微骨折术联合关节腔内注射富血小板血浆治疗小面积距骨骨软骨损伤

Micro-fracture therapy combined with intra-articular injection of platelet-rich plasma for small sized osteochondral lesion of the talus

目的探讨微骨折术联合关节腔内注射富血小板血浆(platelet-rich plasma,PRP)治疗小面积距骨骨软骨损伤(osteochondral lesion of the talus,OLT)的临床疗效。方法以2014年9月-2017年10月收治且符合选择标准的43例小面积OLT患者为研究对象,采用随机数字表法将其分为两组,微骨折组(21例)行单纯微骨折术治疗,联合组(22例)采用微骨折术联合关节腔内注射自体PRP治疗。两组患者性别、年龄、病程、侧别、损伤部位、病损面积、Mintz分型、术前疼痛视觉模拟评分(VAS)及美国矫形足踝协会(AOFAS)踝与后足评分比较,差异均无统计学意义(P>0.05)。治疗后采用MRI评价OLT恢复情况,VAS评分及AOFAS踝与后足评分评价踝关节疼痛及功能。结果术后两组切口均Ⅰ期愈合,无静脉血栓形成、踝关节内感染等并发症发生。两组患者均获随访,随访时间12~18个月,平均15.6个月。术后6、12个月两组患者VAS评分及AOFAS踝与后足评分均较术前显著改善,术后12个月较6个月时进一步改善,差异均有统计学意义(P<0.05)。术后6、12个月,联合组VAS评分及AOFAS踝与后足评分均显著优于微骨折组,差异有统计学意义(P<0.05)。MRI复查示术后12个月两组患者OLT处均填充良好。结论与单纯微骨折术相比,微骨折术联合关节腔内注射自体PRP治疗小面积OLT可有效减轻疼痛、改善踝关节功能,具有良好临床疗效。

Objective To investigate the effectiveness of micro-fracture therapy combined with intra-articular injection of platelet-rich plasma(PRP) in the treatment of small sized osteochondral lesion of the talus(OLT).Methods Between September 2014 and October 2017, 43 patients with small sized OLT met the inclusive criteria were admitted and randomly divided into micro-fracture group(21 cases) and combined group(22 cases). Patients in the micro-fracture group were treated with micro-fracture therapy, and patients in the combined group were treated with micro-fracture therapy combined with intra-articular injection of PRP. There was no significant difference in gender, age,disease duration, side of OLT, injured position, lesion area, Mintz classification, and preoperative American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hind foot score and visual analogue scale(VAS) score between the two groups(P>0.05). After treatment, MRI, VAS score, and AOFAS ankle-hind foot score were used to evaluate the recovery of OLT and the ankle function. Results All incisions healed by first intention, and no complications such as venous thrombosis and ankle joint infection occurred. All patients were followed up 12-18 months after operation, with an average of 15.6 months. The VAS scores and the AOFAS ankle-hind foot scores were significantly improved at 6 and 12 months after operation in the two groups(P<0.05), and the scores at 12 months were significantly improved when compared with postoperative scores at 6 months(P<0.05). Compared with the micro-fracture group, the VAS score and the AOFAS ankle-hind foot score were significantly improved in the combined group at 6 and 12 months after operation(P<0.05).MRI showed that OLT was well filled in both groups at 12 months after operation. Conclusion Compared with microfracture therapy, micro-fracture therapy combined with intra-articular injection of PRP can effectively reduce pain,improve ankle function, and has a good effectiveness in the treatment of small sized OLT.