富血小板血浆与自体骨软骨移植术治疗距骨软骨损伤的临床比较

Comparison of the clinical effect of platelet rich plasma and autogenous osteochondral transplantation in the treatment of talar cartilage injury

目的评价自体富血小板血浆关节腔内注射治疗距骨软骨损伤的临床疗效。方法选取2017年5月至2019年5月于武警海警医院就诊并接受治疗的距骨软骨损伤患者128例为研究对象,按照随机数字表法分为研究组和对照组,每组64例患者,对照组患者予以自体骨软骨移植术治疗,研究组患者予以自体富血小板血浆关节腔内注射治疗。比较两组患者疼痛反应程度,评价患者踝关节功能变化,测定踝关节背伸活动度和跖屈活动度,观察患者并发症发生情况。结果治疗后,研究组视觉模拟评分(VAS)为(2.41±0.34)分,显著低于对照组的(3.57±0.45)分(t=8.639,P<0.05);研究组美国足踝矫形外科学会踝-后足评分系统(AOFAS)为(88.73±6.68)分,显著高于对照组的(82.35±6.41)分,(t=3.684,P<0.05);研究组踝关节功能总体优良率(95.31%)显著高于对照组(82.81%)(χ2=5.133,P<0.05);研究组患者踝关节背伸活动度[(24.83±3.31)°]、跖屈活动度[(44.92±5.17)°]均显著高于对照组[(20.65±3.08)°和(39.61±5.27)°](t=5.247、4.083,均P<0.05);研究组治疗后并发症总体发生率(21.88%)显著低于对照组(7.81%)(χ2=5.006,P<0.05)。结论较自体骨软骨移植术,自体富血小板血浆关节腔内注射可更有效缓解距骨软骨损伤患者疼痛反应,提高踝关节功能及活动度恢复水平,降低并发症发生率,值得临床推广使用。

Objective To evaluate the clinical effect of intra-articular injection of platelet rich plasma in the treatment of talar cartilage injury.Methods From May 2017 to May 2019,128 patients with talar cartilage injury who were treated in Marine Police Hospital of the Chinese People's Armed Police Force were selected as the study objects.According to the random number table method,they were divided into two groups,with 64 patients in each group.The control group was treated with autogenous osteochondral transplantation,and the study group was treated with autogenous platelet rich plasma intra-articular injection.The degree of pain response was compared between the two groups.The change of ankle function was evaluated,the degree of ankle dorsiflexion and plantar flexion were measured,and the complications after treatment were observed.Results After treatment,the visual analogue scale(VAS)score of the study group[(2.41±0.34)points]was significantly lower than that of the control group[(3.57±0.45)points](t=8.639,P<0.05).The ankle hind-foot scale(AOFAS)score of the study group[(88.73±6.68)points]was significantly higher than that of the control group[(82.35±6.41)points](t=3.684,P<0.05).The overall excellent and good rate of ankle function of the study group(95.31%)was significantly higher than that of the control group(82.81%)(χ2=5.133,P<0.05).In the study group,the ankle dorsiflexion[(24.83±3.31)°]and plantar flexion[(44.92±5.17)°]were significantly higher than those in the control group[(20.65±3.08)°and(39.61±5.27)°](t=5.247,4.083,all P<0.05).The overall incidence of complications in the study group(21.88%)was significantly lower than that in the control group(7.81%)(χ2=5.006,P<0.05).Conclusion Compared with autograft osteochondral transplantation,the intra-articular injection of platelet rich plasma can effectively alleviate the pain response of patients with talar cartilage injury,improve the ankle joint function and activity recovery level,and reduce the incidence of complications,which is worthy of clinical application.