富血小板血浆对半月板损伤患者炎症及关节功能的影响

目的探究富血小板血浆联合关节镜手术对半月板损伤患者白介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)及膝关节功能的影响。 方法2018年1月至2019年7月苏州市第九人民医院和南京市第一医院骨科收治的68例半月板损伤患者，入组患者具备关节镜手术治疗指征，未合并影响运动功能的疾病，排除既往存在膝关节手术史者，凝血功能异常者。通过随机数字表法分为观察组(n＝34)、对照组(n＝34)。对照组接受膝关节镜下半月板成形术治疗，观察组在对照组基础上注射富血小板血浆。治疗后6个月两组疗效、6个月内不良反应发生情况，使用卡方检验和Fisher精确检验比较；治疗前、治疗后2周、治疗后6个月两组膝关节功能及血清IL-1、TNF-α水平使用t检验，不同时间点的比较使用重复测量方差分析，组间和时间的比较采用多变量方差分析。 结果治疗后6个月，观察组总有效率为88.24%，显著高于对照组的67.65%(χ²＝4.191，P<0.05)。两组在治疗后2周、治疗后6个月Lysholm量表评分(LKSS)、国际膝关节文献协会膝关节主观功能(IKDC)、较治疗前均升高(F＝8.236，5.267，P<0.05)；治疗后6个月观察组以上评分高于对照组(F＝4.035，4.535，P<0.05)。治疗后2周、治疗后6个月两组血清IL-1、TNF-α水平较治疗前均下降(F＝133.35，12.145，P<0.05)，且观察组低于对照组(F＝23.672，10.245，均为P<0.05)。治疗后6个月内，对照组有2例(5.88%)患者出现轻度关节肿痛以及活动受限，观察组无不良反应发生(0.00%)，组间比较无统计学差异(P>0.05)。 结论在关节镜手术的基础上，联用富血小板血浆可改善半月板损伤患者膝关节功能，降低IL-1、TNF-α水平，抑制炎性损伤，安全有效，值得临床推广应用。

Effects of platelet-rich plasma combined with arthroscopic surgery on inflammation and knee function inpatients with meniscus injury

ObjectiveTo investigate the effects of platelet-rich plasma combined with arthroscopic surgery on IL-1, TNF-α and knee function in patients with meniscus injury. MethodsBetween January 2017 and July 2018, 68 meniscuses were treated in orthopaedics departments of the Ninth People’s Hospital of Suzhou and the Fist Hospital of Nanjing. The enrolled patients had indications for arthroscopic surgery and did not incorporate diseases that affected motor function, and patients with a history of knee surgery and abnormal blood coagulation were excluded. For the injured patients, the random number table method was used for the observation group (n=34) and the control group (n=34). The control group received arthroscopic surgery, and the observation group was injected with platelet-rich plasma on the basis of the control group. After six months of treatment, the efficacy of the two groups and the occurrence of adverse reactions in the two groups within six months were compared using the chi-square test and the Fisher’s exact test; before treatment, two weeks after treatment, and six months after treatment, knee function and serum interleukin (IL)-1, and tumor necrosis factor (TNF)-α levels in the two groups were analyzed by t test, repeated measurement analysis of variance was used for comparison at different time points, and multivariate analysis of variance was used for comparison between groups and time. ResultsSix months after the treatment, the total effective rate in the observation group was 88.24%, which was higher than that(67.65%) in the control group (χ²=4.191, P<0.05). The Lysholm and International Knee Documentation Committee(IKDC)knee fuction scores of the two groups were higher than those before the treatment at two weeks and six months after the treatment (F=8.236, 5.267, P<0.05); the scores of the observation group were higher than the control group at six months after the treatment (F=4.035, 4.535, P<0.05). The levels of serum IL-1 and TNF-α in the two groups decreased two weeks after treatment and six months after treatment (F=133.35, 12.145, P<0.05), and the observation group was lower than the control group (F=23.672, 10.245, P<0.05). Within six months after treatment, two patients (5.88%) in the control group had mild joint swelling and pain and limited movement. No adverse reaction occurred in the observation group (0.00%), and there was no statistical difference between the groups (P>0.05). ConclusionBased on arthroscopic surgery, combined with platelet-rich plasma can improve knee function, reduce IL-1, TNF-α levels, inhibit inflammatory damage, and increase the healing rate in patients with meniscus injury, which is worthy for clinical application.