保留韧带残留纤维前交叉韧带解剖重建术联合富血小板血浆对患者早期髌骨关节软骨的影响

Effect of anterior cruciate ligament anatomical reconstruction with ligament residual fibers preservation combined with platelet-rich plasma on early patellar articular cartilage

目的研究保留韧带残留纤维前交叉韧带解剖重建术联合富血小板血浆对患者早期髌骨关节软骨的影响。方法选择2019年6月~2020年6月我院收治的82例前交叉韧带损伤患者,其中男53例,女29例,患者均行前交叉韧带解剖重建术,依据随机数字表法将患者分为观察组和对照组,各41例。对照组患者仅行保留韧带残留纤维前交叉韧带解剖重建术,观察组患者在对照组基础上联合应用富血小板血浆,术后患者均获得随访,随访时间为12个月。记录和比较两组患者膝关节功能、胫骨隧道缩小程度、髌骨关节软骨相关指标、髌骨关节软骨损伤程度及安全性等。结果术前两组患者Lysholm评分差异无统计学意义(P>0.05),观察组患者术后6个月和12个月Lysholm评分明显高于对照组,且术后12个月两组患者Lysholm评分明显高于术前和术后6个月(P<0.05)。观察组患者术后6个月和术后12个月胫骨隧道缩小程度明显高于对照组,且两组患者术后12个月胫骨隧道缩小程度明显高于术后6个月(P<0.05)。术后1周,两组患者髌骨内侧T2值差异无统计学意义(P>0.05),观察组患者髌骨外侧T2值和髌骨外侧角差值明显低于对照组(P<0.05);两组患者髌骨关节软骨损伤分级差异有统计学意义(P<0.05),且观察组患者0~Ⅱ级例数明显多于对照组(P<0.05)。结论富血小板血浆联合保留韧带残留纤维前交叉韧带解剖重建术可有效改善患者膝关节功能,缩小胫骨隧道,降低髌骨关节软骨损伤分级。

Objective To study the effect of anterior cruciate ligament anatomical reconstruction with ligament residual fibers preservation combined with platelet-rich plasma on early patellar articular cartilage.Methods Eightytwo patients with anterior cruciate ligament injury treated in our hospital from Jun 2019 to Jun 2020 were selected,including 53 males and 29 females.All patients underwent anatomical reconstruction and the patients were randomly divided into observation group(n=41)and control group(n=41)according to random number table method.Patients in the control group only underwent anterior cruciate ligament anatomical reconstruction with ligament residual fibers preservation,while patients in the observation group were treated with platelet-rich plasma on the basis of the control group.The knee joint function,tibial tunnel reduction,patellar articular cartilage related indexes,patellar articular cartilage injury degree and safety were recorded and compared between the two groups.Results There was no significant difference in Lysholm score between the two groups before operation,while the Lysholm score in the observation group at 6 and 12 months after operation was significantly higher than that of the control group,and the Lysholm score in the two groups at 12 months after operation was significantly higher than that before operation and 6 months after operation(P<0.05).The reduction degree of tibial tunnel in the observation group was significantly higher than that in the control group at 6 months and 12 months after operation,and the reduction degree of tibial tunnel at 12 months after operation in both groups was significantly higher than that at 6 months after operation(P<0.05).One week after operation,there was no significant difference in medial patellar T2 between the two groups,but the difference of lateral patellar T2 and lateral patellar angle in the observation group was significantly lower than that in the control group.There was significant difference in the grade of patellar articular cartilage injury between the two groups,and the number of cases of 0~Ⅱgrade in the observation group was significantly more than that in the control group(P<0.05).Conclusion Platelet-rich plasma combined with anterior cruciate ligament anatomical reconstruction with ligament residual fibers preservation can effectively improve the function of the patients’knee joint,narrow the tibial tunnel,reduce the classification of patellar articular catilage injury.