胫骨高位截骨富血小板血浆治疗膝内侧骨性关节炎△

High tibial osteotomy combined with platelet-rich plasma for medial knee osteoarthritis

摘要:

［目的］ 评价胫骨高位截骨 （high tibial osteotomy, HTO） 联合富血小板血浆 （platelet-rich plasma, PRP） 治疗膝内侧骨关节炎 （medial knee osteoarthritis, MKOA） 的疗效。［方法］ 回顾性分析 2016 年 12 月—2020 年 3 月本院收治的 88 例 MKOA 患者的临床资料，根据医患沟通结果，将患者分为三组，29 例行 HTO （HTO 组），31 例行 PRP （PRP 组），28 例行 HTO 和 PRP 治疗 （复合组）。比较三组围手术期、随访及影像资料。［结果］三组患者均顺利完成手术，术中均无严重并发症，均获随访 18 个月以上。复合组完全负重活动时间显著早于 HTO 组（P<0.05）。术后随时间推移，三组 VAS 评分均显著减少（P<0.05）， 而膝关节屈伸 ROM 和 KOOS 评分显著增加（P<0.05）。术前三组上述指标的差异均无统计学意义（P>0.05）；术后 6 个月，复合组上述指标均显著优于其他两组（P<0.05）；末次随访，HTO 组及复合组患者各评分均显著优于 PRP 组（P<0.05），而复合组与 HTO 组各评分差异无统计学意义（P>0.05）。影像方面，与术前相比，术后即刻及末次随访时，HTO 组与复合组的股胫角（femo- rotibial angle, FTA）、胫骨近段内侧角（medial proximal tibial angle, MPTA）均显著改善（P<0.05），但内侧室 Kellgren-Lawrence 分级无显著改变（P>0.05）。相应时间点，两组间上述影像指标的差异均无统计学意义（P>0.05）。［结论］HTO 联合 PRP 治疗可显著改善膝关节功能，缓解疼痛，优于任何单一治疗。

Abstract:

[Objective] To evaluate the clinical outcomes of high tibial osteotomy (HTO) combined with platelet-rich plasma (PRP) for medial knee osteoarthritis (MKOA) . [Methods] A retrospective study was conducted on 88 patients for MKOA in our hospital from Decem- ber 2016 to March 2020. According to doctor-patient communication results, patients were divided into 3 groups, 29 patients received HTO, 31 patients underwent PRP, while the remaining 28 patients were treated by HTO combined with PRP (the combined group) . The periopera- tive period, follow-up and imaging data were compared among the 3 groups. [Results] All the patients in the 3 groups had the corresponding procedures performed successfully without serious complications, and were followed up for more than 18 months. The combined group re- sumed full weight-bearing activity significantly earlier than the HTO group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , while the knee flexion and extension ROM and KOOS scores significantly increased in all the 3 groups over time (P＜0.05) . Although there was no significant difference in the above items among the three groups before operation (P＞0.05) , the combined group proved significantly superior to the other two groups at 6 months after operation (P＜0.05) . At latest follow-up, the HTO group and the combined group proved sig- nificantly superior to the PRP group in terms of abovementioned scores (P＜0.05) , while there were no significant differences in the scores be- tween the composite group and the HTO group (P＞0.05) . Regarding imaging, the femorotibial angle (FTA) and medial proximal tibial angle (MPTA) were significantly improved in the HTO group and the combined group both immediately after surgery and at the last follow-up (P＜ 0.05) , but there was no significant change in Kellgren-Lawrence grade in the medial compartment (P＞0.05) . At the corresponding time points, there was no significant difference in the above imaging indexes between the two groups (P＞0.05) . [Conclusion] This HTO com- bined with PRP does significantly improve knee function and relieve pain, which is superior to any single therapy.