富血小板血浆对早期股骨头坏死患者术后股骨头修复影响

Effects of platelet rich plasma on postoperative femoral head repair in patients with early osteonecrosis of femoral head

目的股骨头坏死(ONFH)是一种常见的骨科难治性疾病,本研究观察富血小板血浆(PRP)对早期ONFH患者术后股骨头修复的影响。方法选择2016-10-14-2019-10-14驻马店市中心医院收治的72例早期ONFH患者为研究对象,采用组间基本特征均衡可比的原则将患者分为对照组和观察组,各36例。对照组采用髓芯减压术治疗,观察组在对照组基础上采用PRP治疗。分别于术前、术后1个月和6个月,检测2组患者骨密度、血清转化生长因子β1(TGF-β1)和血管内皮生长因子(VEGF)水平,采用视觉模拟评分法(VAS)评估患者术后疼痛程度,Harris髋关节评分系统(HHS)评估患者髋关节功能。术后6个月,评估股骨头坏死组织修复情况。结果观察组患者治疗后股骨头坏死组织修复优良率为86.11%,对照组为72.22%,差异无统计学意义,χ2=2.893,P=0.155。观察组患者术后1个月血清TGF-β1水平为(29.27±5.42)ng/mL,低于对照组的(33.59±5.50)ng/mL,t=3.357,P=0.001;VAS评分为(1.90±0.48)分,低于对照组的(2.21±0.53)分,t=2.601,P=0.011;HSS评分为(79.23±9.97)分,高于对照组的(72.54±9.83)分,t=2.867,P=0.006。术后6个月血清TGF-β1水平为(24.16±4.21)ng/mL,低于对照组的(27.58±4.64)ng/mL,t=3.275,P=0.002;VAS评分为(1.12±0.29)分,低于对照组的(1.30±0.32)分,t=2.501,P=0.015;HSS评分为(86.41±7.78)分,高于对照组的(81.52±8.16)分,t=2.602,P=0.011。结论PRP治疗可以缓解早期ONFH患者髓芯减压术后疼痛,改善髋关节功能,可以促进早期ONFH患者髓芯减压术后股骨头坏死组织的修复,值得临床推广应用。

Objective Osteonecrosis of femoral head(ONFH)is a common refractory orthopedic disease.This study aimed to observe the effects of platelet rich plasma(PRP)on postoperative femoral head repair in patients with early ONFH.Methods Early ONFH patients who were admitted to the hospital from October 14,2016 to October 14,2019 were enrolled as the research objects.They were divided into control group and observation group by balancing between-group basic characteristics method,36 cases in each group.The control group was treated with core decompression,while observation group was treated with PRP on basis of control group.Before surgery,at 1 month and 6 months after surgery,bone mineral density,levels of serum transforming growth factorβ1(TGF-β1)and vascular endothelial growth factor(VEGF)in both groups were detected.The postoperative pain was evaluated by visual analogue scale(VAS)scores.The hip function was assessed by Harris hip score(HHS).At 6 months after surgery,the repair conditions of femoral head necrosis tissues were evaluated.Results After treatment,there was no significant difference in the good rate of femoral head necrosis tissues repair between observation group and control group(86.11%vs 72.22%),χ2=2.893,P=0.155.The serum TGF-β1 level of the observation group was(29.27±5.42)ng/ml at 1 month after operation,which was lower than the control group’s(33.59±5.50)ng/ml,t=3.357,P=0.001.The VAS score was(1.90±0.48)points,lower than the control group’s(2.21±0.53)points,t=2.601,P=0.011.The HSS score was(79.23±9.97)points,higher than the control group’s(72.54±9.83)points,t=2.867,P=0.006.The serum TGF-β1 level at 6 months after operation was(24.16±4.21)ng/ml,which was lower than the control group’s(27.58±4.64)ng/ml,t=3.275,P=0.002.The VAS score was(1.12±0.29)points,which was lower than the(1.30±0.32)scores of the control group,t=2.501,P=0.015.The HSS score was(86.41±7.78)scores,which was higher than the(81.52±8.16)scores of the control group,t=2.602,P=0.011.Conclusions PRP therapy can relieve the pain after core decompression in patients with early ONFH,improve hip joint function,and promote the repair of femoral head necrosis after core decompression in patients with early ONFH.It is worthy of clinical application.