胫骨高位截骨是否联合富血小板血浆的比较

Open wedge high tibial osteotomy with or without intraarticular injection of platelet-rich plasma

摘要:

[目的] 评价膝内侧骨关节炎 （medial knee osteoarthritis, KOA） 行内侧开放楔形胫骨高位截骨术 （open wedge high tibial osteotomy, OWHTO） 联合关节腔注射富血小板血浆 （platelet-rich plasma, PRP） 的临床疗效。[方法] 回顾性分析 2021 年 3 月—2022 年 5 月本院行 OWHTO 45 例膝骨关节炎患者的临床资料，根据医患沟通结果，21 例仅行 OWHTO，未注射 PRP （non-PRP 组），另外 24 例患者行 OWHTO 后关节内注射 3 次 PRP （PRP 组），另外。比较两组围手术期、随访及影像结果。 [结果]所有患者均顺利完成手术，两组手术时间、切口总长度、术中出血量、术后引流量、下地行走时间、主动屈曲 90°时间、 切口愈合等级、住院时间差异均无统计学意义 （P＞0.05）。non-PRP 组治疗费用显著少于 PRP 组 [(2.3±0.1) 万元 vs (3.0±1.2) 万元, P＜0.001]。两组患者随访时间均超过 24 个月，随时间推移，两组膝关节 NRS、KSS、HSS、Lysholm 评分以及膝屈-伸 ROM 均显著改善（P＜0.05），末次随访 non-PRP 组膝关节 KSS [(94.0±2.8) vs (95.8±2.0), P=0.020]、Lysholm 评分 [(93.4±2.5) vs (95.8±2.5), P= 0.002] 以及膝屈-伸 ROM [(110.9±5.5)° vs (115.4±8.8)°, P=0.042] 明显不及 PRP 组。影像方面，末次随访时两组的胫骨后倾角 （pos- terior tibial slope,PTS）、胫骨股骨角 （femur tibia angle, FTA）、胫骨近端内侧角（medial proximal tibial angle, MPTA）以及髋膝踝角 （hip-knee-ankle angle, HKA）均较术前显著改善（P＜0.05)，但是，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]关节内注射 PRP 可显著提升 OWHTO 的临床结果，有利于患者功能恢复。

Abstract:

[Objective] To evaluate clinical efficacy of open wedge high tibial osteotomy (OWHTO) combined with intraarticular injection of plateletrich plasma (PRP) for medial knee osteoarthritis (MKOA). [Methods] A retrospective study was conducted on 45 patients who received OWHTO for MKOA in our hospital from March 2021 to May 2022. According to doctor-patient communication, 21 patients only underwent OWHTO without PRP injection (the non-PRP group), while other 24 patients received OWHTO combined with three times intra-articular injections of PRP after the OWHTO (the PRP group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both group had OWHTO performed successfully without statistically significant differences in terms of operation time, total incision length, intraoperative blood loss, postoperative drainage volume, walking time, active flexion of 90° time , incision healing grade, and hospital stay between the two groups (P＞0.05). However, the non-PRP group consumed significantly less hospitalization cost than the PRP group [(23 000±1 000) yuan vs (30 000±12 000) yuan, P＜0.001]. All of them were followed up for more than 24 months. The NRS, KSS, HSS and Lysholm scores, as well as knee flexion-extension range of motion (ROM) in both groups were significantly improved over time (P＜0.05). At the last follow-up, the non-PRP group proved significantly inferior to the PRP group in terms of KSS score [(94.0±2.8) vs (95.8±2.0), P=0.020], Lysholm score [(93.4±2.5) vs (95.8±2.5), P=0.002] and knee flexion-extension ROM [(110.9±5.5)° vs (115.4±8.8)°, P=0.042]. Regarding imaging, the posterior tibial slope (PTS), femur tibia angle (FTA), and medial proximal tibial angle (MPTA) and hip-knee-ankle angle (HKA) in both groups were significantly improved at the latest follow-up compared with those before the operation (P＜0.05), whereas which were not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] Intraarticular injection of PRP does significantly improve the clinical outcomes of OWHTO, and is beneficial for the functional recovery of patients