富血小板血浆在同种异体肌腱重建前交叉韧带中的应用

Application of autologous platelet-rich serum in ACL reconstruction with allogenic tendon

目的探讨膝关节镜下同种异体肌腱重建前交叉韧带(anterior cruciate ligament,ACL)联合自体富血小板血浆(platelet rich plasma,PRP)治疗膝关节ACL断裂的价值。方法选取2020年11月至2022年11月符合纳入标准与排除标准的47例膝关节ACL断裂的患者,将患者按住院号末位奇偶数分成试验组(n=24)和观察组(n=23)。两组患者均采用同种异体肌腱重建ACL,试验组在重建ACL时联合PRP治疗,观察组行常规ACL重建治疗。用Lysholm评分法及国际膝关节文献委员会(the International Knee Documentation Committee,IKDC)评分评价患者膝关节的功能状态,用疼痛视觉模拟评分(visual analogue scale,VAS)评价患者膝关节的疼痛程度,术后随访12个月,比较两组患者在不同时间段内膝关节功能状态和疼痛程度,并在术后6个月、12个月对患者进行MRI检查。结果术后两组患者的各项评分均优于术前,术后3个月试验组的Lysholm评分64.22±10.55、IKDC评分60.22±9.77及VAS评分6.03±1.44优于观察组(分别为72.11±9.44,68.55±10.77,4.43±1.66),术后6个月试验组的MRI评分2.12±0.87及Lysholm评分73.22±9.33、IKDC评分70.12±8.66、VAS评分5.11±1.23优于观察组(分别为2.66±0.88,89.56±6.33,75.66±9.55,3.59±0.56),且差异均有统计学意义(P<0.05),术后12个月两组各项评分差异无统计学意义(P>0.05)。术后6个月膝关节MRI显示对照组相比试验组移植物信号更加混杂,提示愈合不佳,术后12个月两组移植物呈均一低信号,提示愈合良好。结论自体PRP在同种异体肌腱重建ACL的治疗中能够在一定程度上缓解术后患者的早期疼痛,还能够加快ACL重塑的过程。

Objective To investigate the value of anterior cruciate ligament(ACL)combined with autologous platelet rich plasma(PRP)in knee arthroscopic allogeneic tendon reconstruction in the treatment of knee ACL rupture.Methods A total of 47 patients with knee ACL rupture who met the inclusion criteria from November 2020 to November 2022 were enrolled,and the patients were divided into the experimental group(n=24)and observation group(n=23)according to the odd and even numbers of the last hospitalization number.Allogeneic tendon reconstruction of ACL was used in both groups.The experimental group was treated with platelet-rich plasma when reconstructing ACL,and the observation group was treated with conventional ACL reconstruction.The functional status of the knee joint was evaluated by the Lysholm score and the International Knee Documentation Committee(IKDC)score.The pain level of the knee joint was evaluated by the visual analogue scale(VAS).The postoperative follow-up was 12 months.The functional status and pain level of the knee joint in different time periods were compared between the two groups.MRI examinations were performed at 6 and 12 months after surgery.Results The scores of the two groups were better than those before surgery.The Lysholm score 64.22±10.55,IKDC score 60.22±9.77 and VAS score 6.03±1.44 of the experimental group 3 months after surgery were better than those in the observation group(72.11±9.44,68.55±10.77,4.43±1.66),and there were statistically significant differences(P<0.05).MRI score 2.12±0.87,Lysholm score 73.22±9.33,IKDC score 70.12±8.66 and VAS score 5.11±1.23in the experimental group 6 months after surgery were better than those in the observation group(2.66±0.88,89.56±6.33,75.66±9.55,3.59±0.56),and there were statistically significant differences(P<0.05).No statistical difference was noted between the two groups 12 months after surgery(P>0.05).Knee MRI 6 months after surgery showed that the graft signal of the control group was more mixed than that of the experimental group,indicating poor healing.The graft signals in both groups were uniform and low 12 months after surgery,indicating good healing.Conclusions Autologous platelet-rich plasma can alleviate the early pain of patients in the treatment of allogeneic tendon reconstruction ACL,accelerating the process of ACL remodeling.