自体富血小板血浆在治疗急性经舟骨月骨周围脱位中的应用

Platelet Rich Plasma in Treatment of Acute Trans Scaphoid Perilunate Dislocation

目的探讨自体富血小板血浆(platelet rich plasma,PRP)关节注射联合切开复位内固定术治疗急性经舟骨月骨周围脱位(trans scaphoid perilunate dislocation,TSPD)的临床疗效,分析其应用价值。方法选取2016年7月至2018年7月于我科行切开复位内固定术后腕关节注射PRP的TSPD患者18例为PRP组,其中男性12例,女性6例;年龄25~53岁,平均(34.8±11.3)岁;受伤原因:摔伤8例,机器挤压伤6例,车祸高能损伤4例。选取2014年6月至2016年6月于我科单纯行切开复位内固定术治疗的TSPD患者18例为对照组,其中男性10例,女性8例;年龄23~51岁,平均(32.5±9.2)岁;受伤原因:摔伤7例,机器挤压伤6例,车祸高能损伤5例。所有患者Herbert分型为B4型。对比两组患者Krimmer腕关节评分、影像学结果、并发症及上肢功能评分(disability of arm shoulder and hand,DASH),末次随访采用Mayo腕关节评分评价两组疗效。结果患者术后均获随访,随访时间24~48个月,平均(32.5±7.8)个月。PRP组末次随访Krimmer腕关节评分明显高于对照组(P<0.01),其中PRP组Krimmer腕关节功能优16例,良1例,可1例,优良率为94.44%;对照组优10例,良3例,可3例,差2例,优良率为72.22%;PRP组所有患者术后X线片均未见骨不连,随访期间未见正中神经损伤及创伤性关节炎等并发症。对照组4例患者出现舟状骨缺血性坏死,3例患者出现创伤性关节炎,1例患者术后出现术后伤口感染。两组患者并发症发生率比较,差异具有统计学意义(P<0.01)。末次随访平均DASH评分:PRP组为(12.83±2.27)分,对照组为(49.20±5.41)分,两组比较,差异具有统计学意义(P<0.05)。术后两组Mayo腕关节评分均较术前改善,末次随访时PRP组Mayo腕关节评分较对照组高,差异具有统计学意义(P<0.05)。结论PRP治疗TSPD可促进骨折愈合,修复关节软骨损伤,减少术后并发症的发生率,从而改善患者的生活质量,具有较高的临床应用价值。

Objective To investigate the clinical effect of intra-articular injection of intra-articular Platelet-Rich Plasma(PRP)combined with open reduction and internal fixation in the treatment of acute trans-scaphoid perilunate dislocation(TSPD).Methods Between July 2016 and July 2018,18 TSPD patients treated with PRP injection after open reduction and internal fixation were selected as the PRP group.There were 12 males and 6 females,with an average age of(34.8±11.3)years(range,25~53 years).The causes of injury inclued as follows:8 cases of falling,6 cases of machine impact,4 cases of violent injury in traffic accidents.Between June 2014 and June 2016,18 patients with TSPD who underwent open reduction and internal fixation in our department were selected as the control group,including 10 males and 8 females,with an average age of(32.5±9.2)years(range,23~51 years).The causes of injury inclued as follows:7 cases of falling,6 cases of machine impact,5 cases of violent injury in traffic accidents.According to Herbert’s classification,all fractures in injury were type B4.Before operation and at last follow-up,Krimmer wrist score,imaging results,complications,disability of arm shoulder and hand(DASH)and Mayo function score were compared between the two groups.Results All patients were followed up with an average of(32.5±7.8)months(range,24~48 months).In the PRP group,the Krimmer score was significantly higher than that in the control group(P<0.01).In the PRP group,the Krimmer wrist function was excellent in 16 cases,good in 1 case,fair in 1 case,and poor in 0 case,and the excellent and good rate of 94.44%.In the control group,10 cases were excellent,3 cases were good,3 cases were fair,and 2 cases were poor,and the excellent and good rate was 72.22%;All patients in the PRP group had no necrosis of the scaphoid and lunate at last follow-up,and there was no infection and traumatic arthritis during the follow-up.In the control group,4 cases result in avascular necrosis of scaphoid,3 patients had traumatic arthritis,and 1 patient had postoperative wound infection.There was significant difference in the incidence of complications between the two groups(P<0.01).At last follow-up,the average DASH score was(12.83±2.27)in PRP group and(49.20±5.41)in control group.The difference was statistically significant(P<0.05).The Mayo wrist score of the two groups was improved after operation,and the Mayo wrist score of PRP group was higher than that of the control group at the last follow-up,the difference was statistically significant(P<0.05).Conclusion PRP in the treatment of TSPD can promote fracture healing,repair articular cartilage damage and reduce the incidence of post-operative complications,so as to improve the quality of life,which may have better application values.