同种异体半月板移植联合富血小板血浆关节腔内注射的临床对照研究  

A comparative study of meniscus allograft transplantation with intra-articular platelet-rich plasma injection

作　　者：陈施羊 张华[1] 周爱国[1] 闫文龙[1] 张健[1] Chen Shiyang;Zhang Hua;Zhou A iguo;Yan Wenlong;Zhang Jian(Department of Orthopedics,The First Affiliated Hospital of Chongqing Medical Universit)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《重庆医科大学学报》2018年第10期1364-1369,共6页Journal of Chongqing Medical University

摘　　要：目的:探究同种异体半月板移植联合富血小板血浆(platelet-rich plasma,PRP)关节腔内注射治疗半月板全切除或次全切除术后患者的临床效果。方法:本研究回顾性分析了27例患者,根据是否行PRP关节腔内注射分为A组与B组,其中A组为单纯行半月板移植术的患者,共15例(男9例,女6例,手术时平均年龄29.7岁);B组为行半月板移植术联合PRP关节腔注射的患者,共12例(男4例,女8例,手术时平均年龄33.6岁)。所有患者均在术后半年、1年及以后的每年随访,并行体格检查、影像学检查及International Knee Documentation Committee(IKDC)评分、Lysholm评分、Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)评分、Tegner评分和Visual Analog Scale(VAS)疼痛评分。结果:术后的Tegner评分在2组中没有统计学差异(P>0.05);B组在术后半年的Lysholm评分、WOMAC评分及VAS疼痛评分较A组高(P<0.05),但术后1年及2年2组无统计学差异(P>0.05)。B组在术后半年及术后1年的IKDC评分均高于A组(P<0.05),术后2年2组无统计学差异(P>0.05)。术后2年A组的绝对外凸值为(1.43±1.18)cm,B组为(1.88±1.21)cm,2组无统计学差异(P>0.05)。2组在术后2年的Outerbridge分级无统计学差异(P>0.05)。2组各有1例患者术后功能评分较术前下降:A组1例术后2年出现局部软骨Ⅳ度磨损;B组1例术后出现中度股四头肌萎缩。结论:同种异体半月板移植术联合PRP关节腔内注射相比单纯行同种异体半月板移植术,可以在术后1年内更有效地减轻术后疼痛,改善患膝功能。Objective：To compare the clinical and imaging outcomes between meniscus allograft transplantation（MAT） and MAT combined with intra-articular platelet-rich plasma（PRP） injection. Methods：A total of 27 patients were retrospectively included and divided into two groups. Group A contains 15 patients who underwent MAT and group B contains 12 patents who underwent MAT combined with intra-articular PRP injection. The Lysholm,International Knee Documentation Committee（IKDC）,Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）,Tegner activity level and Visual Analog Scale （VAS） for pain scores were used to evaluate the outcomes for all patients. Magnetic resonance imaging scans were performed postoperatively to assess graft position and chondral degeneration. Results：There was no significant difference in Tegner score postoperatively（P〉0.05）. Group B achieved higher Lysholm,WOMAC and VAS at 6-month follow-up than group A（P〈0.05）. However,no significant differences was found in these scores at 1-year and 2-year follow-up（P〉0.05）. Group B demonstrated higher IKDC than group A at 6-month and 1-year follow-up（P〈0.05）,yet there was no significant difference between them at 2-year follow-up（P〉0.05）. There was no significant difference in the distribution of the grade of chondral damage and graft extrusion between two groups at 2-year follow-up（P〉0.05）. There was one patient in each group resulted decreased function scores after surgery. One in group A showed a focal Ⅳ grade chondral damage and another in group B showed a moderate quadriceps femoris atrophy. Conclusion：MAT combined with intra-articular PRP injection shows higher improvements in pain relief and knee function than MAT during 1 year postoperatively.

关 键 词：半月板移植 富血小板血浆 半月板外凸 

分 类 号：R687.4[医药卫生—骨科学]