富血小板血浆应用于前交叉韧带重建术的疗效

目的探讨前交叉韧带重建术中及术后应用富血小板血浆的临床疗效。方法选取2016年7月至2017年7月安徽医科大学第一附属医院运动创伤与关节镜外科收治的符合纳入标准的膝关节前交叉韧带(ACL)断裂的患者70例,按住院号末位奇偶数分为试验组及对照组,两组均采用自体腘绳肌腱重建ACL,试验组采用富血小板血浆(PRP)浸泡移植肌腱及关节腔注射,对照组采用生理盐水浸泡肌腱及关节腔注射。试验组术后第3周开始,连续3周每周在关节腔内注射PRP,对照组术后不作特殊处理。测量两组患者术前1天及术后第3天大、小腿周径,术后3、6、12个月采用视觉模拟评分法(VAS)、Lysholm评分及国际膝关节文献委员会膝关节评估表(IKDC)评估术后膝关节功能及疼痛;术后6、12个月行膝关节MRI检查。结果术后随访12～17个月,平均14个月。术后第3天,试验组大、小腿周径与术前差值均小于对照组(P <0. 05);术后3、6、12个月,两组患者VAS评分、膝关节Lysholm评分及膝关节IKDC评分均较术前提高(P <0. 05);两组患者术后VAS评分差异无统计学意义(P> 0. 05);两组患者术后Lysholm评分及IKDC评分差异有统计学意义,且试验组术后3、6个月时膝关节Lysholm评分及膝关节IKDC评分均优于对照组(P <0. 05),试验组术后12个月膝关节Lysholm评分及膝关节IKDC评分较对照组稍高,但差异无统计学意义(P> 0. 05)。试验组术后6个月MRI评分优于对照组(P <0. 05),术后12个月两组MRI评分比较差异无统计学意义(P> 0. 05)。随访期间两组患者均未出现膝关节感染、切口愈合不良及膝关节僵硬等术后并发症。结论 PRP能够改善ACL重建术后患者早期膝关节功能,缓解膝关节肿胀,促进移植韧带重塑。

Clinical efficacy of platelet-rich plasma in anterior cruciate ligament reconstruction

Objective To explore the clinical efficacy of the application of platelet-rich plasma in the reconstruction of anterior cruciate ligament and after the operation. Methods From July 2016 to July 2017, 70 patients with ACL ruptures who met the inclusion criteria were randomly divided into the experimental group and the control group. The patients of both groups were reconstructed ACL with autologous hamstring tendon. PRP (trial group) or saline (control group) was performed with soak autologous hamstring tendons and injected in articular cavity. Control group was treated with normal saline soaked tendon and joint cavity injection. The trial group and control group received respectively the weekly intra-articular injection of sodium hyaluronate or PRP in postoperative two weeks, for three consecutive weeks. The circumference of thigh and calf before the day before surgery and the third day after surgery was measured. Visual analogue scale (VAS), Lysholm score and IKDC activity were used to evaluate postoperative knee function and pain wthin 3, 6, and 12 months postoperatively. The knee joint MRI examination was performed 6 and 12 months postoperatively.Results All patients were followed up 12 to 17 months with an average of 14 months. The differences in thigh circumference and calf circumference between preoperative and third day after surgery were smaller than those of control (P<0.05). There was no significant difference in VAS score between two groups (P>0.05). There were significant differences in Lysholm score and IKDC score between two groups. The Lysholm score and IKDC score of knee joint in experimental group were better than those in control group 3 and 6 months after operation (P<0.05). The Lysholm score and IKDC score of knee joint in experimental group were slightly higher than those in control group 12 months after operation, but there was no significant difference (P>0.05). The MRI scores of the trial group was better than that of control group 6 months postoperatively (P<0.05). There was no significant difference in MRI score between two groups 12 months after operation (P<0.05). No complications of infection, poor healing of the incision and knee stiffness were detected in both groups. Conclusion PRP can improve the early knee function after ACL reconstruction, relieve knee swelling, and promote graft ligament remodeling.