踝关节镜联合富血小板血浆治疗距骨软骨损伤的效果

CLINICAL EFFECTIVENESS OF ANKLE ARTHROSCOPY COMBINED WITH PLATELET-RICH PLASMA THERAPY FOR OSTEOCHONDRAL LESIONS OF THE TALUS

目的观察关节镜下踝关节清理术联合富血小板血浆(PRP)治疗距骨软骨损伤(OLTs)的效果。方法回顾性分析2016年12月—2017年8月我院确诊为OLTs HeppleⅠ~Ⅲ级并接受踝关节镜检查的32例患者的临床资料。按手术方式不同将患者分为治疗组和对照组,每组16例;对照组行踝关节镜检查术、骨髓刺激术等,治疗组在对照组基础上分别于术中和术后第4周于患者关节腔内注射PRP 2 mL。比较两组治疗前(T0)及治疗后6个月(T1)、12个月(T2)、18个月(T3)的疼痛视觉模拟评分(VAS)、Kofoed评分。并对两组患者T0和T1时间点MRI表现进行比较。结果治疗前所有患者MRI均显示距骨有明显软骨缺损和骨髓水肿,对照组和治疗组T1时间点MRI显示骨髓水肿范围较T0时间点明显减小,软骨缺损处较治疗前有明显填充,两组T0和T1时间点MRI表现无明显差异。与T0时间点相比较,治疗组T1、T2、T3时间点的VAS评分均显著降低(95%CI=2.50~3.88,95%CI=2.69~4.44,95%CI=3.04~4.83,P<0.05);与T0时间点相比,对照组T1、T2、T3时间点的VAS评分也均显著降低(95%CI=1.81~2.69,95%CI=2.32~3.31,95%CI=2.54~3.96,P<0.05)。治疗组T1、T2、T3时间点VAS评分明显低于对照组相应时间点,差异均有显著性(F=6.361~12.739,P<0.05)。与T0时间点相比,治疗组T1、T2、T3时间点的Kofoed评分均显著升高(95%CI=43.29~51.84,95%CI=45.00~52.38,95%CI=46.24~53.76,P<0.05);与T0时间点相比,对照组T1、T2、T3时间点的Kofoed评分也均显著升高(95%CI=37.45~44.80,95%CI=41.14~48.36,95%CI=42.17~50.33,P<0.05)。治疗组T1、T2、T3时间点Kofoed评分明显高于对照组相应时间点,差异均有显著性(F=37.955~47.503,P<0.05)。结论关节镜下踝关节清理术联合PRP与单纯行关节镜下踝关节清理术治疗OLTs均可缓解患者疼痛,改善关节功能;前者在缓解患者疼痛、改善关节功能方面表现更好。

Objective To investigate the clinical effectiveness of arthroscopic debridement of the ankle combined with platelet-rich plasma(PRP)therapy for osteochondral lesions of the talus(OLTs).Methods A retrospective analysis was performed on 32 patients diagnosed with OLTs(Hepple stagesⅠ-Ⅲ)who underwent ankle arthroscopy in the Affiliated Hospital of Qingdao University from December 2016 to August 2017.The patients were divided into treatment group and control group,with 16 cases in each group.The control group underwent ankle arthroscopy and bone marrow stimulation,while the treatment group,in addition to the treatment for the control group,received intra-articular injection of 2 mL PRP during operation and in the fourth week after operation.The visual analogue scale(VAS)score and Kofoed score were compared between the two groups before treatment(T0)and at six months(T1),12 months(T2),and 18 months(T3)after treatment,as well as MRI findings at T0 and T1.Results All the patients had significant cartilage defects and bone marrow edema on MRI at T0.There was a significant reduction in the extent of bone marrow edema and significant filling of cartilage defects at T1 in both groups.No significant differences in MRI findings were observed between the two groups at T0 or T1.Compared with that at T0,VAS scores at T1,T2,and T3 were significantly reduced both in the treatment group(95%CI=2.50-3.88,2.69-4.44,3.04-4.83,P<0.05)and the control group(95%CI=1.81-2.69,2.32-3.31,2.54-3.96,P<0.05);the treatment group had significantly lower VAS scores at T1,T2,and T3 than the control group(F=6.361-12.739,P<0.05).Compared with that at T0,Kofoed scores at T1,T2,and T3 were significantly increased both in the treatment group(95%CI=43.29-51.84,45.00-52.38,46.24-53.76,P<0.05)and the control group(95%CI=37.45-44.80,41.14-48.36,42.17-50.33,P<0.05);the treatment group had significantly higher Kofoed scores at T1,T2,and T3 than the control group(F=37.955-47.503,P<0.05).Conclusion Arthroscopic debridement of the ankle combined with PRP therapy is superior to arthroscopic debridement of the ankle alone for patients with OLTs in relieving pain and improving ankle function.