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[1]王勇,張宇,劉英,等.富血小板血漿關(guān)節(jié)腔注射在關(guān)節(jié)鏡下微骨折術(shù)治療距骨骨軟骨損傷中的應(yīng)用[J].中醫(yī)正骨,2022,34(05):6-12.
　WANG Yong,ZHANG Yu,LIU Ying,et al.Application of intra-articular injection of platelet-rich plasma in arthroscopic microfracture surgery for treatment of osteochondral lesion of the talus[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(05):6-12.
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富血小板血漿關(guān)節(jié)腔注射在關(guān)節(jié)鏡下微骨折術(shù)治療距骨骨軟骨損傷中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年05期
頁碼:
6-12
欄目:
臨床研究
出版日期:
2022-05-20

文章信息/Info

Title:
Application of intra-articular injection of platelet-rich plasma in arthroscopic microfracture surgery for treatment of osteochondral lesion of the talus
作者:
王勇; 張宇; 劉英; 張文舉; 徐善強; 李平; 何凱元
(四川省骨科醫(yī)院,四川 成都 610041)
Author(s):
WANG Yong; ZHANG Yu; LIU Ying; ZHANG Wenju; XU Shanqiang; LI Ping; HE Kaiyuan
Sichuan Province Orthopedic Hospital,Chengdu 610041,Sichuan,China
關(guān)鍵詞:
距骨;  軟骨疾病;  關(guān)節(jié)成形術(shù); 軟骨下;  關(guān)節(jié)鏡檢查;  富血小板血漿;  注射; 關(guān)節(jié)內(nèi)
Keywords:
talus;  cartilage diseases;  arthroplasty; subchondral;  arthroscopy;  platelet-rich plasma;  injections; intra-articular
摘要:
目的:探討富血小板血漿(platelet-rich plasma,PRP)關(guān)節(jié)腔注射在關(guān)節(jié)鏡下微骨折術(shù)治療距骨骨軟骨損傷(osteochondral lesion of the talus,OLT)中的應(yīng)用價值。方法:回顧性分析36例OLT患者的病例資料,其中采用關(guān)節(jié)鏡下微骨折術(shù)聯(lián)合PRP關(guān)節(jié)腔注射治療19例(聯(lián)合治療組),單純采用關(guān)節(jié)鏡下微骨折術(shù)治療17例(手術(shù)治療組)。比較2組患者治療前、治療后6個月、治療后12個月踝關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分、足與踝關(guān)節(jié)結(jié)局評分(foot and ankle outcome score,FAOS)、美國足與踝關(guān)節(jié)協(xié)會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評分及軟骨下骨骨髓水腫體積。結(jié)果:①踝關(guān)節(jié)疼痛VAS評分。時間因素和分組因素存在交互效應(yīng)(F=12.291,P=0.003); 2組患者踝關(guān)節(jié)疼痛VAS評分總體比較,組間差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=2.617,P=0.137); 治療前后不同時間點踝關(guān)節(jié)疼痛VAS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=354.262,P=0.000); 2組患者踝關(guān)節(jié)疼痛VAS評分隨時間變化均呈下降趨勢,但2組的下降趨勢不完全一致[聯(lián)合治療組:(5.74±1.27)分,(1.94±0.64)分,(0.76±0.25)分,F=532.326,P=0.000; 手術(shù)治療組:(5.47±1.05)分,(3.21±0.74)分,(1.64±0.23)分,F=70.097,P=0.000]; 治療前,2組患者踝關(guān)節(jié)疼痛VAS評分比較,差異無統(tǒng)計學(xué)意義(t=0.833,P=0.424); 治療后6個月、12個月,聯(lián)合治療組踝關(guān)節(jié)疼痛VAS評分均低于手術(shù)治療組(t=3.634,P=0.005; t=3.627,P=0.005)。②FAOS。時間因素和分組因素存在交互效應(yīng)(F=7.269,P=0.004); 2組患者FAOS總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=3.473,P=0.006); 治療前后不同時間點FAOS的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=856.830,P=0.000); 2組患者FAOS隨時間變化均呈上升趨勢,但2組的上升趨勢不完全一致[聯(lián)合治療組:(61.27±3.68)分,(87.81±5.19)分,(97.64±2.43)分,F=630.157,P=0.000; 手術(shù)治療組:(60.42±4.82)分,(79.70±7.14)分,(91.12±3.70)分,F=240.758,P=0.000]; 治療前,2組患者FAOS比較,差異無統(tǒng)計學(xué)意義(t=0.421,P=0.683); 治療后6個月、12個月,聯(lián)合治療組FAOS均高于手術(shù)治療組(t=5.846,P=0.000; t=5.420,P=0.000)。③AOFAS踝與后足評分。時間因素和分組因素不存在交互效應(yīng)(F=0.666,P=0.461); 2組患者AOFAS踝與后足評分總體比較,組間差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=1.377,P=0.286); 治療前后不同時間點AOFAS踝與后足評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=1 033.580,P=0.000); 2組患者AOFAS踝與后足評分隨時間變化均呈上升趨勢,但2組的上升趨勢不完全一致[聯(lián)合治療組:(66.93±5.99)分,(88.19±7.87)分,(98.43±6.67)分,F=498.276,P=0.000; 手術(shù)治療組:(65.44±4.82)分,(86.47±8.44)分,(94.12±5.09)分,F=413.547,P=0.000]; 治療前、治療后6個月,2組患者AOFAS踝與后足評分比較,組間差異均無統(tǒng)計學(xué)意義(t=0.460,P=0.655; t=0.640,P=0.536); 治療后12個月,聯(lián)合治療組AOFAS踝與后足評分高于手術(shù)治療組(t=2.400,P=0.037)。④軟骨下骨骨髓水腫體積。時間因素和分組因素存在交互效應(yīng)(F=13.723,P=0.002); 2組患者軟骨下骨骨髓水腫體積總體比較,組間差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=2.256,P=0.164); 治療前后不同時間點軟骨下骨骨髓水腫體積的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=383.914,P=0.000); 2組患者軟骨下骨骨髓水腫體積隨時間變化均呈下降趨勢,但2組的下降趨勢不完全一致[聯(lián)合治療組:(1.01±0.43)cm3,(0.30±0.17)cm3,(0.12±0.09)cm3,F=204.682,P=0.000; 手術(shù)治療組:(0.93±0.37)cm3,(0.52±0.29)cm3,(0.38±0.11)cm3,F=137.510,P=0.000]; 治療前,2組患者軟骨下骨骨髓水腫體積比較,差異無統(tǒng)計學(xué)意義(t=0.760,P=0.465); 治療后6個月、12個月,聯(lián)合治療組軟骨下骨骨髓水腫體積均小于手術(shù)治療組(t=2.825,P=0.018; t=4.012,P=0.002)。結(jié)論:在關(guān)節(jié)鏡下微骨折術(shù)治療OLT中應(yīng)用PRP關(guān)節(jié)腔注射,有利于減輕軟骨下骨骨髓水腫、緩解踝關(guān)節(jié)疼痛、改善踝關(guān)節(jié)功能。
Abstract:
Objective:To explore the applied value of intra-articular injection of platelet-rich plasma(PRP)in arthroscopic microfracture surgery for treatment of osteochondral lesion of the talus(OLT).Methods:The medical records of 36 OLT patients were analyzed retrospectively.Nineteen patients were treated with arthroscopic microfracture surgery and intra-articular injection of PRP(combination therapy group),while the others with arthroscopic microfracture surgery alone(surgical therapy group).The ankle pain visual analogue scale(VAS)score,foot and ankle outcome score(FAOS),American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and subchondral bone marrow edema(SBME)volume measured before the treatment and at 6 and 12 months after the treatment were compared between the 2 groups.Results:①There was interaction between time factor and group factor in ankle pain VAS score(F=12.291,P=0.003).There was no statistical difference in ankle pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=2.617,P=0.137).There was statistical difference in ankle pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=354.262,P=0.000).The ankle pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(combination therapy group:5.74±1.27,1.94±0.64,0.76±0.25 points,F=532.326,P=0.000; surgical therapy group:5.47±1.05,3.21±0.74,1.64±0.23 points,F=70.097,P=0.000).There was no statistical difference in ankle pain VAS scores between the 2 groups before the treatment(t=0.833,P=0.424); while the ankle pain VAS scores were lower in combination therapy group compared to surgical therapy group at 6 and 12 months after the treatment(t=3.634,P=0.005; t=3.627,P=0.005).②There was interaction between time factor and group factor in FAOS(F=7.269,P=0.004).There was statistical difference in FAOSs between the 2 groups in general,in other words,there was group effect(F=3.473,P=0.006).There was statistical difference in FAOSs between different timepoints before and after the treatment,in other words,there was time effect(F=856.830,P=0.000).The FAOSs presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(combination therapy group:61.27±3.68,87.81±5.19,97.64±2.43 points,F=630.157,P=0.000; surgical therapy group:60.42±4.82,79.70±7.14,91.12±3.70 points,F=240.758,P=0.000).There was no statistical difference in FAOSs between the 2 groups before the treatment(t=0.421,P=0.683); while the FAOSs were higher in combination therapy group compared to surgical therapy group at 6 and 12 months after the treatment(t=5.846,P=0.000; t=5.420,P=0.000).③There was no interaction between time factor and group factor in AOFAS ankle-hindfoot score(F=0.666,P=0.461).There was no statistical difference in AOFAS ankle-hindfoot scores between the 2 groups in general,in other words,there was no group effect(F=1.377,P=0.286).There was statistical difference in AOFAS ankle-hindfoot scores between different timepoints before and after the treatment,in other words,there was time effect(F=1 033.580,P=0.000).The AOFAS ankle-hindfoot scores presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(combination therapy group:66.93±5.99,88.19±7.87,98.43±6.67 points,F=498.276,P=0.000; surgical therapy group:65.44±4.82,86.47±8.44,94.12±5.09 points,F=413.547,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot scores between the 2 groups before the treatment and at 6 months after the treatment(t=0.460,P=0.655; t=0.640,P=0.536); while the AOFAS ankle-hindfoot scores were higher in combination therapy group compared to surgical therapy group at 12 months after the treatment(t=2.400,P=0.037).④There was interaction between time factor and group factor in SBME volume(F=13.723,P=0.002).There was no statistical difference in SBME volume between the 2 groups in general,in other words,there was no group effect(F=2.256,P=0.164).There was statistical difference in SBME volume between different timepoints before and after the treatment,in other words,there was time effect(F=383.914,P=0.000).The SBME volume presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(combination therapy group:1.01±0.43,0.30±0.17,0.12±0.09 cm(3),F=204.682,P=0.000; surgical therapy group:0.93±0.37,0.52±0.29,0.38±0.11 cm(3),F=137.510,P=0.000).There was no statistical difference in SBME volume between the 2 groups before the treatment(t=0.760,P=0.465); while the SBME volume was smaller in combination therapy group compared to surgical therapy group at 6 and 12 months after the treatment(t=2.825,P=0.018; t=4.012,P=0.002).Conclusion:Application of intra-articular injection of PRP in arthroscopic microfracture surgery is helpful to reduce SBME,relieve ankle pain and improve ankle function in treatment of OLT.

參考文獻/References:

[1] LOOZE C A,CAPO J,RYAN M K,et al.Evaluation and management of osteochondral lesions of the talus[J].Cartilage,2017,8(1):19-30.
[2] POWERS R T,DOWD T C,GIZA E.Surgical treatment for osteochondral lesions of the talus[J].Arthroscopy,2021,37(12):3393-3396.
[3] WANG C C,YANG K C,CHEN I H.Current treatment concepts for osteochondral lesions of the talus[J].Tzu Chi Med J,2020,33(3):243-249.
[4] BECHER C,DRIESSEN A,HESS T,et al.Microfracture for chondral defects of the talus:maintenance of early results at midterm follow-up[J].Knee Surg Sports Traumatol Arthrosc,2010,18(5):656-663.
[5] EVERTS P,ONISHI K,JAYARAM P,et al.Platelet-rich plasma:new performance understandings and therapeutic considerations in 2020[J].Int J Mol Sci,2020,21(20):7794.
[6] SHIMOZONO Y,SEOW D,KENNEDY J G,et al.Ankle arthroscopic surgery[J].Sports Med Arthrosc Rev,2018,26(4):190-195.
[7] ROOS E M,BRANDSSON S,KARLSSON J.Validation of the foot and ankle outcome score for ankle ligament reconstruction[J].Foot Ankle Int,2001,22(10):788-794.
[8] KITAOKA H B,ALEXANDER I J,ADELAAR R S,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[9] KUNI B,SCHMITT H,CHLORIDIS D,et al.Clinical and MRI results after microfracture of osteochondral lesions of the talus[J].Arch Orthop Trauma Surg,2012,132(12):1765-1771.
[10] YOUNGER A,SHIMOZONO Y,KENNEDY J G,et al.Osteochondral defects of the talus:current management dilemmas[J].Instr Course Lect,2018,67:283-295.
[11] 李延煒,洪海森,翟文亮.距骨軟骨損傷的診療及研究進展[J].中華臨床醫(yī)師雜志(電子版),2013,7(8):3510-3512.
[12] DEKKER T J,DEKKER P K,TAINTER D M,et al.Treatment of osteochondral lesions of the talus:a critical analysis review[J].JBJS Rev,2017,5(3):e4.
[13] LOOZE C A,CAPO J,RYAN M K,et al.Evaluation and management of osteochondral lesions of the talus[J].Cartilage,2017,8(1):19-30.
[14] PARK H W,LEE K B.Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture[J].Knee Surg Sports Traumatol Arthrosc,2015,23(3):860-867.
[15] 魏民,劉洋.關(guān)節(jié)鏡下微骨折治療距骨骨軟骨損傷的臨床觀察[J].中國骨傷,2017,30(8):751-754.
[16] NEHRER S,SPECTOR M,MINAS T.Histologic analysis of tissue after failed cartilage repair procedures[J].Clin Orthop Relat Res,1999(365):149-162.
[17] LANHAM N S,CARROLL J J,COOPER M T,et al.A comparison of outcomes of particulated juvenile articular cartilage and bone marrow aspirate concentrate for articular cartilage lesions of the talus[J].Foot Ankle Spec,2017,10(4):315-321.
[18] FERKEL R D,ZANOTTI R M,KOMENDA G A,et al.Arthroscopic treatment of chronic osteochondral lesions of the talus:long term results[J].Am J Sports Med,2008,36(9):1750-1762.
[19] YANG H Y,LEE K B.Arthroscopic microfracture for osteochondral lesions of the talus:second-look arthroscopic and magnetic resonance analysis of cartilage repair tissue outcomes[J].J Bone Joint Surg Am,2020,102(1):10-20.
[20] XIE X,ZHANG C,TUAN R S.Biology of platelet-rich plasma and its clinical application in cartilage repair[J].Arthritis Res Ther,2014,16(1):204.
[21] GUNEY A,YURDAKUL E,KARAMAN I,et al.Medium-term outcomes of mosaicplasty versus arthroscopic microfracture with or without platelet-rich plasma in the treatment of osteochondral lesions of the talus[J].Knee Surg Sports Traumatol Arthrosc,2016,24(4):1293-1298.
[22] SHANG X L,TAO H Y,CHEN S Y,et al.Clinical and MRI outcomes of HA injection following arthroscopic microfracture for osteochondral lesions of the talus[J].Knee Surg Sports Traumatol Arthrosc,2016,24(4):1243-1249.
[23] ZHU Y,YUAN M,MENG H Y,et al.Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis:a review[J].Osteoarthritis Cartilage,2013,21(11):1627-1637.
[24] D'HOOGHE P,MURAWSKI C D,BOAKYE L A T,et al.Rehabilitation and return to sports:proceedings of the international consensus meeting on cartilage repair of the ankle[J].Foot Ankle Int,2018,39(1 suppl):S61-S67.
(收稿日期:2021-12-26 本文編輯:呂寧)

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備注/Memo

備注/Memo:
基金項目:四川省醫(yī)學(xué)會骨科(尚安通)專項科研課題(2021SAT18) 通訊作者:張宇 E-mail:[email protected]
更新日期/Last Update: 1900-01-01