镜下清理富血小板血浆治疗轻中度膝骨关节炎△（开放获取）

Arthroscopic debridement combined with plateletrich plasma for treatment of mild and moderate knee osteoarthritis

摘要:

[目的] 探究关节镜下清理术联合富血小板血浆 （platelet-rich plasma, PRP） 治疗轻中度膝骨关节炎 （knee osteoarthritis, KOA） 的疗效及可能机制。[方法] 2021 年 1 月—2022 年 4 月收治的轻中度 KOA 患者 110 例，抽签法随机将其分为两组，每组 55 例。联合组接受关节镜下清理术联合 PRP 治疗，清理组仅关节镜下清理术治疗。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、切口总长度、术中失血量、下地行走时间、切口愈合等级及住院时间的差异均无统计学意义（P＞0.05）。术后 7 d 联合组肿胀 VAS 评分 [(4.0±1.1) vs (4.5±1.0), P＜0.05] 显著低于清理组。随访 12 个月以上，联合组完全负重活动时间显著早于清理组 [(45.2±6.2) d vs (50.1±7.2) d, P＜0.05]。随时间推移，两组 VAS、WOMAC 和 Lysholm 膝关节评分均显著改善（P＜0.05）。术后 12 个月联合组的 VAS [(1.3±0.4) vs (2.1±0.6), P＜0.05]、WOMAC [(25.0±5.2) vs (31.5±5.0), P＜0.05]、Lysholm 评分 [(90.5±8.0) vs (85.3±8.1), P＜0.05] 均显著优于清理组。辅助检查方面，与治疗前相比，治疗后 1 个月两组患者血清 TLR-4、 MMP-9、SDF-1 水平均显著下降 （P＜0.05）；治疗后 1 个月，联合组的血清 TLR-4 [(7.0±2.0) ng/ml vs (8.4±2.2) ng/ml, P＜0.05]、 MMP-9 [(26.0±7.0) pg/ml vs (30.1±7.3) pg/ml, P＜0.05] 和 SDF-1 [(453.4±47.2) μg/L vs (495.8±52.2) μg/L, P＜0.05] 显著优于清理组。 [结论] 关节镜下清理联合 PRP 治疗可减轻中度 KOA 患者疼痛，改善其膝关节功能，其机理可能与降低血液 TLR-4、MMP9、SDF-1 水平有关。

Abstract:

[Objective] To explore the clinical efficacy and possible mechanism of arthroscopic debridement combined with platelet rich plasma (PRP) in the treatment of mild-to-moderate knee osteoarthritis (KOA). [Methods] A total of 110 patients with mild to moderate KOA admitted from January 2021 to April 2022 were randomly divided into two groups, with 55 patients in each group. The combined group received arthroscopic debridement combined with PRP, while the debridement group received arthroscopic debridement only. The documents regarding perioperative period, follow-up and auxiliary examination were compared between the two groups. [Results] There were no significant differences in operation time, total incision length, intraoperative blood loss, walking time, incision healing grade and hospital stay between the two groups (P＞0.05), while the combined group proved significantly superior to the debridement in term of the swelling VAS score 7 days postoperatively [(4.0±1.1) vs (4.5±1.0), P＜0.05]. The follow-up period lasted for more than 12 months, and the combined group resumed full weight-bearing activity significantly earlier than the debridement group [(45.2±6.2) days vs (50.1±7.2) days, P＜0.05]. The VAS, WOMAC and Lysholm scores were significantly improved over time in both groups (P＜0.05). The combined group proved significantly better than the debridement group in terms of VAS [(1.3±0.4) vs (2.1± 0.6), P＜0.05], WOMAC [(25.0±5.2) vs (31.5± 5.0), P＜0.05] and Lysholm scores [(90.5±8.0) vs (85.3±8.1), P＜0.05]. Regarding auxiliary examination, the serum levels of TLR-4, MMP-9 and SDF-1 in both groups were significantly decreased 1 month after treatment compared with those before treatment (P＜0.05). The combined group was significantly lower than the debridement group in TLR-4 [(7.0±2.0) ng/ml vs (8.4±2.2 ng/ml, P＜0.05], MMP- 9 [(26.0±7.0) pg/ml vs (30.1±7.3) pg/ml, P＜0.05] and SDF-1 [(453.4±47.2) μg/L vs (495.8±52.2) μg /L, P＜0.05]. [Conclusion] The arthroscopic debridement combined with PRP does relieve pain and improve knee joint function for mid and moderate KOA, its mechanism may be related to reducing blood TLR-4, MMP-9 and SDF-1 levels.