Xiang Cheng-Hao, Fan Cheng-Long, Qin Wen-Jie, Chen Wen-Ge, Yang Zhao-Hui, Chen Tian-Wu, Chen Gang
Department of Orthopaedics, the Affiliated Minda Hospital of Hubei Minzu University, Enshi 445000, Hubei, China.
Zhongguo Gu Shang. 2022 Jan 25;35(1):26-32. doi: 10.12200/j.issn.1003-0034.2022.01.006.
To explore clinical effect of arthroscopic debridement combined with platelet-rich plasma (PRP) injection for Kellgren-Lawrence(K-L) gradeⅠ-Ⅲ knee osteoarthritis (KOA) .
Totally 117 patients with KOA who underwent arthroscopic debridement combined with injection from November 2015 to January 2019 were retrospectively analyzed. According to different injection drugs, the patients were divided into sodium hyaluronate group(group A) and PRP group(group B). In group A, there were 60 patients, including 27 males and 33 females, aged from 49 to 67 years old with an average age of (54.1±4.8) years old;12 patients with gradeⅠ, 23 patients with gradeⅡand 25 patients with grade Ⅲ according to K-L clssification, 2 ml(20 g) sodium hyaluronate was injected into knee joint after intraoperative, 1, 2, 3 weeks after operation for 4 times. In group B, there were 57 patients, including 25 males and 32 females, aged from 47 to 70 years old with an average of (55.8±5.0) years old, 10 patients with gradeⅠ, 20 patients with gradeⅡand 27 patients with grade Ⅲ according to K-L classification, injected 5 ml PRP at the same time. Postoperative complications was recorded between two groups. Postoperative visual analogue scale(VAS) and Lysholm score at 3, 6, 12 months were used to evaluate improvement of knee pain and joint function.
All patients were followed up for 12 to 19 months with an average of (14.1±1.6) months. There was no significant difference in postopertaive complications between group A and group B (>0.05). Postoperative VAS score in group A at 3, 6, 12 months were 3.0±0.8, 2.0±0.8, 2.6±0.9 respectively, and 2.9±0.8, 1.9±0.7, 2.2±0.8 in group B respectively; and no differnece at 3 and 6 months after operation between two groups (<0.05), while VAS score in group B was higher than group A at 12 months after operation(<0.05). Postoperative Lysholm score in group A at 1, 6, 12 months (86.6±1.8, 93.1±2.0, 86.7±1.7) were lower than group B(88.9±1.9, 95.0±2.0, 89.0±1.9)(<0.05).
Arthroscopic debridement combined with sodium hyaluronate or PRP injection for K-L gradeⅠ-Ⅲ KOA could effectively relieve pain and improve joint function with higher safety in short term, but the medium-long-term effect of PRP injection is stable.
探讨关节镜下清理术联合富血小板血浆（PRP）注射治疗Kellgren-Lawrence（K-L）Ⅰ-Ⅲ级膝关节骨关节炎（KOA）的临床效果。
回顾性分析2015年11月至2019年1月期间117例行关节镜下清理术联合注射治疗的KOA患者。根据注射药物不同，将患者分为透明质酸钠组（A组）和PRP组（B组）。A组60例，男27例，女33例，年龄49～67岁，平均（54.1±4.8）岁；根据K-L分级，Ⅰ级12例，Ⅱ级23例，Ⅲ级25例，术中及术后1、2、3周膝关节腔内注射2 ml（20 mg）透明质酸钠，共4次。B组57例，男25例，女32例，年龄47～70岁，平均（55.8±5.0）岁；根据K-L分级，Ⅰ级10例，Ⅱ级20例，Ⅲ级27例，同时注射5 ml PRP。记录两组术后并发症情况。采用术后3、6、12个月的视觉模拟评分（VAS）和Lysholm评分评估膝关节疼痛及关节功能改善情况。
所有患者均随访12～19个月，平均（14.1±1.6）个月。A组与B组术后并发症差异无统计学意义（P>0.05）。A组术后3、6、12个月VAS评分分别为3.0±0.8、2.0±0.8、2.6±0.9，B组分别为2.9±0.8、1.9±0.7、2.2±0.8；术后3、6个月两组差异无统计学意义（P<0.05），术后12个月B组VAS评分高于A组（P<0.05）。A组术后1、6、12个月Lysholm评分（86.6±1.8、93.1±2.0、86.7±1.7）低于B组（88.9±1.9、95.0±2.0、89.0±1.9）（P<0.05）。
关节镜下清理术联合透明质酸钠或PRP注射治疗K-LⅠ-Ⅲ级KOA短期内可有效缓解疼痛、改善关节功能，安全性较高，但PRP注射的中长期效果更稳定。
