射频联合富血小板血浆修复半月板白区撕裂

Radiofrequency combined with platelet-rich plasma for repair of white meniscal tears

背景:应用生物学方法有助于半月板白区损伤的修复,物理学方法亦能促进半月板的修复,两者联合使用的效果可能更好。目的:了解射频联合富血小板血浆对半月板白区撕裂修复的影响。方法:48只成年新西兰大白兔随机分为:单纯缝合组、射频组、富血小板血浆组、射频联合富血小板血浆组共4组。所有实验动物均建立半月板后角损伤模型。单纯缝合组仅行半月板间断褥式缝合;射频组在半月板缝合后给予射频治疗(20 W,45℃);富血小板血浆组在半月板缝合后关节内注射富血小板血浆凝胶;射频联合富血小板血浆组在半月板缝合后先予射频治疗,再在关节内注射富血小板血浆。术后3,12周时观察半月板大体形态及组织学变化,并检测转化生长因子、血管内皮生长因子、血小板衍生生长因子的表达。结果与结论:(1)术后12周标本显示单纯缝合组的半月板裂口仍然未见愈合;射频组和富血小板血浆组半月板创口部分填塞,射频联合富血小板血浆组半月板创口闭合,愈合组织内可见软骨细胞、胶原纤维排列较未愈合组织规则;射频联合富血小板血浆组与单纯缝合组之间愈合率有明显差异(P=0.003);(2)在3周时射频组、富血小板血浆组及射频联合富血小板血浆组血管内皮生长因子的表达较单纯缝合组明显增高,12周时明显下降。3周时各实验组,尤其是富血小板血浆组和射频联合富血小板血浆组,血小板衍生生长因子的表达增高。在12周时富血小板血浆组转化生长因子β1仍较高表达;(3)结果说明,射频联合富血小板血浆促进了半月板白区撕裂的修复,增加细胞增殖、促进细胞有丝分裂及血管形成是其机制之一。

BACKGROUND： Both biological and physical methods contribute to the repair of white meniscal tears, so the combined use will be better. OBJECTIVE： To study the influence of radiofrequency combined with platelet-rich plasma（PRP） on the repair of white meniscal tears. METHODS： Forty-eight adult New Zealand white rabbits were randomly divided into four groups, including simple suture, radiofrequency, PRP, and combination groups, and then the model of medial meniscus posterior root tears was established in all experimental animals. The simple suture group underwent interrupted mattress suture; the radiofrequency group was treated with radiofrequency（20 W, 45 ℃） after suture; the PRP group received the intra-articular injection of PRP after suture; the combination group was firstly treated with radiofrequency after suture, and then underwent the intra-articular injection of PRP. The gross and histological changes of the meniscus were observed, and the expression levels of transforming growth factor β1, vascular endothelial growth factor and platelet-derived growth factor were detected at 3 and 12 weeks postoperatively. RESULTS AND CONCLUSION： At 12 weeks after operation, the simple suture group showed no healing; the radiofrequency and PRP groups healed partially; and the combination group healed completely, and chondrocytes and collagen fibers arranged regularly. There was a significant difference in the healing rate between combination and simple suture groups（P=0.003）. At 3 weeks postoperatively, the expression levels of vascular endothelial growth factor in the radiofrequency, PRP and combination groups were obviously higher than that in the simple suture group, which decreased markedly at the 12 th week. At 3 weeks postoperatively, the expression level of platelet-derived growth factor was increased in all groups, especially in the PRP and combination groups. The PRP group showed the highest level of transforming growth factor β1 at 12 weeks postoperatively. These results manifest that the combination of radiofrequency and PRP promotes the repair of white meniscal tears by increasing the cell proliferation, cell mitosis and angiogenesis.