富血小板血浆联合手术治疗膝骨关节炎复合半月板损伤

Platelet rich plasma combined with surgery for treatment of knee osteoarthritis with meniscus injury

目的观察富血小板血浆联合胫骨高位截骨、关节镜清理治疗复合内侧半月板损伤的内翻性膝骨关节炎的临床疗效。方法回顾性分析浙江大学医学院附属第二医院骨科2016年6月至2019年6月收治的12例复合内侧半月板损伤的内翻性膝骨关节炎,采用膝关节镜清理、半月板成型,胫骨高位截骨调整力线,纠正膝关节内翻,富血小板血浆分别于术中,术后2周和术后4周关节腔注射治疗膝骨关节炎。在术前、术后1月、3月、6月、1年和2年记录疼痛视觉模拟评分(VAS),特种外科医院(HSS)膝关节评分。计量资料采用t检验,不同时间点分析采用单因素重复测量数据方差分析。结果本组患者共12例,其中男性5例,女性7例,术前胫骨近端内侧角(MPTA)(81.6±2.2)°,股胫角(FTA)(185.7±2.4)°,股骨远端外侧角(LDFA)(88.4±1.9)°,VAS评分(3.9±1.1),HSS评分(52.8±6.5)。术后MPTA(93.2±2.9)°,FTA(172.8±2.3)°,患者术后各时间点VAS评分(F=4.79,P<0.001)和HSS评分(F=2.01,P=0.02)逐渐改善。结论通过富血小板血浆和胫骨高位截骨、关节镜清理联合治疗复合内侧半月板损伤的内翻性膝骨关节炎具有良好的临床效果,缓解患者的疼痛,改善膝关节功能。

Objective To observe the effect of treatment for the varus knee osteoarthritis with the medial meniscus injury by platelet rich plasma(PRP)combined with high tibial osteotomy(HTO)and arthroscopy.Methods Retrospective analysis of 12 cases of varus knee osteoarthritis with the medial meniscus injury treated by PRP combined with HTO and arthroscopy between June 2016 and June 2019.PRP was injected at the time of operation,two weeks and four weeks after operation.Visual analogue scale(VAS)and Hospital for Special Surgery(HSS)knee score were recorded at the time of operation,one month,three months,six months,one year and two years after operation.The t test was used for measurement data,and repeated measurement data variance was used for analysis of different time points.Results There were 12 patients(five males and seven females).preoperative MPTA was(81.6±2.2)°,femorotibial angle(FTA)was(185.7±2.4)°,lateral distal femoral angle(LDFA)was(88.4+1.9)°,VAS score was(3.9±1.1)and HSS score was(52.8±6.5).Postoperative medial proximal tibial angle(MPTA)was(93.2±2.9)°and FTA was(172.8±2.3)°.The VAS score(F=4.79,P<0.001)and HSS score(F=2.01,P=0.02)were improved significantly after operation.Conclusion The combination treatment of PRP,HTO and arthroscopy for the varus knee osteoarthritis with the medial meniscus injury has been confirmed,which reduces the pain of patients,improve the function of the knee joint.