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[1]高文香,王明君,李曉峰,等.關(guān)節(jié)鏡下微骨折術(shù)聯(lián)合富血小板血漿與纖維蛋白凝膠覆蓋微骨折創(chuàng)面治療膝骨關(guān)節(jié)炎軟骨退變?nèi)睋p[J].中醫(yī)正骨,2019,31(11):21-25.
　GAO Wenxiang,WANG Mingjun,LI Xiaofeng,et al.Arthroscopic microfracture surgery combined with microfractured wound surface coverage with platelet rich plasma and fibrin gels for treatment of degenerative cartilage defects in patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(11):21-25.
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關(guān)節(jié)鏡下微骨折術(shù)聯(lián)合富血小板血漿與纖維蛋白凝膠覆蓋微骨折創(chuàng)面治療膝骨關(guān)節(jié)炎軟骨退變?nèi)睋p()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年11期
頁碼:
21-25
欄目:
臨床研究
出版日期:
2019-11-20

文章信息/Info

Title:
Arthroscopic microfracture surgery combined with microfractured wound surface coverage with platelet rich plasma and fibrin gels for treatment of degenerative cartilage defects in patients with knee osteoarthritis
作者:
高文香; 王明君; 李曉峰; 李鵬; 楊鑫; 王鴻雁; 鄒春雨; 郝軍; 王冬
(河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 鄭州 450016)
Author(s):
GAO Wenxiang; WANG Mingjun; LI Xiaofeng; LI Peng; YANG Xin; WANG Hongyan; ZOU Chunyu; HAO Jun; WANG Dong
Luoyang Orthopedic-Traumatological Hospital,Zhengzhou 450016,Henan,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  軟骨;  關(guān)節(jié)成形術(shù);  軟骨下;  富血小板血漿;  纖維蛋白;  凝膠;  關(guān)節(jié)鏡檢查;  臨床試驗(yàn)
Keywords:
osteoarthritis; knee;  cartilage;  arthroplasty; subchondral;  platelet-rich plasma;  fibrin;  gels;  arthroscopy;  clinical trial
摘要:
目的:觀察關(guān)節(jié)鏡下微骨折術(shù)聯(lián)合富血小板血漿(platelet rich plasma,PRP)與纖維蛋白凝膠覆蓋微骨折創(chuàng)面治療膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)軟骨退變?nèi)睋p的臨床療效和安全性。方法:將符合要求的KOA軟骨退變?nèi)睋p患者隨機(jī)納入聯(lián)合組或微骨折組。聯(lián)合組先于關(guān)節(jié)鏡下在軟骨缺損處軟骨下骨行微骨折術(shù),然后用PRP與凝血酶填充微骨折處理后的軟骨缺損處,最后用纖維蛋白凝膠進(jìn)行封口處理。微骨折組僅進(jìn)行微骨折處理。術(shù)前及術(shù)后隨訪時(shí),測(cè)定患者上下10級(jí)樓梯后的膝關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分,測(cè)量同一位置軟骨退變?nèi)睋p面積,測(cè)定患者的西安大略和麥克馬斯特大學(xué)(Western Ontario and McMaster Universities,WOMAC)骨關(guān)節(jié)炎指數(shù)。觀察治療及隨訪期間的并發(fā)癥發(fā)生情況。結(jié)果:共納入32例患者,聯(lián)合組和微骨折組各16例。所有患者均獲得隨訪,隨訪時(shí)間10～15個(gè)月,中位數(shù)12個(gè)月。治療及隨訪期間均未出現(xiàn)并發(fā)癥。治療前2組患者的膝關(guān)節(jié)疼痛VAS評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(6.67±1.05)分,(6.60±1.30)分,t=0.155,P=0.878]; 末次隨訪時(shí)2組患者的膝關(guān)節(jié)疼痛VAS評(píng)分均較治療前降低(t=10.990,P=0.000; t=5.641,P=0.000),聯(lián)合組的評(píng)分低于微骨折組[(2.13±1.25)分,(3.38±1.43)分,t=-2.221,P=0.035]。治療前2組患者的軟骨退變?nèi)睋p面積比較,差異無統(tǒng)計(jì)學(xué)意義[(2.91±0.70)cm2,(2.57±0.68)cm2,t=1.354,P=0.187]; 末次隨訪時(shí)2組患者的軟骨退變?nèi)睋p面積均較治療前減小(t=6.688,P=0.000; t=2.772,P=0.015),聯(lián)合組的軟骨退變?nèi)睋p面積小于微骨折組[(1.18±0.74)cm2,(1.83±0.76)cm2,t=-2.241,P=0.022]。治療前2組患者的WOMAC骨關(guān)節(jié)炎指數(shù)比較,差異無統(tǒng)計(jì)學(xué)意義[(108.27±12.89)分,(106.87±13.11)分,t=0.295,P=0.770]; 末次隨訪時(shí)2組患者的WOMAC骨關(guān)節(jié)炎指數(shù)均較治療前減小(t=17.318,P=0.000; t=17.760,P=0.000),聯(lián)合組的WOMAC骨關(guān)節(jié)炎指數(shù)小于微骨折組[(24.69±12.53)分,(36.57±14.97)分,t=-2.354,P=0.026]。結(jié)論:關(guān)節(jié)鏡下微骨折術(shù)聯(lián)合PRP與纖維蛋白凝膠覆蓋微骨折創(chuàng)面,可修復(fù)KOA軟骨退變?nèi)睋p,減輕膝關(guān)節(jié)疼痛癥狀、改善膝關(guān)節(jié)功能,安全性較高,療效優(yōu)于單純微骨折術(shù)治療。
Abstract:
Objective:To observe the clinical curative effects and safety of arthroscopic microfracture surgery combined with microfractured wound surface coverage with platelet rich plasma(PRP)and fibrin gels(FG)for treatment of degenerative cartilage defects in patients with knee osteoarthritis(KOA).Methods:Thirty-two patients with KOA and degenerative cartilage defects were enrolled in the study and were randomly divided into combination group and microfracture group,16 cases in each group.The patients in combination group were treated with arthroscopic microfracture surgeries on subchondral bones,and their cartilage defects were filled with PRP and thrombin and were sealed with FG; while the patients in microfracture group were merely treated with arthroscopic microfracture surgeries.The knee pain visual analogue scale(VAS)scores were measured after the patients went up and down 10 stairs,and the area of degenerative cartilage defects and the Western Ontario and McMaster Universities(WOMAC)osteoarthritis index were measured through the preoperative and postoperative follow-up respectively.Moreover,the complication incidences were observed and compared between the 2 groups during the treatment and follow-up period.Results:All patients in the 2 groups were followed up for 10-15 months with a median of 12 months.No complications were found in the 2 groups during the treatment and follow-up period.There was no statistical difference in knee pain VAS scores between the 2 groups before the treatment(6.67+/-1.05 vs 6.60+/-1.30 points,t=0.155,P=0.878).The knee pain VAS scores decreased at last follow-up compared to pretreatment in the 2 groups(t=10.990,P=0.000; t=5.641,P=0.000),and were lower in combination group compared to microfracture group(2.13+/-1.25 vs 3.38+/-1.43 points,t=-2.221,P=0.035).There was no statistical difference in the area of degenerative cartilage defect between the 2 groups before the treatment(2.91+/-0.70 vs 2.57+/-0.68 cm(2),t=1.354,P=0.187).The area of degenerative cartilage defect decreased at last follow-up compared to pretreatment in the 2 groups(t=6.688,P=0.000; t=2.772,P=0.015),and was less in combination group compared to microfracture group(1.18+/-0.74 vs 1.83+/-0.76 cm(2),t=-2.241,P=0.022).There were no statistical difference in WOMAC osteoarthritis index between the 2 groups before the treatment(108.27+/-12.89 vs 106.87+/-13.11 points,t=0.295,P=0.770).The WOMAC osteoarthritis index decreased at last follow-up compared to pretreatment in the 2 groups(t=17.318,P=0.000; t=17.760,P=0.000),and was lower in combination group compared to microfracture group(24.69+/-12.53 vs 36.57+/-14.97 points,t=-2.354,P=0.026).Conclusion:The combination therapy of arthroscopic microfracture surgery and microfractured wound surface coverage with PRP and FG can repair degenerative cartilage defect,relieve the knee pain and improve the knee function in patients with KOA,meanwhile,it has high safty and its curative effect is better than that of monotherapy of arthroscopic microfracture surgery.

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備注/Memo

備注/Memo:
基金項(xiàng)目:河南省重點(diǎn)中醫(yī)學(xué)科(專科)學(xué)術(shù)帶頭人培養(yǎng)項(xiàng)目(2015ZY03008)(收稿日期:2019-08-06 本文編輯:李曉樂)
更新日期/Last Update: 2019-11-10