镜下股骨髋臼撞击症治疗是否使用富血小板血浆△

Arthroscopic correction of femoroacetabular impingement with or without intraarticular injection of platelet-rich plasma

摘要:

［目的］评价髋关节镜下矫形联合应用富含血小板血浆（platelet-rich plasma, PRP）治疗股骨髋臼撞击综合征（femo- roacetabular impingement, FAI）的早期临床效果。［方法］回顾性分析 2021 年 1 月—2022 年 1 月本院镜下手术治疗 FAI 的 32 例患者的临床资料。根据医患沟通结果，17 例采用髋关节镜手术联合关节内注射 PRP （PRP 组），15 例采用单纯髋关节镜手术 （非 PRP 组），比较两组围手术期、随访及影像结果。［结果］两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。 两组手术时间、切口总长度、术中失血量、下地行走时间、切口愈合情况、住院时间的差异均无统计学意义（P>0.05）。所有患者均获得随访，随访时间平均（12.8±0.9）个月，两组完全负重活动时间的差异无统计学意义（P>0.05）。随术后时间推移，两组患者 VAS 评分显著减少 （P<0.05），Harris 评分、伸-屈 ROM 及内-外旋 ROM 评分显著增加 （P<0.05）。术后 1 个月，PRP 组在 VAS 评分 [(3.1±1.5) vs (4.2±1.3), P<0.05]、Harris 评分 [(70.5±4.4) vs (64.2±2.8), P<0.05]、伸-屈 ROM [(102.6±5.5)° vs (95.3±6.4)°, P< 0.05] 及内-外旋 ROM [(38.3 ± 4.2)° vs (35.2 ±2.8)°, P<0.05] 均显著优于非 PRP 组（P<0.05）；但是术后 6 个月及末次随访，两组上述指标的差异均无统计学意义（P>0.05）。影像方面，两组术后 1 个月及末次随访时，髋关节 α 角、LCEA、Offset 值及均较术前显著改善（P<0.05），但 T?nnis 分级无显著变化（P>0.05）。相应时间点，两组上述影像指标的差异均无统计学意义（P>0.05）。 ［结论］髋关节镜联合 PRP 治疗 FAI 可减轻疼痛、改善髋关节功能并提高早期临床疗效。

Abstract:

[Objective] To evaluate the early clinical outcomes of arthroscopic correction combined with intraarticular injection of plate-let rich plasma (PRP) for femoroacetabular impingement (FAI). [Methods] A retrospective study was performed on 32 patients who under-went arthroscopic surgery for FAI in our hospital from January 2021 to January 2022. According to doctor-patient communication, 17 pa-tients received hip arthroscopy combined with intraarticular injection of PRP (PRP group), while the remaining 15 patients received hip ar-throscopy only without PRP injection (non-PRP group). The perioperative period, follow-up and imaging data of the two groups were com-pared. [Results] All patients in both groups had operation performed successfully without neurovascular injury and other serious complica-tions. There were no significant differences in operation time, total incision length, intraoperative blood loss, postoperative walking time, inci-sion healing grade and hospital stay between the two groups (P＜0.05). All patients were followed up for an average of (12.8±0.9) months, andthere was no significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). The VAS score de-creased significantly (P＜0.05), whereas the Harris score, extension-flexion ROM and internal-external rotation ROM scores increased signif-icantly in both groups over time postoperatively (P＜0.05). The PRP group proved significantly superior to the non-PRP group in terms ofVAS score [(3.1±1.5) vs (4.2±1.3), P＜0.05], Harris score [(70.5±4.4) vs (64.2±2.8), P＜0.05], extension-flexion ROM [(102.6±5.5)° vs (95.3±6.4)°, P＜0.05] and internal-external rotation ROM [ (38.3±4.2)° vs (35.2±2.8)°, P＜0.05] 1 month postoperatively, whereas which became notstatistically significant between the two groups at 6 months after surgery and the last follow-up (P＞0.05). Radiographically, the α angle, later-al center edge angle (LCEA) and femoral head-neck offset (FHNO) significantly improved (P＜0.05), but T?nnis classification remained un-changed (P＞0.05) in both groups at 1 month after surgery and the latest follow-up. At any corresponding time points, there was no statistical significance in the above image indexes between the two groups (P＞0.05). [Conclusion] Hip arthroscopy combined with PRP in the treat- ment of FAI does reduce pain, improve hip function and improve early clinical outcomes.