HTO联合关节清理富血小板血浆治疗膝内侧骨关节炎

High tibial osteotomy combined with arthroscopic debridement and platelet rich plasma for medial knee osteoarthritis

[目的]探讨胫骨高位截骨(high tibial osteotomy,HTO)联合关节镜清理(arthroscopic debridement,AD)和富血小板血浆(platelet-rich plasma,PRP)关节内注射治疗膝内侧骨关节炎(medial knee osteoarthritis,mKOA)的临床疗效。[方法]回顾性分析2015年11月—2019年7月本院采用HTO治疗mKOA 33例患者。根据医患沟通结果,17例行HTO+AD+PRP治疗(联合组),另外16例仅行HTO治疗。比较两组围手术期、随访及影像资料。[结果]两组患者手术顺利完成。两组手术时间、切口总长度、术中出血量、切口愈合、开始行走时间及住院时间差异均无统计学意义(P>0.05)。所有患者均获随访30个月以上,联合组恢复完全负重活动时间显著早于HTO组[(58.1±4.6)d vs(66.1±4.0)d,P<0.05]。随时间推移,两组VAS和WOMAC评分均显著减少(P<0.05),而Lysholm和HSS评分均显著增加(P<0.05)。术前两组上述指标的差异均无统计学意义(P>0.05),末次随访时,联合组在VAS[(2.4±0.5)vs(2.8±0.5),P<0.05]、WOMAC[(18.4±2.0)vs(23.7±2.5),P<0.05]、HSS[(80.8±3.0)vs(73.3±2.5),P<0.05]和Lysholm评分[(79.1±3.6)vs(71.4±2.8),P<0.05]均显著优于HTO组。影像学方面,术前相比,两组术后6个月、术后1年MPTA和FTA显著改善(P<0.05),K-L分级无显著改变(P>0.05),相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。[结论]HTO联合关节镜清理、PRP治疗,可显著改善膝关节功能,缓解疼痛,提高患者满意度,临床疗效优于单一HTO。

[Objective]To investigate clinical efficacy of high tibial osteotomy(HTO)combined with arthroscopic debridement(AD)and platelet-rich plasma(PRP)intraarticular injection for medial knee osteoarthritis(mKOA).[Methods]A retrospective study was conduct-ed on 33 patients who received HTO for mKOA in our hospital from November 2015 to July 2019.According to doctor-patient communica-tion,17 patients received HTO+AD+PRP treatment(combination group),and the other 16 patients received HTO treatment only.The periop-erative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups were operated on smoothly,with-out significant differences in operation time,total incision length,intraoperative blood loss,incision healing grade,ambulation time and hos-pital stay between the two groups(P>0.05).All patients were followed up for more than 30 months,and the combined group resumed fullweight-bearing activities significantly earlier than the HTO group[(58.1±4.6)days vs(66.1±4.0)days,P<0.05].The VAS and WOMACscores decreased significantly(P<0.05),while Lysholm and HSS scores significantly increased over time in both groups(P<0.05).Althoughthere was no significant differences in abovesaid scores between the two groups before operation(P>0.05),the combined group proved signifi-cantly superior to the HTO group in terms of VAS[(2.4±0.5)vs(2.8±0.5),P<0.05],WOMAC[(18.4±2.0)vs(23.7±2.5),P<0.05],HSS[(80.8±3.0)vs(73.3±2.5),P<0.05]and Lysholm score[(79.1±3.6)vs(71.4±2.8),P<0.05]at the latest follow-up.Regarding imaging,the medial prox-imal tibial angle(MPTA)and femorotibial angle(FTA)significantly improved(P<0.05),whereas the K-L classification remained unchangedin both groups at 6 months and 1 year after surgery compared with those preoperatively(P>0.05).However,there were no statistically signifi-cant differences in the above imaging items between the two groups at any time points accordingly(P>0.05).[Conclusion]HTO combinedwith arthroscopic debridement and PRP does significantly improve knee joint function,relieve pain and improve patient satisfaction,andachieves clinical efficacy better than that of HTO only.