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[1]婁磊,俞光榮,倘艷鋒,等.純富血小板血漿關(guān)節(jié)腔注射聯(lián)合手術(shù)治療HeppleⅤ型距骨骨軟骨損傷[J].中醫(yī)正骨,2020,32(12):25-30.
　LOU Lei,YU Guangrong,TANG YanFeng,et al.Intra-articular injection of pure platelet-rich plasma combined with surgery for treatment of Hepple typeⅤosteochondral lesions of the talus[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(12):25-30.
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純富血小板血漿關(guān)節(jié)腔注射聯(lián)合手術(shù)治療HeppleⅤ型距骨骨軟骨損傷()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年12期
頁碼:
25-30
欄目:
臨床研究
出版日期:
2020-12-20

文章信息/Info

Title:
Intra-articular injection of pure platelet-rich plasma combined with surgery for treatment of Hepple typeⅤosteochondral lesions of the talus
作者:
婁磊1; 俞光榮2; 倘艷鋒1; 蘇攀1; 馬源1
(1.河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽 471002; 2.同濟(jì)大學(xué)附屬同濟(jì)醫(yī)院,上海 200065)
Author(s):
LOU Lei1; YU Guangrong2; TANG YanFeng1; SU Pan1; MA Yuan1
1.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China2.Tongji Hospital of Tongji University,Shanghai 200065,China
關(guān)鍵詞:
踝損傷;  距骨;  軟骨損傷;  富血小板血漿;  臨床試驗(yàn)
Keywords:
ankle injuries;  talus;  cartilage injuries;  platelet-rich plasma;  clinical trial
摘要:
目的:觀察純富血小板血漿(pure platelet-rich plasma,P-PRP)關(guān)節(jié)腔注射聯(lián)合手術(shù)治療HeppleⅤ型距骨骨軟骨損傷的臨床療效和安全性。方法:將40例HeppleⅤ型距骨骨軟骨損傷患者隨機(jī)分為2組,每組20例。單純手術(shù)組采用微骨折術(shù)或松質(zhì)骨植骨術(shù)治療,聯(lián)合治療組在單純手術(shù)組治療的基礎(chǔ)上聯(lián)合P-PRP關(guān)節(jié)腔注射治療。分別于術(shù)前及術(shù)后12個(gè)月記錄并比較2組患者踝關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分、美國足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足功能評(píng)分、簡(jiǎn)明健康狀況調(diào)查表(short form 36 health survey questionnaire,SF-36)評(píng)分,并觀察并發(fā)癥發(fā)生情況。結(jié)果:①踝關(guān)節(jié)疼痛VAS評(píng)分。術(shù)前2組患者踝關(guān)節(jié)疼痛VAS評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(6.40±1.14)分,(6.20±0.52)分,t=0.712,P=0.481]; 術(shù)后12個(gè)月,聯(lián)合治療組踝關(guān)節(jié)疼痛VAS評(píng)分小于單純手術(shù)組[(2.20±0.70)分,(3.15±0.58)分,t=3.730,P=0.001],2組患者踝關(guān)節(jié)疼痛VAS評(píng)分均小于術(shù)前(t=15.698,P=0.000; t=19.874,P=0.000)。②AOFAS踝與后足功能評(píng)分。術(shù)前2組患者AOFAS踝與后足功能評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(39.75±3.85)分,(41.20±5.28)分,t=0.993,P=0.327]; 術(shù)后12個(gè)月,聯(lián)合治療組AOFAS踝與后足功能評(píng)分大于單純手術(shù)組[(90.45±2.31)分,(74.55±6.73)分,t=7.220,P=0.001],2組患者AOFAS踝與后足功能評(píng)分均大于術(shù)前(t=48.562,P=0.000; t=15.583,P=0.000)。③SF-36評(píng)分。術(shù)前2組患者SF-36評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(64.75±7.74)分,(64.00±7.20)分,t=0.317,P=0.753]; 術(shù)后12個(gè)月,聯(lián)合治療組SF-36評(píng)分大于單純手術(shù)組[(90.45±1.76)分,(83.80±4.58)分,t=2.410,P=0.021],2組患者SF-36評(píng)分均大于術(shù)前(t=15.187,P=0.000; t=11.230,P=0.000)。④安全性。單純手術(shù)組2例出現(xiàn)切口周圍皮膚麻木,未做特殊處理,術(shù)后6個(gè)月逐漸改善; 聯(lián)合治療組1例出現(xiàn)關(guān)節(jié)過度增生,患者拒絕做特殊處理; 2組患者均未出現(xiàn)切口感染、皮膚壞死等并發(fā)癥。2組并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.000,P=1.000)。結(jié)論:采用P-PRP關(guān)節(jié)腔注射聯(lián)合手術(shù)治療HeppleⅤ型距骨骨軟骨損傷,與單純手術(shù)治療相比,能更好地緩解踝關(guān)節(jié)疼痛、促進(jìn)踝關(guān)節(jié)功能的恢復(fù)、提高患者生活質(zhì)量,但兩者安全性相當(dāng)。
Abstract:
To observe the clinical curative effects and safety of intra-articular injection of pure platelet-rich plasma(P-PRP)combined with surgery for treatment of Hepple typeⅤosteochondral lesions of the talus(OLT).Methods:Forty patients with Hepple typeⅤOLT were enrolled in the study and were randomly divided into surgery group and combination therapy group,20 cases in each group.All patients in the 2 groups were treated with microfracture surgery or cancellous bone grafting.Moreover,the patients in combination therapy group were treated with intra-articular injection of P-PRP.The ankle pain visual analogue scale(VAS)scores,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores and short form 36 health survey questionnaire(SF-36)scores were recorded and compared between the 2 groups before the surgery and at 12 months after the surgery respectively,and the complications were observed.Results:There was no statistical difference in ankle pain VAS scores between the 2 groups before the surgery(6.40+/-1.14 vs 6.20+/-0.52 points,t=0.712,P=0.481).The ankle pain VAS scores were lower in combination therapy group compared to surgery group at 12 months after the surgery(2.20+/-0.70 vs 3.15+/-0.58 points,t=3.730,P=0.001).The ankle pain VAS scores decreased in the 2 groups at 12 months after the surgery compared to pre-surgery(t=15.698,P=0.000; t=19.874,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot function scores between the 2 groups before the surgery(39.75+/-3.85 vs 41.20+/-5.28 points,t=0.993,P=0.327).The AOFAS ankle-hindfoot function scores were higher in combination therapy group compared to surgery group at 12 months after the surgery(90.45+/-2.31 vs 74.55+/-6.73 points,t=7.220,P=0.001).The AOFAS ankle-hindfoot function scores increased in the 2 groups at 12 months after the surgery compared to pre-surgery(t=48.562,P=0.000; t=15.583,P=0.000).There was no statistical difference in SF-36 scores between the 2 groups before the surgery(64.75+/-7.74 vs 64.00+/-7.20 points,t=0.317,P=0.753).The SF-36 scores were higher in combination therapy group compared to surgery group at 12 months after the surgery(90.45+/-1.76 vs 83.80+/-4.58 points,t=2.410,P=0.021).The SF-36 scores increased in the 2 groups at 12 months after the surgery compared to pre-surgery(t=15.187,P=0.000; t=11.230,P=0.000).The skin numbness was found around the incision in 2 patients in surgery group,and the numbness was relieved at 6 months after the surgery without any special treatment.The joint hyperplasia was found in 1 patient in combination therapy group,and the special treatment was refused by the patient.No complications such as incision infection and cutaneous necrosis were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(χ2=0.000,P=1.000).Conclusion:The combination therapy of intra-articular injection of P-PRP and surgery can better relieve ankle pain,promote ankle function recovery and improve patient’s life quality compared to monotherapy of surgery in treatment of Hepple typeⅤOLT,while they are similar to each other in safety.

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備注/Memo

備注/Memo:
基金項(xiàng)目:洛陽市科技計(jì)劃醫(yī)療衛(wèi)生項(xiàng)目(1830004A)
通訊作者:俞光榮 E-mail:yuguangrong@#edu.cn
更新日期/Last Update: 2020-12-20