关节镜清理联合富血小板血浆治疗创伤性踝关节炎

Arthroscopic debridement combined with platelet-rich plasma for post-traumatic osteoarthritis of the ankle

[目的]探讨关节镜清理联合富血小板血浆(platelet-rich plasma,PRP)治疗创伤性踝关节炎(post-traumatic osteoarthritis,PTOA)的临床疗效及安全性。[方法]回顾性分析2019年2月—2021年2月收治的41例PTOA患者的临床资料。依据医患沟通结果,23例采用关节镜术联合PRP治疗,18例采用关节镜术联合透明质酸(hyaluronate acid,HA)治疗。比较两组围手术期、随访及辅助检查结果。[结果]两组手术时间、术中出血量、切口总长度、切口愈合等级、下肢深静脉血栓形成、住院时间的差异均无统计学意义(P>0.05)。两组患者均获12个月以上随访,两组完全负重活动时间差异无统计学意义(P>0.05)。随时间推移,两组VAS评分、AOFAS评分显著改善(P<0.05),踝背伸-跖屈ROM无显著变化(P>0.05)。术后12个月PRP组的VAS评分[(1.3±0.6)vs(2.7±1.1),P<0.05]和AOFAS评分[(80.9±6.5)vs(71.0±5.6),P<0.05]均显著优于HA组。检验方面,随时间推移,两组患者Hs-CRP、IL-6、TNF-α均显著减少(P<0.05)。术后12个月PRP组的Hs-CRP[(3.1±0.3)mg/L vs(6.7±0.1)mg/L,P<0.05]、IL-6[(3.0±0.3)ng/L vs(4.0±0.3)ng/L,P<0.05]和TNF-α[(4.2±0.6)ng/L vs(5.2±0.6)ng/L,P<0.05]均显著优于HA组。影像方面:与术前相比,术后6、12个月两组患者TT、mLDTA无明显变化(P>0.05)。术后12个月PRP组K-L分期较术前显著改善(P<0.05),HA组无明显变化(P>0.05)。术后12个月PRP组的K-L分期[Ⅰ/Ⅱ/Ⅲa/Ⅲb/Ⅳ,(0/16/6/1/0)vs(0/7/7/4/0),P<0.05]显著优于HA组。[结论]关节镜清理联微骨折联合PRP治疗踝PTOA可显著改善治疗效果,安全性高。

[Objective]To investigate the clinical efficacy and safety of arthroscopic debridement and microfracture combined withplatelet-rich plasma(PRP)for post-traumatic osteoarthritis(PTOA)of the ankle.[Methods]A retrospective study was done on 41 patientswho received surgical treatment for PTOA from February 2019 to February 2021.According to doctor-patient communication,23 patients received PRP injection intraarticularly following the arthroscopic procedure,while the remaining 18 patients had hyaluronic acid(HA)injected intraarticularly after surgery.The document regarding perioperative period,follow-up and auxiliary examination were compared betweenthe two groups.[Results]There were no significant differences in operation time,intraoperative blood loss,total incision length,incisionhealing grade,deep venous thrombosis of lower limbs and hospital stay between the two groups(P>0.05).All patients in both groups were followed up for more than 12 months,without a significant difference in the time to resume full weight-bearing activity between the two groups(P>0.05).The VAS and AOFAS scores improved significantly(P<0.05),while the ankle dorsal-plantar flexion range of motion(ROM)remained unchanged over time in both groups(P>0.05).At 12 months after surgery,the PRP group proved significantly superior to the HAgroup in terms of VAS score[(1.3±0.6)vs(2.7±1.1),P<0.05]and AOFAS score[(80.9±6.5)vs(71.0±5.6),P<0.05].Regarding laboratory testing,the Hs-CRP,IL-6 and TNF-α significantly decreased in both groups over time(P<0.05).The PRP group was significantly better thanthe HA group in terms of Hs-CRP[(3.1±0.3)mg/L vs(6.7±0.1)mg/L,P<0.05],IL-6[(3.0±0.3)ng/L vs(4.0±0.3)ng/L,P<0.05]and TNF-α[(4.2±0.6)ng/L vs(5.2±0.6)ng/L,P<0.05]12 months postoperatively.Radiographically,there were no significant changes in TT and mLDTAin both groups 6 and 12 months postoperatively compared with those preoperatively(P>0.05).However,the Kellgren-Lawrence(K-L)classification for osteoarthritis in the PRP group significantly improved 12 months after surgery(P<0.05),which in the HA group remained not sig-nificantly changed(P>0.05).At 12 months after surgery,the PRP group proved significantly superior to the HA group in K-L stage[I/II/IIIa/IIIb/IV,(0/16/6/1/0)vs(0/7/7/4/0),P<0.05].[Conclusion]Arthroscopic debridement and microfracture combined with PRP does significantly improve the clinical efficacy for post-traumatic osteoarthritis of the ankle with high safety.