胫骨近端精准截骨联合富血小板血浆治疗膝关节骨关节炎疗效观察

Efficacy Observation Precise Proximal Tibial Osteotomy Combined with Platelet-Rich Plasma for Treatment of Knee Osteoarthritis

目的:探讨胫骨近端内侧高位开放截骨术(OWHTO)联合富血小板血浆(PRP)治疗膝关节骨关节炎的临床疗效。方法:回顾性分析2015年1月-2017年12月郑州市骨科医院关节外科收治的70例膝关节骨关节炎患者,根据治疗方法不同,将应用OWHTO联合PRP治疗的26例患者纳入联合治疗组;将仅采用OWHTO治疗的44例患者纳入单纯治疗组。两组术中均应用Tomofix钢板进行固定,联合治疗组在OWHTO治疗后1周进行PRP操作,1次/周,连续3次。比较两组术后手术情况,术后5年日本膝关节骨关节炎功能评估量表(JKOM)评分、西安大略和麦克马斯特大学骨关节炎指数评分(WOMAC)评分、Lysholm评分、膝关节活动度变化(ROM)、膝关节损伤和骨关节炎评分(KOOS)。结果:两组患者术后无切口愈合不良、合页断裂、撑开角度丢失、感染、钢板断裂、神经损伤等严重并发症。术后5年,联合治疗组患者JKOM评分、WOMAC评分、Lysholm评分、KOOS评分的日常生活、运动休闲、生活质量评分高于单纯治疗组,差异有统计学意义(P<0.05)。结论:OWHTO联合PRP治疗膝关节骨关节炎是一种有效的方法,在纠正力线的同时改善膝关节内环境,促进软骨细胞再生,明显减轻症状,避免膝关节骨关节炎的继续加重。

Objective:To investigate the clinical efficacy of open-wedge high tibial osteotomy(OWHTO)combined with plateletrich plasma(PRP)in the treatment of knee osteoarthritis.Methods:A retrospective analysis was performed among 70 patients with knee osteoarthritis treated in Joint Surgery Department of Zhengzhou Orthopedics Hospital from January 2015 to December 2017.According to different treatment methods,26 patients who were treated with OWHTO combined with PRP were included in the combined treatment group,and 44 patients who were treated with OWHTO alone were included in the simple treatment group.During surgery,Tomofix plate was used for fixation.The combined treatment group performed PRP operations 1 week after OWHTO surgery,once/week,for 3 consecutive times.The postoperative condition,Japan Knee Osteoarthritis Measure(JKOM)score,the Western Ontario and McMaster University Osteoarthritis Index(WOMAC)score,the Lysholm score,the change in knee range of motion(ROM),and the Knee Injury and Osteoarthritis Outcome Score(KOOS)at postoperative 5 years were compared between two groups.Results:There were no serious complications such as poor incision healing,hinge rupture,loss of stretching angle,infection,plate rupture,and nerve injury in two groups after surgery.At 5 years after surgery,JKOM score,WOMAC score,Lysholm score and KOOS score of daily life,exercise and leisure,and quality of life in the combined treatment group were higher than those in the simple treatment group,with statistically significant differences(P<0.05).Conclusion:OWHTO combined with PRP is an effective method for the treatment of knee osteoarthritis.It can correct the force line,improve the internal environment of the knee joint,promote the regeneration of chondrocytes,obviously alleviate the symptoms,and avoids the aggravation of knee osteoarthritis.