同种异体骨移植辅助PRP技术对Hepple V型距骨骨软骨损伤患者短期效果及TGF⁃β1、PDG、VEGF的影响

Effects of allograft bone grafting assisted PRP technique on short⁃term effect and TGF⁃β1,PDG,VEGF values in patients with Hepple V type talus osteochondral injury

目的分析同种异体骨移植辅助富血小板血浆技术(PRP)技术对HeppleV型距骨骨软骨损伤患者短期效果及转化生长因子β1(TGF⁃β1)、血小板衍生生长因子(PDG)、血管内皮生长因子(VEGF)的影响。方法选择河北省沧州中西医结合医院自2021年7月至2022年11月间收诊的116例HeppleV型距骨骨软骨损伤患者,根据不同的治疗方案分为对照组(自体骨软骨移植治疗,n=57)、研究组(同种异体骨移植辅助PRP技术治疗,n=59),对比两组临床相关指标情况[视觉模拟量表(VAS)、完全负重时间、住院时间]、踝功能情况[囊肿直径、踝与后足功能评分(AOFAS)、核磁共振关节软骨损伤修复评估表(MOCART)]、生长因子水平(TGF⁃β1、PDG、VEGF)、短期疗效、并发症情况。结果研究组治疗后VAS评分小于对照组,其完全负重时间、住院时间明显短于对照组,差异有统计学意义(P<0.05);治疗后,两组囊肿直径减少,AOFAS评分、MOCART评分升高,其中研究组各项指标改善更明显,差异有统计学意义(P<0.05);与治疗前比较,治疗后两组TGF⁃β1水平降低,PDG、VEGF水平升高,其中研究组三种因子变化更明显,差异有统计学意义(P<0.05);研究组短期治疗总有效率高于对照组,差异有统计学意义(P<0.05);研究组骨不连、骨折愈合延迟、伤口感染的总发生率低于对照组,差异有统计学意义(P<0.05)。结论同种异体骨移植辅助PRP技术对HeppleV型距骨骨软骨损伤患者短期治疗效果明显,可改善患者TGF⁃β1、PDG、VEGF因子水平,有较高的临床应用价值,可经深入试验后推广应用。

Objective To analyze the effects of allograft bone grafting assisted Platelet⁃rich plas⁃ma(PRP)on short⁃term effect and Transforming Growth Factorβ(TGF⁃β1),Platelet Derived Growth factor(PDG)and Vascular Endothelial Growth Factor(VEGF)values in patients with Hepple V type talus osteo⁃chondral injury.Methods 116 patients with Hepple V type talus osteochondral injury admitted to Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2021 to November 2022 were selected,and according to different treatment plans,they were divided into two groups,the control group(autologous osteochondral transplantation,n=57),the study group(allograft bone graft assisted PRP technology treatment,n=59).The clinical related indicators[visual analogue scale(VAS),full weight⁃bear⁃ing time,hospitalization time],ankle function Conditions[cyst diameter,ankle and hindfoot function score(AOFAS),magnetic resonance articular cartilage repair assessment table(MOCART)],growth factor levels(including:TGF⁃β1,PDG,VEGF),short⁃term efficacy,and complications of the two groups were com⁃pared.Results After treatment,the VAS score in the study group was lower than that in the control group,and the full weight⁃bearing time and hospitalization time in the study group were significantly shorter than those in the control group,the difference was statistically significant(P<0.05).After treatment,the diameter of cysts in the two groups decreased,and the scores of AOFAS and MOCART increased,and the indicators in the study group improved more significantly,the difference was statistically significant(P<0.05).Compared with before treatment,the levels of TGF⁃β1 in the two groups decreased after treatment,the levels of PDG and VEGF increased,and the changes of the three factors in the study group were more obvious,the differ⁃ence was statistically significant(P<0.05).The total effective rate of short⁃term treatment in the study group was higher than that in the control group,the difference was statistically significant(P<0.05).The total inci⁃dence of nonunion,delayed fracture healing,and wound infection in the study group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion Allogeneic bone grafting assisted PRP technique has obvious short⁃term therapeutic effects on patients with Hepple V type talus osteo⁃chondral injury,and can improve the levels of TGF⁃β1,PDG,and VEGF factors in patients,which has high clinical application value and can be applied after in⁃depth trials.