富血小板血浆关节腔注射联合冲击波综合治疗Ⅰ/Ⅱ期距骨骨软骨损伤的临床研究

Clinical Study on the Combination of Intra-Articular Injection of Platelet Rich Plasma and Shockwave Therapy forⅠ/ⅡStage Osteochondral Lesion of the Talus

目的:探讨富血小板血浆(PRP)关节腔注射联合冲击波综合疗法治疗Ⅰ/Ⅱ期距骨骨软骨损伤(OLT)的临床疗效。方法:收集2022年1月至2022年12月治疗的距骨骨软骨损伤患者资料60例,按照随机数字表法将患者随机分为2组,观察组30例(其中有4例脱落),对照组30例。观察组采用富血小板血浆关节腔注射联合冲击波及常规治疗方法,对照组采用冲击波及常规治疗方法,治疗6个月后采用美国足与踝关节协会(AOFAS)踝与足评分、疼痛视觉模拟量表(VAS)评分、软骨及软骨下骨损伤体积、骨髓水肿体积等指标的变化评定患者的临床疗效。结果:56例距骨骨软骨损伤患者中男性发病率高于女性(64.3%vs 35.7%),左踝发病率明显高于右踝(62.5%vs 37.5%),距骨圆顶内侧发病率明显高于外侧(78.6%vs 21.4%)。两组距骨骨软骨损伤患者治疗后6个月的AOFAS评分均升高,观察组升高更明显,差异有统计学意义(P<0.05);两组距骨骨软骨损伤患者治疗后6个月的VAS评分、软骨及软骨下骨损伤体积、骨髓水肿体积均缩小,且观察组缩小更明显,差异有统计学意义(P<0.05)。结论:富血小板血浆关节腔内注射联合冲击波综合治疗可改善距骨骨软骨损伤患者踝关节功能,减轻患者临床症状,促进病灶修复及骨髓水肿吸收,疗效更好,值得临床推广应用。

Objective:To explore the clinical value of intra-articular injection of platelet-rich plasma(PRP)combined with extracorporeal shockwave on the treatment of stageⅠ/Ⅱosteochondral lesion of the talus(OLT).Methods:60 OLT patients were collected who were treated from January 2022 to December 2022.According to the random number table method,the patients were randomly divided into two groups:an observation group of 30 cases(4 cases were fell out)and a control group of 30 cases.The observation group used PRP joint cavity injection combined with shockwave and basic treatment,while the control group used shockwave and basic treatment.The clinical efficacy of the patients was evaluated using changes in American Orthopaedic Foot and Ankle Society(AOFAS)scores,visual analogue scale(VAS)scores of pain,osteochondral injury of volume,and bone marrow edema of volume after 6 months of treatment.Results:In 56 OLT patients,the male incidence rate was higher than the female(64.3%vs 35.7%),the left ankle incidence rate was significantly higher than the right(62.5%vs 37.5%),and the medial part of the talus incidence rate was significantly higher than the lateral(78.6%vs 21.4%).The AOFAS scores increased after 6 months of treatment in both groups of OLT patients,with a significant increase in the observation group(P<0.05).The VAS scores,osteochondral injury of volume,and bone marrow edema of volume all decreased,and the reduction was significant in the observation group(P<0.05).Conclusion:The comprehensive treatment of PRP intra-articular injection combined with extracorporeal shockwave can improve ankle joint function in OLT patients,alleviate clinical symptoms,promote lesion repair and bone marrow edema absorption,and have a more significant therapeutic efficacy,which is worthy of clinical promotion.