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中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 344 -352. doi: 10.3877/cma.j.issn.1674-134X.2026.03.011

综述

富血小板血浆促关节软骨修复机制及关节镜辅助应用进展
王德羽1, 薛甫民1, 魏巍2, 关雪峰3,()   
  1. 1 110847 沈阳,辽宁中医药大学第一临床学院
    2 110034 沈阳,辽宁中医药大学附属第二医院骨二科
    3 110016 沈阳药科大学临床药学院
  • 收稿日期:2025-07-27 出版日期:2026-06-01
  • 通信作者: 关雪峰
  • 基金资助:
    辽宁省中央引导地方科技发展专项基金项目(2023JH6/100100007); 沈阳市科技局科技项目(RC240227)

Mechanisms of platelet-rich plasma in promoting articular cartilage repair and advances in its adjunctive use in arthroscopy

Deyu Wang1, Fumin Xue1, Wei Wei2, Xuefeng Guan3,()   

  1. 1 The First Clinical College of Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China
    2 Department of Orthopaedics Ⅱ, The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110034, China
    3 School of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
  • Received:2025-07-27 Published:2026-06-01
  • Corresponding author: Xuefeng Guan
引用本文:

王德羽, 薛甫民, 魏巍, 关雪峰. 富血小板血浆促关节软骨修复机制及关节镜辅助应用进展[J/OL]. 中华关节外科杂志(电子版), 2026, 20(03): 344-352.

Deyu Wang, Fumin Xue, Wei Wei, Xuefeng Guan. Mechanisms of platelet-rich plasma in promoting articular cartilage repair and advances in its adjunctive use in arthroscopy[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 344-352.

关节软骨损伤后自我修复能力有限,其再生修复是骨科领域的研究难点。富血小板血浆(PRP)取自自体血液,富含多种生长因子,具有制备简便、安全性高等特点,已成为软骨修复研究的重要方向。PRP可通过调控软骨细胞凋亡与自噬、缓解炎症反应及平衡血管生成等途径改善修复微环境,促进软骨再生。在应用层面,PRP除单纯关节腔注射外,已作为关节镜手术的辅助手段,经术中或术后注射及生物支架递送等方式应用于软骨缺损修复,在提高修复质量、缓解疼痛与恢复关节功能方面具有协同作用。目前,注射方案、制备标准化及个体化治疗等关键问题尚未统一,仍是制约其临床转化的主要因素。本文在梳理PRP促软骨修复机制的基础上,分析其联合关节镜手术的应用策略与疗效证据,辨析现存争议,并就其与干细胞、外泌体及组织工程等新技术的联合应用进行展望,以期为关节软骨修复的精准化治疗提供参考。

Articular cartilage has limited capacity for self-repair, making cartilage regeneration a persistent challenge in orthopaedics. Platelet-rich plasma (PRP), derived from autologous blood and rich in growth factors, is simple to prepare and well tolerated, and has become an active area of cartilage repair research. PRP improves the repair microenvironment and supports cartilage regeneration by regulating chondrocyte apoptosis and autophagy, easing inflammation, and balancing angiogenesis. As an adjunct to arthroscopic surgery, it can be delivered by intraoperative or postoperative injection or via biomaterial scaffolds, helping to improve repair quality, relieve pain, and restore joint function. Its clinical use is still limited by unsettled questions over injection protocols, preparation standardization, and individualized treatment. This review outlined the mechanisms by which PRP promotes cartilage repair, examines its use alongside arthroscopic surgery and the supporting evidence, weighs current controversies, and considers its combination with stem cells, exosomes, and tissue engineering, aiming to inform cartilage repair in clinical practice.

表1 PRP中部分生长因子及其在关节软骨损伤修复中的作用
Table 1 Selected growth factors in PRP and their roles in articular cartilage repair
表2 PRP在关节镜术后软骨修复的临床应用与疗效
Table 2 Clinical application and efficacy of PRP in cartilage repair after arthroscopic surgery
作者 年份 患者数(例) 部位 手术方式 软骨情况 干预方式 应用方案 疗效
Luo等63 2022 57 髋关节 MF Outerbridge Ⅳ级 PRP微粉化软骨+同种异体移植物 直接注射至缺损区 Tegner评分显著改善,术后1年总体生存率超过90%
丁晨等64 2023 80 膝关节 AD Kellgren-Lawrence分级Ⅰ~Ⅲ PRP 注射1次,5 ml /次 调节炎性因子和骨代谢,促进修复
Wang等65 2022 28 膝关节 MF 孤立全层软骨缺损 PRP和FG覆盖 注射1次,4 ml/次 有效修复缺损,缓解疼痛,改善功能
Krakowski等66 2020 29 膝关节 MF Ⅲ或Ⅳ级 PRP 直接注射至缺损区 显著改善WOMAC评分
朱艳艳等67 2024 92 踝关节 MF HeppleⅠ~Ⅲ期 体外冲击波联合PRP 注射4次,间隔7 d 减轻疼痛,改善功能
刘核达等68 2024 60 踝关节 MF HeppleⅤ期 PRP 注射3次,5 ml /次,间隔7 d VAS、AOFAS改善
徐涛等69 2024 24 踝关节 带骨膜髂骨移植 HeppleⅤ期 PRP凝胶 直接注射至缺损区 VAS、AOFAS改善
Fu等70 2022 355 踝关节 MF MRI病灶<150 mm2 PRP 1次,3~5 ml /次 显著减缓影像学和功能性退化
张志伟等71 2022 38 踝关节 OAT HeppleⅤ期 PRP 注射1次,5 ml /次 减轻疼痛,改善功能
杨金杰72 2020 43 踝关节 MF 损伤面积<1.5 cm2 PRP 注射4次,2.5 ml /次,间隔7 d 减轻疼痛,改善功能
任弘73 2021 100 踝关节 AD+MF 单侧距骨软骨损伤 PRP 注射3次,3 ml /次,间隔10 d 改善功能,减轻疼痛
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