伴有下胫腓损伤的踝部骨折术后局部注射富血小板血浆对病人早期炎症反应及功能恢复的影响  

Effect of postoperative local injection of platelet-rich plasma in ankle fractures associated with lower tibiofibular injuries on the patients’early inflammatory response and functional recovery

作　　者：华炯 龚军 郑旻 张贵宝 吴洪亮 HUA Jiong;GONG Jun;ZHENG Min;ZHANG Guibao;Wu Honliang(Punan Branch of Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200125,China)

机构地区：[1]上海交通大学医学院附属仁济医院浦南分院骨科,200125 [2]上海交通大学医学院附属仁济医院浦南分院检验科,200125

出　　处：《临床外科杂志》2024年第11期1205-1209,共5页Journal of Clinical Surgery

基　　金：上海市浦东新区学科带头人计划(PWRd2021-11)。

摘　　要：目的观察术后局部富血小板血浆(PRP)对伴有下胫腓损伤的踝部骨折病人早期炎症反应及功能恢复的影响。方法2017年1月~2022年12月在我院收治的50例伴有下胫腓损伤的踝部骨折病人术后局部注射PRP作为PRP组,选取同期性别、年龄与其相匹配的接受韧带修复方案手术治疗的50例伴有下胫腓损伤的踝部骨折病人作为常规组。比较两组病人术后情况、术后3天肿胀情况、术后疼痛视觉模拟(VAS)评分及血小板衍生生长因子(PDGF)、转化生长因子(TGF)-β1、炎症介质水平,统计两组术后24周优良率、踝关节跖屈-背伸活动度、复位质量和并发症。结果PRP组术后3天肿胀分级(Ⅰ级28例、Ⅱ级20例、Ⅲ级2例)低于常规组(Ⅰ级15例、Ⅱ级23例、Ⅲ级12例),术后3天、7天的VAS评分[(3.24±0.61)分、(2.40±0.42)分]低于常规组[(3.78±0.74)分、(2.96±0.55)分],下肢负重活动时间(4.01±0.65)周、骨折愈合时间(3.05±0.42)个月、术后恢复正常工作时间(3.17±0.47)个月短于常规组[下肢负重活动时间(4.29±0.74)周、骨折愈合时间(3.23±0.48)月、术后恢复正常工作时间(3.40±0.59)个月],而手术时间(106.53±19.77)分钟、术中透视次数(14.47±3.23)次、术中失血量(84.07±25.60)ml与常规组[手术时间(108.20±18.41)分钟、术中透视次数(14.53±3.06)次、术中失血量(86.23±22.17)ml]比较,差异无统计学意义(P>0.05)。两组术前炎性介质、PDGF、TGF-β1比较,差异无统计学意义(P>0.05)。两组术后12周PDGF较术前升高,白细胞介素(IL)-6、TGF-β1、C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α较术前降低,差异有统计学意义(P<0.05)。PRP组术后12周PDGF高于常规组,炎性介质、TGF-β1低于常规组,差异有统计学意义(P<0.05)。PRP组术后24周优良率和踝关节跖屈-背伸活动度高于常规组,下胫腓联合前间距(ITFACS)和下胫腓联合后间距(ITFPCS)低于常规组,两组比较差异有统计学意义(P<0.05)。�Objective To observe the effect of postoperative local injection of platelet-rich plasma(PRP)on patients’early inflammatory response and functional recovery in ankle fractures with lower tibiofibular injuries.Methods Fifty ankle fracture patients with lower tibiofibular injuries admitted to our hospital from January 2017 to December 2022 with postoperative local injection of PRP were selected as the PRP group,and 50 ankle fracture patients with lower tibiofibular injuries undergoing surgical treatment with ligament repair protocols in the same time period with their matched gender and age were selected as the conventional group.We compared the postoperative conditions,postoperative 3 d swelling,postoperative pain visual analogue(VAS)scores and levels of platelet-derived growth factor(PDGF),transforming growth factorβ1(TGF-β1),and inflammatory mediators in the two groups,and counted the 24-week postoperative good rate,ankle plantarflexion-dorsiflexion mobility,the quality of the restoration,and the complications in the two groups.Results The swelling grading in the PRP group was lower than that in the conventional group(28 cases of grade I,20 cases of grade II,and 2 cases of grade III)in the 3 d postoperative period(15 cases of gradeⅠ,23 cases of gradeⅡ,and 12 cases of gradeⅢ),and the VAS scores in the 3 d and 7 d postoperative period[(3.24±0.61)and(2.40±0.42)points]were lower than those in the conventional group[(3.78±0.74)and(2.96±0.55)],and the lower limb weight-bearing activity time(4.01±0.65)weeks,fracture healing time(3.05±0.42)months,and postoperative return to normal work time(3.17±0.47)months were shorter than those in the conventional group[weight-bearing activity time of lower limbs(4.29±0.74)weeks,fracture healing time(3.23±0.48)months,and postoperative return to normal work time(3.40±0.59)months].While the operation time(106.53±19.77)min,number of intraoperative fluoroscopies(14.47±3.23)times,and intraoperative blood loss(84.07±25.60)ml were not statistically different from thos

关 键 词：富血小板血浆 韧带修复 下胫腓损伤 踝部骨折 炎症反应 并发症 

分 类 号：R687.3[医药卫生—骨科学]