Frei R, Biosca F E, Handl M, Trc T
Klinika detské a dospelé ortopedie a traumatologie 2. LF UK a FN Motol, Praha.
Acta Chir Orthop Traumatol Cech. 2008 Feb;75(1):28-33.
The authors describe the therapeutic utilization of separated/isolated autologous growth factors in semiconservative treatment of type III injury to the ankle ligamentous complex.
Between October 2004 and March 2005 a group of 11 patients, two women and nine men, aged 18 to 41 (average, 25.09) years with acute injury to the lateral ligamentous complex of the ankle were treated by plasma rich in growth factors (PRGF) infiltration. On functional radiographic examination, the post-traumatic lateral opening of the tibiotalar intraarticular space was 17.45 degrees (range, 12.0-30.0; s = 5.68).
The injured patients were clinically examined and standard forced inversion radiographs were made using topical anesthesia. Autologous PRGF activated with calcium chloride was used to infiltrate the injured tissues. The treatment was followed by immobilization of the joint and its subsequent rehabilitation. Clinical examination of injured tissues was carried out at 4 and 6 weeks of follow-up, using stability assessment tests and functional radiography of the ankle. Physical therapy included standard procedures, but faster regeneration of the soft tissues allowed for more exercises.
The average time of healing was 5.18 weeks. Five patients showed no signs of instability at 4 weeks after therapy and could return to their previous sports activities. One patient had lateral ankle instability at 5 weeks and therefore the therapy continued with prolonged immobilization and then rehabilitation at a slower pace. The average lateral opening of the tibiotalar intra-articular space at 4 or 6 follow-up weeks was 4.73 degrees (range, 3.0 - 7.0; s = 1.19). At 6 weeks after therapy, 90.9% of the patients resumed their full sports activities.
Ankle distortion with swelling, hematoma and pain, but with no radiographic findings of ligament lesions, is usually treated conservatively by ankle immobilization and early rehabilitation. When an injury to the fibular ankle ligaments occurs (i.e., opening of the tibiotalar intra-articular space laterally by more than 10 degrees), surgery and reconstruction of the injured tissues is indicated. An alternative treatment of acute injury to the ligamentous ankle complex includes application of growth factors into the injured tissues. The presence of growth factors facilitates the healing and remodeling of soft tissues and regenaration may begin before leukocytes infiltrate the affected site. At a relatively low level of interleukins, the inflammatory phase of healing is suppressed, pain is reduced and the process of reparation and regenaration is accelerated.
The use of bioinductive properties of growth factors is one of the options for treating injuries to the ligamentous complex of the ankle. It can be used alternatively to conventional surgery or as an adjunct accelerating and improving the healing of traumatic lesions and postoperative conditions.
作者描述了分离/隔离的自体生长因子在踝关节韧带复合体III型损伤的半保守治疗中的治疗应用。
2004年10月至2005年3月期间，一组11例患者（2名女性和9名男性，年龄18至41岁，平均25.09岁）因踝关节外侧韧带复合体急性损伤接受了富含生长因子的血浆（PRGF）浸润治疗。在功能影像学检查中，创伤后胫距关节内间隙的外侧开口为17.45度（范围12.0 - 30.0；标准差 = 5.68）。
对受伤患者进行临床检查，并在局部麻醉下拍摄标准的强迫内翻X线片。用氯化钙激活的自体PRGF浸润受伤组织。治疗后关节固定并随后进行康复治疗。在随访的4周和6周时，使用稳定性评估测试和踝关节功能影像学对受伤组织进行临床检查。物理治疗包括标准程序，但软组织更快的再生允许进行更多的锻炼。
平均愈合时间为5.18周。5例患者在治疗后4周无不稳定迹象，可恢复之前的体育活动。1例患者在5周时出现踝关节外侧不稳定，因此治疗继续进行，延长固定时间，然后以较慢的速度进行康复治疗。随访4周或6周时，胫距关节内间隙的平均外侧开口为4.73度（范围3.0 - 7.0；标准差 = 1.19）。治疗后6周，90.9%的患者恢复了全部体育活动。
踝关节扭伤伴肿胀、血肿和疼痛，但X线片无韧带损伤表现，通常通过踝关节固定和早期康复进行保守治疗。当腓骨踝关节韧带损伤时（即胫距关节内间隙外侧开口超过10度），需进行手术并重建受伤组织。踝关节韧带复合体急性损伤的另一种治疗方法包括将生长因子应用于受伤组织。生长因子的存在促进软组织的愈合和重塑，再生可能在白细胞浸润受影响部位之前就开始。在白细胞介素水平相对较低时，愈合的炎症期受到抑制，疼痛减轻，修复和再生过程加速。
利用生长因子的生物诱导特性是治疗踝关节韧带复合体损伤的选择之一。它可替代传统手术使用，或作为辅助手段加速和改善创伤性病变及术后情况的愈合。
