富血小板血浆在膝关节前十字韧带重建术中的应用

 目的 探讨富血小板血浆在膝关节前十字韧带重建术中应用的效果。方法 2010年1月至2013年1月，将40例拟接受初次膝关节前十字韧带重建的单纯前十字韧带断裂患者随机分为两组，每组20例。采用自体股薄肌腱和半腱肌腱移植物进行重建。一组术中应用自体富血小板血浆和血凝酶浸泡移植物（富血小板血浆组），另一组应用同等剂量的生理盐水和血凝酶浸泡移植物（生理盐水组）。术后1、3、12个月进行随访，评估术后引流量、伤口炎性反应程度、伤口愈合等级、前抽屉试验、Lachman试验、轴移试验、膝关节功能Lysholm评分及KNEELAX3检查。结果 术后随访12~24个月，平均18个月。富血小板血浆组引流量为（142±24） ml，与生理盐水的差异有统计学意义。术后第4天，富血小板血浆组伤口炎症反应程度为轻者1例、中1例、无反应18例，生理盐水组分别为2例、2例、16例。富血小板血浆组伤口均达甲级愈合；生理盐水组甲级愈合19例、乙级愈合1例。两组术前前抽屉试验、Lachman试验及轴移试验均为阳性，术后均为阴性。富血小板血浆组Lysholm评分由术前（39.8±8.9）分提高至术后12个月（92.1±2.7）分，术后评分与生理盐水组比较差异无统计学意义；富血小板血浆组KNEELAX3测量结果由术前（9.4±1.2） mm降至术后12个月（1.2±1.1） mm，术后结果与生理盐水组比较差异有统计学意义。结论 膝关节前十字韧带重建术中使用富血小板血浆浸泡移植物可减少术后引流量，促进骨隧道内腱骨结合部的愈合及膝关节功能的恢复。

The effect of platelet-rich plasma in anterior cruciate ligament reconstruction

Objective To investigate the effect of platelet-rich plasma (PRP) in anterior cruciate ligament (ACL) reconstruction. Methods From January 2010 to January 2013, 40 patients with ACL ruptures who underwent arthroscopic ACL reconstruction with gracilis and semitendinosus tendon were randomly divided into two groups: PRP group and normal saline group. 20 patients received graft soaked with PRP and hemocoagulase while 20 patients received graft soaked with normal saline and hemocoagulase. All patients were followed up in 1, 3 and 12 months. Evaluation consisted of postoperative drainage volume, inflammatory reaction, grade of wound healed, anterior drawer test，Lachman test, pivot shift, Lysholm knee score and KNEELAX3. Results The average follow-up period was 18 months. Postoperative drainage volume was 142±24 ml in PRP group and 324±22 ml in saline group. The difference was statistically significant. At 4 days after the operation, no inflammatory reaction was observed in 18 cases of PRP group and in 16 cases of saline group, mid inflammatory reaction in 1 case of PRP group and 2 cases of saline group, and moderate inflammatory reaction in 1 case of PRP group and 2 cases of saline group. Wound healed by first intention in 20 patients of PRP group and in 19 patients of saline group. The preoperative results of anterior drawer test, Lachman test and pivot shift were positive, while postoperative results were negative in both two groups. In PRP group, the preoperative and postoperative Lysholm knee scores of patients in 12 months were 39.8±8.9 and 92.1±2.7 points respectively. In saline group, the preoperative and postoperative Lysholm knee scores of patients in 12 months were 38.7±9.8 and 89.9±4.1 points respectively. The differences were not statistically significant. KNEELAX3 measuring results: in PRP group, preoperative measurement was 9.4±1.2 mm in average, while measurement in 12 months postoperatively was 1.2±1.1 mm. In saline group, preoperative measurement was 9.6±1.3 mm, while measurement in 12 months postoperatively was 2.2±1.2 mm. The differences were statistically significant. Conclusion Using graft soaked with PRP in ACL reconstruction could reduce postoperative drainage volume, accelerate the healing of tendon-bone interface in the bone tunnel and the recovery of knee joint function.