关节镜下清理联合富血小板血浆注射治疗Kellgren-Lawrence分级Ⅰ-Ⅲ级膝骨关节炎

Arthroscopic debridement combined with platelet-rich plasma injection for the treatment of Kellgren-Lawrence gradeⅠ-Ⅲknee osteoarthritis

目的:探讨关节镜下清理联合关节腔内注射富血小板血浆(platelet-rich plasma,PRP)治疗Kellgren-Lawrence分级(K-L)Ⅰ-Ⅲ级膝骨关节炎(knee osteoarthritis,KOA)的临床疗效。方法:回顾性分析2015年11月至2019年1月行关节镜下清理联合关节腔内注射药物治疗的117例KOA患者的临床资料,根据注射药物不同分为透明质酸钠组(A组)和PRP组(B组)。A组60例,男27例,女33例;年龄49~67(54.1±4.8)岁;K-L分级Ⅰ级12例,Ⅱ级23例,Ⅲ级25例;术中清理后,术后1、2、3周时分别向患膝关节腔注射透明质酸钠(2 ml,20 g)1次,共4次。B组57例,男25例,女32例;年龄47~70(55.8±5.0)岁;K-L分级Ⅰ级10例,Ⅱ级20例,Ⅲ级27例;注射PRP 5 ml,时间、次数与A组相同。观察两组患者并发症发生情况,分别于治疗后3、6、12个月采用疼痛视觉模拟评分(visual analogue scale,VAS)与Lysholm评分评估患膝疼痛及关节功能改善情况。结果:117例患者均获得随访,时间12~19(14.1±1.6)个月。两组并发症情况比较差异无统计学意义(P>0.05)。治疗后3、6、12个月时,A、B两组VAS评分分别为3.0±0.8、2.0±0.8、2.6±0.9与2.9±0.8、1.9±0.7、2.2±0.8;治疗后3、6个月两组VAS评分比较差异无统计学意义(P>0.05),但治疗后12个月时B组评分低于A组(P<0.05)。A组治疗后3、6、12个月Lysholm评分分别为86.6±1.8、93.1±2.0、86.7±1.7,B组分别为88.9±1.9、95.0±2.0、89.0±1.9,A组均低于B组(P<0.05)。结论:关节镜下清理联合关节腔内注射透明质酸钠和PRP治疗K-L分级Ⅰ-Ⅲ级KOA患者在短期内均可有效改善患膝疼痛及关节功能且安全性好,但注射PRP中远期疗效更持久。

Objective:To explore clinical effect of arthroscopic debridement combined with platelet-rich plasma(PRP)injection for Kellgren-Lawrence(K-L)gradeⅠ-Ⅲknee osteoarthritis(KOA).Methods:Totally 117 patients with KOA who underwent arthroscopic debridement combined with injection from November 2015 to January 2019 were retrospectively analyzed.According to different injection drugs,the patients were divided into sodium hyaluronate group(group A)and PRP group(group B).In group A,there were 60 patients,including 27 males and 33 females,aged from 49 to 67 years old with an average age of(54.1±4.8)years old;12 patients with gradeⅠ,23 patients with gradeⅡand 25 patients with gradeⅢaccording to K-L clssification,2 ml(20 g)sodium hyaluronate was injected into knee joint after intraoperative,1,2,3 weeks after operation for 4 times.In group B,there were 57 patients,including 25 males and 32 females,aged from 47 to 70 years old with an average of(55.8±5.0)years old,10 patients with gradeⅠ,20 patients with gradeⅡand 27 patients with gradeⅢaccording to K-L classification,injected 5 ml PRP at the same time.Postoperative complications was recorded between two groups.Postoperative visual analogue scale(VAS)and Lysholm score at 3,6,12 months were used to evaluate improvement of knee pain and joint function.Results:All patients were followed up for 12 to 19 months with an average of(14.1±1.6)months.There was no significant difference in postopertaive complications between group A and group B(P>0.05).Postoperative VAS score in group A at 3,6,12 months were 3.0±0.8,2.0±0.8,2.6±0.9 respectively,and 2.9±0.8,1.9±0.7,2.2±0.8 in group B respectively;and no differnece at 3 and 6 months after operation between two groups(P<0.05),while VAS score in group B was higher than group A at 12 months after operation(P<0.05).Postoperative Lysholm score in group A at 1,6,12 months(86.6±1.8,93.1±2.0,86.7±1.7)were lower than group B(88.9±1.9,95.0±2.0,89.0±1.9)(P<0.05).Conclusion:Arthroscopic debridement combined with sodium hyaluronate or PRP injection for K-L gradeⅠ-ⅢKOA could effectively relieve pain and improve joint function with higher safety in short term,but the medium-long-term effect of PRP injection is stable.