HTO联合关节清理富血小板血浆治疗膝内侧骨关节炎△

High tibial osteotomy combined with arthroscopic debridement and platelet rich plasma for medial knee osteoarthritis

摘要:

[目的] 探讨胫骨高位截骨（high tibial osteotomy, HTO） 联合关节镜清理（arthroscopic debridement, AD） 和富血小板血浆（platelet-rich plasma, PRP） 关节内注射治疗膝内侧骨关节炎（medial knee osteoarthritis, mKOA） 的临床疗效。[方法] 回顾性分析2015 年11 月—2019 年7 月本院采用HTO 治疗mKOA 33 例患者。根据医患沟通结果，17 例行HTO+AD+PRP 治疗（联合组），另外16 例仅行HTO 治疗。比较两组围手术期、随访及影像资料。[结果]两组患者手术顺利完成。两组手术时间、切口总长度、术中出血量、切口愈合、开始行走时间及住院时间差异均无统计学意义（P＞0.05）。所有患者均获随访30 个月以上，联合组恢复完全负重活动时间显著早于HTO 组[(58.1±4.6) d vs (66.1±4.0) d, P＜0.05]。随时间推移，两组VAS 和WOMAC 评分均显著减少（P＜0.05），而Lysholm 和HSS 评分均显著增加（P＜0.05）。术前两组上述指标的差异均无统计学意义（P＞0.05），末次随访时，联合组在VAS [(2.4±0.5) vs (2.8±0.5), P＜0.05]、WOMAC [(18.4±2.0) vs (23.7±2.5), P＜0.05]、HSS [(80.8±3.0) vs (73.3±2.5), P＜0.05] 和Lysholm 评分[(79.1±3.6) vs (71.4±2.8), P＜0.05] 均显著优于HTO 组。影像学方面， 术前相比，两组术后6 个月、术后1 年MPTA 和FTA 显著改善（P＜0.05），K-L 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 联合关节镜清理、PRP 治疗，可显著改善膝关节功能，缓解疼痛，提高患者满意度，临床疗效优于单一HTO。

Abstract:

[Objective] To investigate clinical efficacy of high tibial osteotomy (HTO) combined with arthroscopic debridement (AD)and platelet-rich plasma (PRP) intraarticular injection for medial knee osteoarthritis (mKOA). [Methods] A retrospective study was conduct-ed on 33 patients who received HTO for mKOA in our hospital from November 2015 to July 2019. According to doctor-patient communica-tion, 17 patients received HTO+AD+PRP treatment (combination group), and the other 16 patients received HTO treatment only. The periop-erative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were operated on smoothly, with-out significant differences in operation time, total incision length, intraoperative blood loss, incision healing grade, ambulation time and hos-pital stay between the two groups (P＞0.05). All patients were followed up for more than 30 months, and the combined group resumed fullweight-bearing activities significantly earlier than the HTO group [(58.1±4.6) days vs (66.1±4.0) days, P＜0.05]. The VAS and WOMACscores decreased significantly (P＜0.05), while Lysholm and HSS scores significantly increased over time in both groups (P＜0.05). Althoughthere was no significant differences in abovesaid scores between the two groups before operation (P＞0.05), the combined group proved signifi-cantly superior to the HTO group in terms of VAS [(2.4±0.5) vs (2.8 ±0.5), P＜0.05], WOMAC [(18.4± 2.0) vs (23.7±2.5), P＜0.05], HSS [(80.8±3.0) vs (73.3±2.5), P＜0.05] and Lysholm score [(79.1±3.6) vs (71.4±2.8), P＜0.05] at the latest follow-up. Regarding imaging, the medial prox-imal tibial angle (MPTA) and femorotibial angle (FTA) significantly improved (P＜0.05), whereas the K-L classification remained unchangedin both groups at 6 months and 1 year after surgery compared with those preoperatively (P＞0.05). However, there were no statistically signifi-cant differences in the above imaging items between the two groups at any time points accordingly (P＞0.05). [Conclusion] HTO combinedwith arthroscopic debridement and PRP does significantly improve knee joint function, relieve pain and improve patient satisfaction, andachieves clinical efficacy better than that of HTO only.