关节镜清理联合富血小板血浆治疗创伤性踝关节炎△

Arthroscopic debridement combined with platelet- rich plasma for post- traumatic osteoarthritis of the ankle

摘要:

[目的] 探讨关节镜清理联合富血小板血浆（platelet-rich plasma, PRP） 治疗创伤性踝关节炎（post-traumatic osteoar-thritis, PTOA） 的临床疗效及安全性。[方法] 回顾性分析2019 年2 月— 2021 年2 月收治的41 例PTOA 患者的临床资料。依据医患沟通结果，23 例采用关节镜术联合PRP 治疗，18 例采用关节镜术联合透明质酸（hyaluronate acid, HA） 治疗。比较两组围手术期、随访及辅助检查结果。[结果] 两组手术时间、术中出血量、切口总长度、切口愈合等级、下肢深静脉血栓形成、住院时间的差异均无统计学意义（P＞0.05）。两组患者均获12 个月以上随访，两组完全负重活动时间差异无统计学意义（P＞0.05）。随时间推移，两组VAS 评分、AOFAS 评分显著改善（P＜0.05），踝背伸-跖屈ROM 无显著变化（P＞0.05）。术后12 个月PRP 组的VAS 评分[(1.3±0.6) vs (2.7±1.1), P＜0.05] 和AOFAS 评分[(80.9±6.5) vs (71.0±5.6), P＜0.05] 均显著优于HA 组。检验方面，随时间推移，两组患者Hs-CRP、IL-6、TNF-α 均显著减少（P＜0.05）。术后12 个月PRP 组的Hs-CRP [(3.1±0.3) mg/L vs (6.7±0.1) mg/L, P＜0.05]、IL-6 [(3.0±0.3) ng/L vs (4.0±0.3) ng/L, P＜0.05] 和TNF-α [(4.2±0.6) ng/L vs (5.2±0.6) ng/L, P＜0.05] 均显著优于HA 组。影像方面：与术前相比，术后6、12 个月两组患者TT、mLDTA 无明显变化（P＞0.05）。术后12 个月PRP 组K-L 分期较术前显著改善（P＜0.05），HA 组无明显变化（P＞0.05）。术后12 个月PRP 组的K-L 分期[I/II/IIIa/IIIb/IV, (0/16/6/1/0) vs (0/7/7/4/0), P＜0.05] 显著优于HA 组。[结论] 关节镜清理联微骨折联合PRP 治疗踝PTOA 可显著改善治疗效果，安全性高。

Abstract:

[Objective] To investigate the clinical efficacy and safety of arthroscopic debridement and microfracture combined withplatelet-rich plasma (PRP) for post-traumatic osteoarthritis (PTOA) of the ankle. [Methods] A retrospective study was done on 41 patientswho received surgical treatment for PTOA from February 2019 to February 2021. According to doctor-patient communication, 23 patients re-ceived PRP injection intraarticularly following the arthroscopic procedure, while the remaining 18 patients had hyaluronic acid (HA) inject-ed intraarticularly after surgery. The document regarding perioperative period, follow-up and auxiliary examination were compared betweenthe two groups. [Results] There were no significant differences in operation time, intraoperative blood loss, total incision length, incisionhealing grade, deep venous thrombosis of lower limbs and hospital stay between the two groups (P＞0.05). All patients in both groups were fol-lowed up for more than 12 months, without a significant difference in the time to resume full weight-bearing activity between the two groups(P＞0.05). The VAS and AOFAS scores improved significantly (P＜0.05), while the ankle dorsal-plantar flexion range of motion (ROM) re-mained unchanged over time in both groups (P＞0.05). At 12 months after surgery, the PRP group proved significantly superior to the HAgroup in terms of VAS score [(1.3±0.6) vs (2.7±1.1), P＜0.05] and AOFAS score [(80.9±6.5) vs (71.0±5.6), P＜0.05]. Regarding laboratory test-ing, the Hs-CRP, IL-6 and TNF-α significantly decreased in both groups over time (P＜0.05). The PRP group was significantly better thanthe HA group in terms of Hs-CRP [(3.1±0.3) mg/L vs (6.7± 0.1) mg/L, P＜0.05], IL-6 [(3.0±0.3) ng/L vs (4.0±0.3) ng/L, P＜0.05] and TNF-α[(4.2±0.6) ng/L vs (5.2±0.6) ng/L, P＜0.05] 12 months postoperatively. Radiographically, there were no significant changes in TT and mLDTAin both groups 6 and 12 months postoperatively compared with those preoperatively (P＞0.05). However, the Kellgren-Lawrence (K-L) classi-fication for osteoarthritis in the PRP group significantly improved 12 months after surgery (P＜0.05), which in the HA group remained not sig-nificantly changed (P＞0.05). At 12 months after surgery, the PRP group proved significantly superior to the HA group in K-L stage [I/II/IIIa/IIIb/IV, (0/16/6/1/0) vs (0/7/7/4/0), P＜0.05]. [Conclusion] Arthroscopic debridement and microfracture combined with PRP does signifi-cantly improve the clinical efficacy for post-traumatic osteoarthritis of the ankle with high safety.