关节镜下微骨折联合富血小板血浆治疗膝骨关节炎

doi:10.3877/cma.j.issn.1674-134X.2026.01.016

目的

探讨关节镜下微骨折联合富血小板血浆治疗膝关节骨关节炎的初步临床疗效。

方法

选取2020年1月至2022年1月中山火炬开发区人民医院骨科收治70例膝关节骨性关节炎患者采取双盲法随机分为实验组和对照组，每组35例。对照组行膝关节镜下微骨折治疗，实验组在对照组基础之上行富血小板血浆（PRP）凝胶治疗。采用视觉模拟评分（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评价两组患者并发症发生情况及手术后患膝3、6、12个月疼痛、活动范围变化，同时对比手术后患膝3、6、12个月的MRI变化。计量资料采用t检验或混合效应模型，计数资料采用卡方检验分析。

结果

治疗后12个月，实验组总有效率为94%，相对于对照组的83%明显增高，差异具有统计学意义（χ²=4.12，P<0.05）；实验组治疗后3个月时VAS评分与对照组比较，差异无统计学意义（P>0.05）。在治疗后6、12个月实验组的VAS评分明显低于对照组（术后6个月：t=2.163，P=0.038；术后12个月：t=5.632，P<0.001）；治疗后3、6、12个月的膝关节WOMAC功能评分均低于对照组（术后3个月：t=3.463，P=0.001；术后6个月：t=3.417，P=0.002；术后12个月：t=4.343，P<0.001）。同时治疗后随访12个月时，两组MRI膝关节软骨缺损范围均有不同程度好转。

结论

中老年膝关节骨关节炎患者关节镜下微骨折联合富血小板血浆治疗，可明显减轻疼痛，改善膝关节功能，术后恢复良好，值得应用于临床治疗并推广。

关键词: 关节镜, 微骨折, 富血小板血浆, 骨关节炎，膝

Objective

To investigate the preliminary clinical efficacy of arthroscopic microfracture combined with platelet-rich plasma (PRP) in the treatment of knee osteoarthritis.

Methods

From January 2020 to January 2022, 70 patients with knee osteoarthritis admitted to the orthopedics department of Zhongshan Torch Development Zone People’s Hospital were randomly divided into the experimental group and the control group using a double-blind method, 35 cases in each group. The control group underwent arthroscopic microfracture treatment, while the experimental group received PRP gel treatment in addition to the same procedure. The incidence of complications, as well as changes in pain and range of motion of the affected knee at three, six and 12 months after surgery, were compared between the two groups using the visual analogue scale (VAS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC). MRI changes of the affected knee at three, six and 12 months after surgery were also compared. Continuous data were analyzed using t test or mixed-effect model, and categorical data were analyzed by chi square test.

Results

At 12 months after treatment, the total effective rate in the experimental group was 94%, which was significantly higher than that (83%) of the control group, with a statistically significant difference (χ²=4.12, P<0.05). There was no statistically significant difference in VAS scores between the experimental group and the control group at three months after treatment (P>0.05). VAS scores in the experimental group were significantly lower than those in the control group at six and 12 months after treatment (six months: t=2.163, P=0.038; 12 months: t=5.632, P<0.001). WOMAC functional scores of the knee in the experimental group were lower than those in the control group at three, six and 12 months after treatment (three months: t=3.463, P=0.001; six months: t=3.417, P=0.002; 12 months: t=4.343, P<0.001). Furthermore, at the 12-month follow-up after treatment, MRI showed varying degrees of improvement in the range of knee cartilage defects in both groups.

Conclusions

For middle-aged and elderly patients with knee osteoarthritis, arthroscopic microfracture combined with PRP treatment can significantly alleviate pain, improve knee joint function, and promote favorable postoperative recovery. This approach is worthy of clinical application and promotion.

Key words: Arthroscope, Microfracture, Platelet-rich plasma, Osteoarthritis, knee

表1 两组患者基线资料比较

Table 1 Comparison of baseline data between two groups

组别Groups	例数Case number	性别Gender		年龄[岁，（±s）]Age（year）	侧别Side		BMI[kg/m²，（±s）]	VAS（±s）	WOMAC（±s）
组别Groups	例数Case number	男Male	女Female	年龄[岁，（±s）]Age（year）	左Left	右Right	BMI[kg/m²，（±s）]	VAS（±s）	WOMAC（±s）
对照组Control group	35	男Male	女Female	15	20	57.3±7.4	16	19	21.6±1.7	5.4±0.6	86.7±6.3
实验组Experimental group	35	12	23	58.7±6.1	16	19	21.8±1.5	5.7±0.9	85.3±6.6
t值		-0.809		-0.729	0		-0.519	3.618	0.894
P值		>0.05		>0.05	>0.05		>0.05	>0.05	>0.05

表1 两组患者基线资料比较

Table 1 Comparison of baseline data between two groups

组别Groups	例数Case number	性别Gender		年龄[岁，（±s）]Age（year）	侧别Side		BMI[kg/m²，（±s）]	VAS（±s）	WOMAC（±s）
组别Groups	例数Case number	男Male	女Female	年龄[岁，（±s）]Age（year）	左Left	右Right	BMI[kg/m²，（±s）]	VAS（±s）	WOMAC（±s）
对照组Control group	35	男Male	女Female	15	20	57.3±7.4	16	19	21.6±1.7	5.4±0.6	86.7±6.3
实验组Experimental group	35	12	23	58.7±6.1	16	19	21.8±1.5	5.7±0.9	85.3±6.6
t值		-0.809		-0.729	0		-0.519	3.618	0.894
P值		>0.05		>0.05	>0.05		>0.05	>0.05	>0.05

表2 两组患者的临床疗效比较

Table 2 Comparison of clinical efficacy in two groups

组别Groups	例数Case number	治愈Cure	显效Significant effect	有效Effective	无效Noneffective	总有效率[n（%）]Overall efficiency
对照组Control group	35	5	15	9	6	29（83）
实验组Experimental group	35	10	13	10	2	33（94）
χ²值						4.12
P值						<0.01

表2 两组患者的临床疗效比较

Table 2 Comparison of clinical efficacy in two groups

组别Groups	例数Case number	治愈Cure	显效Significant effect	有效Effective	无效Noneffective	总有效率[n（%）]Overall efficiency
对照组Control group	35	5	15	9	6	29（83）
实验组Experimental group	35	10	13	10	2	33（94）
χ²值						4.12
P值						<0.01

表3 两组患者治疗前后VAS评分比较[分，（

±s）]

Table 3 Comparison of VAS between two groups before and after treatment

组别Groups	例数Case number	治疗前Before treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment	治疗后12个月12 months after treatment
对照组Control group	35	5.4±0.6	3.3±0.9	2.2±0.6	1.9±0.5
实验组Experimental group	35	5.7±0.9	3.0±0.7	1.8±0.7	1.2±0.4
t值		-1.575	1.276	2.163	5.632
P值		>0.05	>0.05	0.038	<0.001

表3 两组患者治疗前后VAS评分比较[分，（

±s）]

Table 3 Comparison of VAS between two groups before and after treatment

组别Groups	例数Case number	治疗前Before treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment	治疗后12个月12 months after treatment
对照组Control group	35	5.4±0.6	3.3±0.9	2.2±0.6	1.9±0.5
实验组Experimental group	35	5.7±0.9	3.0±0.7	1.8±0.7	1.2±0.4
t值		-1.575	1.276	2.163	5.632
P值		>0.05	>0.05	0.038	<0.001

表4 两组患者治疗前后WOMAC评分比较[分，（

±s）]

Table 4 Comparison of WOMAC between two groups before and after treatment

组别Groups	例数Case number	治疗前Before treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment	治疗后12个月12 months after treatment
对照组Control group	35	87±6	61±9	53±8	46±6
实验组Experimental group	35	85±7	54±8	47±7	40±6
t值		0.894	3.463	3.417	4.343
P值		>0.05	0.001	0.002	<0.001

表4 两组患者治疗前后WOMAC评分比较[分，（

±s）]

Table 4 Comparison of WOMAC between two groups before and after treatment

组别Groups	例数Case number	治疗前Before treatment	治疗后3个月Three months after treatment	治疗后6个月Six months after treatment	治疗后12个月12 months after treatment
对照组Control group	35	87±6	61±9	53±8	46±6
实验组Experimental group	35	85±7	54±8	47±7	40±6
t值		0.894	3.463	3.417	4.343
P值		>0.05	0.001	0.002	<0.001

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Arthroscopic microfracture combined with platelet-rich plasma in treatment of knee osteoarthritis