富血小板血浆对髌骨骨折内固定的影响△

Effect of platelet-rich plasma on clinical outcomes of open reduction and internal fixation of patella fractures

摘要:

［目的］研究富血小板血浆（platelet- rich plasma, PRP）对髌骨骨折内固定的影响。［方法］2018 年 1 月—2021 年 3 月，共 50 例急性闭合性髌骨骨折患者纳入本研究，采用抽签法随机将其分两组，PRP 组 25 例行切开复位内固定后局部注射 PRP 4~4.5 ml；无 PRP 组 25 例仅行常规开放复位内固定。比较两组围手术期资料、随访资料及影像学资料。［结果］两组均顺利完成手术，无严重并发症。两组手术时间、切口长度、术中失血量、术后下地行走时间、住院时间、切口愈合等级、术后 1 周 VAS 评分的差异均无统计学意义 （P>0.05）。两组患者均获随访，平均 （18.62±2.63） 个月，两组临床骨折愈合时间的差异有统计学意义 （P<0.05）。随着时间推移，两组 VAS 评分均显著降低 （P<0.05），而 Bostman 评分、膝伸屈 ROM 均显著增加 （P<0.05）。相应时间点，PRP 组时间点 VAS 评分、Bostman 评分、膝伸屈 ROM 均显著优于无 PRP 组（P<0.05）。影像方面，两组骨折复位质量和影像骨折愈合的差异均无统计学意义 （P>0.05）。随时间推移，Kellgren-Lawrence 骨性关节炎分级有加重趋势，但前后差异无统计学意义 （P>0.05），相应时间点两组间 Kellgren-Lawrence 骨性关节炎分级的差异无统计学意义 （P> 0.05）。［结论］髌骨开放复位内固定时局部使用 PRP 有利于骨折愈合和膝关节功能恢复。

Abstract:

[Objective] To explore the effect of platelet-rich plasma (PRP) on clinical outcomes of open reduction and internal fixation (ORIF) of patella fractures. [Methods] From June 2018 to March 2021, a total of 50 patients with acute closed patella fracture were includ- ed in this study, and were randomly divided into two groups by lottery. Of them, 25 patients in the PRP group had ORIF combined local in- jection of 4~4.5 ml PRP, while the other 25 patients in the non-PRP group had ORIF only. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation performed successfully with no serious com- plications. There were no statistically significant differences between the two groups in operation time, incision length, intraoperative blood loss, postoperative walking time, hospital stay, incision healing, and the early VAS scores (P>0.05) . The patients in both groups were fol- lowed up for (18.62±2.63) month on an average. A statistically significant difference was noticed between the two groups in time of clinical fracture healing (P<0.05) . The VAS scores significantly declined (P<0.05) , while Bostman score and the knee flexion-extension range of motion (ROM) significantly upgraded in both group over time (P<0.05) . The VAS score, Bostman score, and knee extension and flexion ROM of the PRP group were significantly better than those of the non-PRP group at all time points postoperatively (P<0.05) . Radiographi- cally, there were no statistically significant differences between the two groups in fractures reduction quality and fracture healing time on images (P>0.05) . Although there was trend of deterioration over time in Kellgren-Lawrence osteoarthritis classification of patellofemoral joint, it proved not statistically significant (P>0.05) , additionally, the difference between the two groups in Kellgren-Lawrence osteoarthri- tis grade was not statistically significant at any matching time point (P>0.05) . [Conclusion] The local injection of PRP in the ORIF of patel- lar fracture is conducive to improving fracture healing and the recovery of knee functions.