸

Objective

To explorer the clinical efficacy of intra-articular injection of autologous platelet rich plasma (PRP) in the treatment of degenerative meniscus tears.

Method

From May 2021 to August 2023, eighty-one patients were selected with meniscus injury who visited the outpatient department of orthopedics in Yancheng First People’s Hospital. All the patients were confirmed meniscus tear by MRI without trauma history. According to the random number method, patients were divided into PRP group (27 cases), hyaluronic acid (HA) group (27 cases), and control group (27 cases). All the patients refused arthroscopic surgery treatment. Each patient received a intra-articular injection treatment once a week, with PRP 5 ml, HA 2.5 ml, and 5 ml of saline for three weeks consecutively. All the patients were treated with the same rehabilitation plan, and the visual analog pain score (VAS), Lysholm score, and knee injury and osteoarthritis outcome score (KOOS) were recorded before treatment, at one, three, and six months after treatment. The results were analyzed by repeated measurement variance analysis. Any of adverse events were recorded during the follow-up. A knee joint MRI was carried out at six months after treatment and the Stoller grade was evaluated. The situations of meniscus repair were analyzed by chi-square test.

Results

All the patients finished the follow-up successfully in this study. There was no significant difference in age, gender, affected side, body mass index or follow-up duration among the three groups before treatment. There was no statistically significant difference in VAS, Lysholm, or KOOS scores among the three groups before treatment (all P>0.05). After treatment, VAS scores in all three groups were lower than before treatment, while KOOS and Lysholm scores were higher than before treatment. VAS scores in the PRP group (4.2±1.2, 2.6±1.0, 2.0±1.1) were lower than those in the HA group (5.2±1.0, 4.5±1.3, 3.2±1.1) and the control group (5.7±1.4, 4.9±1.2, 4.4±1.2) at one, three, and six months after treatment (F=10.966, 29.388, 30.721, all P<0.01), while Lysholm scores in the PRP group (75.6±4.5, 79.6±4.2, 85.1±5.3) were higher than those in the HA group ( 69.3±4.6, 73.8±4.1, 79.1±4.5) and the control group (64.8±3.6, 68.9±5.3, 70.4±4.3) at one, three, and six months after treatment, with statistically significant differences (F=45.504, 36.868, 67.314, all P<0.001). KOOS scores were higher than those in the control group at three and six months after treatment, with statistically significant differences (all P<0.05).None of the three group experience severe adverse events such as knee joint infection. As for the meniscus repair rate, PRP group (66.7%) was higher than that of the HA group (40.7%) and the control group (19.2%) (χ²=15.738, P=0.015).

Conclusion

PRP intra-articular injection could alleviate pain and improve knee joint function in patients with degenerative meniscus tear, with satisfactory clinical efficacy.

Key words: Knee injuries, Meniscus, Platelet rich plasma, Hyaluronic acid

表1 三组患者基本资料比较

Table 1 Comparison of baseline data among the three groups

组别Groups	例数Case number	性别（男/女）Gender (male/female)	年龄[岁，（±s）]Age	随访时间[月，（±s）]Follow-up time(month)	BMI[kg/m²，（±s）]	患侧（左/右）Side (left/right)
PRP组PRP group	27	13/14	50±12	21±9	23±3	11/16
HA组HA group	27	11/16	49±12	21±9	23±3	10/17
对照组Control group	27	10/17	49±14	20±8	23±3	12/15
统计值Statistical values		χ²=0.701	F=0.085	F=0.179	F=0.274	χ²=0.858
P值		>0.05	>0.05	>0.05	>0.05	>0.05

表1 三组患者基本资料比较

Table 1 Comparison of baseline data among the three groups

组别Groups	例数Case number	性别（男/女）Gender (male/female)	年龄[岁，（±s）]Age	随访时间[月，（±s）]Follow-up time(month)	BMI[kg/m²，（±s）]	患侧（左/右）Side (left/right)
PRP组PRP group	27	13/14	50±12	21±9	23±3	11/16
HA组HA group	27	11/16	49±12	21±9	23±3	10/17
对照组Control group	27	10/17	49±14	20±8	23±3	12/15
统计值Statistical values		χ²=0.701	F=0.085	F=0.179	F=0.274	χ²=0.858
P值		>0.05	>0.05	>0.05	>0.05	>0.05

表2 三组患者VAS及Lysholm评分比较

Table 2 Comparison of VAS and Lysholm scores among the three groups

组别Groups	例数Case number	VAS评分VAS score
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	6.4±1.1	4.2±1.2^ab	2.6±1.0^ab	2.0±1.1^ab
HA组HA group	27	6.5±1.3	5.2±1.0	4.5±1.3	3.2±1.1^a
对照组Control group	27	6.4±1.2	5.7±1.4	4.9±1.2	4.4±1.2
F值		0.060	10.966	29.388	30.721
P值		>0.05	0.010	<0.001	<0.001
组别Groups	例数Case number	Lysholm评分Lysholm score
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	61.9±5.0	75.6±4.5^ab	79.6±4.2^ab	85.1±5.3^ab
HA组HA group	27	61.4±6.3	69.3±4.6^a	73.8±4.1^a	79.1±4.5^a
对照组Control group	27	62.4±4.7	64.8±3.6	68.9±5.3	70.4±4.3
F值		0.202	45.504	36.868	67.314
P值		>0.05	<0.001	<0.001	<0.001

表2 三组患者VAS及Lysholm评分比较

Table 2 Comparison of VAS and Lysholm scores among the three groups

组别Groups	例数Case number	VAS评分VAS score
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	6.4±1.1	4.2±1.2^ab	2.6±1.0^ab	2.0±1.1^ab
HA组HA group	27	6.5±1.3	5.2±1.0	4.5±1.3	3.2±1.1^a
对照组Control group	27	6.4±1.2	5.7±1.4	4.9±1.2	4.4±1.2
F值		0.060	10.966	29.388	30.721
P值		>0.05	0.010	<0.001	<0.001
组别Groups	例数Case number	Lysholm评分Lysholm score
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	61.9±5.0	75.6±4.5^ab	79.6±4.2^ab	85.1±5.3^ab
HA组HA group	27	61.4±6.3	69.3±4.6^a	73.8±4.1^a	79.1±4.5^a
对照组Control group	27	62.4±4.7	64.8±3.6	68.9±5.3	70.4±4.3
F值		0.202	45.504	36.868	67.314
P值		>0.05	<0.001	<0.001	<0.001

表3 三组患者KOOS评分比较

Table 3 Comparison of KOOS cores among the three groups

组别Groups	例数Case number	KOOS-疼痛KOOS-pain
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	53±9	68±12^ab	78±10^ab	84±9^ab
HA组HA group	27	49±10	61±10^a	66±9	69±10^a
对照组Control group	27	49±9	53±8	55±8	55±9
F值		1.241	14.231	41.384	64.721
P值		>0.05	<0.001	<0.001	<0.001
组别Groups	例数Case number	KOOS-症状KOOS-symptom
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	65±14	78±12	85±11^ab	90±8^ab
HA组HA group	27	65±13	72±13	79±11	82±10
对照组Control group	27	68±15	72±14	75±9	78±9
F值		0.451	1.964	6.078	12.769
P值		>0.05	>0.05	<0.01	<0.001
组别Groups	例数Case number	KOOS-ADL
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	66±9	77±9^a	84±10^ab	89±9^ab
HA组HA group	27	69±13	75±10^a	78±11^a	82±8^a
对照组Control group	27	65±14	68±13	71±10	74±9
F值		1.269	4.521	10.406	22.386
P值		>0.05	0.014	<0.001	<0.001
组别Groups	例数Case number	KOOS-S/R
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	38±10	58±11^ab	66±8^ab	77±12^ab
HA组HA group	27	37±8	45±9	55±8^a	70±8^a
对照组Control group	27	38±10	45±12	49±13	56±14
F值		0.314	12.751	18.641	23.252
P值		>0.05	<0.001	<0.001	<0.001
组别Groups	例数Case number	KOOS-QoL
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	35±9	48±10^ab	59±7^ab	68±11^ab
HA组HA group	27	36±8	42±7^a	50±8^a	56±8^a
对照组Control group	27	34±9	39±8	44±10	48±98
F值		0.403	7.970	21.457	34.569
P值		>0.05	<0.01	<0.001	<0.001

表3 三组患者KOOS评分比较

Table 3 Comparison of KOOS cores among the three groups

组别Groups	例数Case number	KOOS-疼痛KOOS-pain
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	53±9	68±12^ab	78±10^ab	84±9^ab
HA组HA group	27	49±10	61±10^a	66±9	69±10^a
对照组Control group	27	49±9	53±8	55±8	55±9
F值		1.241	14.231	41.384	64.721
P值		>0.05	<0.001	<0.001	<0.001
组别Groups	例数Case number	KOOS-症状KOOS-symptom
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	65±14	78±12	85±11^ab	90±8^ab
HA组HA group	27	65±13	72±13	79±11	82±10
对照组Control group	27	68±15	72±14	75±9	78±9
F值		0.451	1.964	6.078	12.769
P值		>0.05	>0.05	<0.01	<0.001
组别Groups	例数Case number	KOOS-ADL
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	66±9	77±9^a	84±10^ab	89±9^ab
HA组HA group	27	69±13	75±10^a	78±11^a	82±8^a
对照组Control group	27	65±14	68±13	71±10	74±9
F值		1.269	4.521	10.406	22.386
P值		>0.05	0.014	<0.001	<0.001
组别Groups	例数Case number	KOOS-S/R
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	38±10	58±11^ab	66±8^ab	77±12^ab
HA组HA group	27	37±8	45±9	55±8^a	70±8^a
对照组Control group	27	38±10	45±12	49±13	56±14
F值		0.314	12.751	18.641	23.252
P值		>0.05	<0.001	<0.001	<0.001
组别Groups	例数Case number	KOOS-QoL
组别Groups	例数Case number	治疗前Before treatment	治疗后1个月One month after treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment
PRP组PRP group	27	35±9	48±10^ab	59±7^ab	68±11^ab
HA组HA group	27	36±8	42±7^a	50±8^a	56±8^a
对照组Control group	27	34±9	39±8	44±10	48±98
F值		0.403	7.970	21.457	34.569
P值		>0.05	<0.01	<0.001	<0.001

表4 三组患者治疗后半月板Stoller分度比较

Table 4 Comparison of Stoller grades after treatment among the three groups

组别Groups	例数Case number	Stoller分度（Stoller grade）
组别Groups	例数Case number	0	Ⅰ	Ⅱ	Ⅲ
PRP组PRP group	27	2	10	6	9
HA组HA group	27	0	6	5	16
对照组Control group	27	0	2	3	22
χ²值		15.738
P值		0.015

表4 三组患者治疗后半月板Stoller分度比较

Table 4 Comparison of Stoller grades after treatment among the three groups

组别Groups	例数Case number	Stoller分度（Stoller grade）
组别Groups	例数Case number	0	Ⅰ	Ⅱ	Ⅲ
PRP组PRP group	27	2	10	6	9
HA组HA group	27	0	6	5	16
对照组Control group	27	0	2	3	22
χ²值		15.738
P值		0.015

图1 左膝半月板损伤PRP（富血小板血浆）治疗前后的膝关节MRI图像。图A为治疗前MRI，示内侧半月板后角损伤为Ⅲ度信号；图B为PRP治疗后6个月MRI，示半月板损伤为Ⅱ度信号

Figure 1 MRI images of left knee with meniscus injury before and after PRP treatment. A is MRI before treatment, showing grade Ⅲ signal of the posterior horn of the medial meniscus; B is MRI after six months of PRP treatment, showing grade Ⅱ signal of the meniscus injury

图2 右膝半月板损伤PRP（富血小板血浆）治疗前后的右膝关节MRI图像。图A为治疗前MRI，示内侧半月板后角损伤为Ⅲ度信号；图B为PRP治疗后6个月MRI，示半月板损伤为Ⅰ度信号

Figure 2 MRI images of right knee with meniscus injury before and after PRP treatment. A is MRI before treatment, showing grade Ⅲ signal of the posterior horn of the medial meniscus; B is MRI after six months of PRP treatment, showing gradeⅠsignal of the meniscus injury

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Efficacy of autologous platelet rich plasma in conservative treatment of degenerative meniscus tear

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Efficacy of autologous platelet rich plasma in conservative treatment of degenerative meniscus tear