关节镜清理术联合自体富血小板血浆对轻中度膝骨关节炎的治疗效果及机制

Therapeutic efficacy of arthroscopic debridement combined with autologous platelet-rich plasma in the treatment of mild to moderate knee osteoarthritis and its mechanism

目的探讨关节镜清理术联合关节腔内注射自体富血小板血浆(PRP)对轻中度膝骨关节炎(KOA)的治疗效果及机制。方法将30例Kellgren-Lawrence(K-L)分级为Ⅱ~Ⅲ级的(KOA)患者均分为观察组和对照组,观察组行膝关节镜清理术,术后立即关节腔内注入PRP 3 m、并于术后第2周末及第4周末再次注入PRP,对照组仅行膝关节镜清理术;比较2组患者治疗前及治疗后第3、第6、12个月时的数字疼痛强度(NRS)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及SF-36生活质量(SF-36)评分,并检测2组患者治疗前、治疗后第6周时关节液肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)及基质金属蛋白酶-3(MMP-3)水平。结果治疗前,2组患者NRS评分、WOMAC评分、SF36评分及关节液中IL-1β、TNF-α及MMP-3水平比较,差异无统计学意义(P>0.05);术后第3个月、第6个月及第12个月时,2组患者NRS评分、WOMAC评分低于治疗前,SF36评分高于治疗前,差异有统计学意义(P<0.05);术后第6个月及第12个月时,观察组患者NRS评分、WOMAC评分低于对照组,SF36评分高于对照组,差异有统计学意义(P<0.05);术后第6周时,2组患者关节液中IL-1β、TNF-α及MMP-3水平均低于治疗前,观察组患者低于对照组,差异有统计学意义(P<0.05)。结论关节镜清理术联合关节腔内注射PRP对轻中度KOA的治疗效果优于单纯膝关节镜清理术,其机制可能与下调关节液中炎性因子水平有关。

Objective To observe the therapeutic efficacy and mechanism of arthroscopic debridement combined with intraarticular injection of autologous platelet-rich plasma(PRP)in the treatment of mild to moderate knee osteoarthritis(KOA).Methods Thirty patients with KOA with Kellgren-Lawrence(K-L)gradeⅡ-Ⅲwere divided into observation and control groups.Observation group underwent knee arthroscopy debridement and injected with 3 mL autologous PRP into the joint cavity immediately after operation and re-injected with PRP at the 2^(nd) and 4^(th) weeks after the operation.Control group underwent knee arthroscopy alone.The scores of numeric pain rating scale(NRS),Western Ontario and McMaster Universities Arthritis Index(WOMAC)and short form 36 health survey questionnaire(SF-36)were compared before treatment,at 3 months,6 months,and 12 months after treatment between two groups.The levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),and matrix metalloproteinase-3(MMP-3)in the synovial fluid of two groups before treatment and at the 6^(th) week after treatment were detected.Results Before treatment,there was no significant differences in NRS scores,WOMAC scores,SF36 scores,the levels of IL-1β,TNF-α,and MMP-3 in synovial fluid between two groups(P>0.05).At the 3^(rd),6^(th),and 12^(th) months after operation,NRS scores,and WOMAC scores of two groups were lower than those before treatment,but SF-36 scores were higher than those before treatment(P<0.05).At the 6^(th) and 12^(th) months after the operation,NRS scores,and WOMAC scores were lower in observation group than those of control group,while SF-36 scores were higher than those in control group(P<0.05).At the 6^(th) week after operation,the levels of IL-1β,TNF-α,and MMP-3 in the synovial fluid of two groups were lower than those before treatment,and their levels was lower in observation group than those in control group(P<0.05).Conclusion The therapeutic efficacy of arthroscopic debridement combined with intra-articular injection of PRP is superior to arthroscopic debridement alone in the treatment of mild to moderate KOA.Its mechanism may be related to the downregulation of inflammatory factors in synovial fluids.