2022 年第 10 期 第 17 卷

关节镜清理术联合富血小板血浆注射治疗早中期膝骨关节炎的临床效果评价

Clinical evaluation of arthroscopic debridement combined with platelet rich plasma injection in the treatment of early metaphase knee osteoarthritis

作者：张莲1侯费祎2李慎松2邵宏斌2杨勤旭2吕友泉3

英文作者：Zhang Lian1 Hou Feiyi2 Li Shensong2 Shao Hongbin2 Yang Qinxu2 Lyu Youquan3

单位：1中国人民解放军联勤保障部队第九四〇医院干部病房，兰州730050；2中国人民解放军联勤保障部队第九四〇医院运动医学科，兰州730050；3甘肃中医药大学，兰州730050

英文单位：1Cadre Ward the 940th Hospital of Joint Logistics Support Center of Chinese People′s Liberation Army Lanzhou 730050 China; 2Department of Sports Medicine the 940th Hospital of Joint Logistics Support Center of Chinese People′s Liberation Army Lanzhou 730050 China; 3Gansu University of Chinese Medicine Lanzhou 730050 China

关键词：膝骨关节炎；富血小板血浆；关节镜；玻璃酸钠

英文关键词：Kneeosteoarthritis;Plateletrichplasma;Arthroscopy;Sodiumhyaluronate

• 摘要：

• 目的 探讨关节镜清理术联合富血小板血浆（PRP）注射治疗早中期膝骨关节炎的临床效果。方法 选取2020年1月至2021年1月中国人民解放军联勤保障部队第九四〇医院收治的40例膝骨关节炎患者为研究对象。依据入院先后顺序，将患者分为PRP组和玻璃酸钠组。所有患者均行关节镜清理术，PRP组给予膝关节腔内注射PRP治疗，玻璃酸钠组给予膝关节腔内玻璃酸钠治疗。比较术前及术后3、6、12个月患者膝关节视觉模拟量表（VAS）评分、Lysholm 膝关节评分、简明健康状况调查量表（SF-36）身体健康评分、SF-36 心理健康评分、膝关节滑膜厚度及关节积液量。结果 随访期间，5例患者退出或失访，PRP组最终纳入20例，Kellgren-Lawrence（K-L）分级2级12例、3级8例；玻璃酸钠组最终纳入15例，K-L分级2级10例、3级5例。术后3、6、12个月，2组VAS评分均低于治疗前，且术后3、6个月PRP组均低于玻璃酸钠组［（2.41±0.53）分比（3.54±0.41）分、（0.84±0.31）分比（1.58±0.28）分］；术后3、6、12个月，2组Lysholm膝关节评分、SF-36心理健康评分均高于术前，且PRP组均高于玻璃酸钠组（均P＜0.05）。在K-L分级2级、3级患者中，2组仍体现上述差异。术后3、6个月，2组膝关节滑膜厚度均低于术前（均P＜0.05），但组间比较差异均无统计学意义（均P＞0.05）。术前及术后3、6、12个月，2组关节积液量比较差异均无统计学意义（均P＞0.05）。结论 关节镜清理术联合PRP注射治疗膝关节早中期膝骨关节炎可明显改善患者临床症状，但对于关节腔内滑膜增生及关节积液的效果不明显。

• Objective  To investigate the clinical effect of arthroscopic debridement combined with platelet rich plasma (PRP) injection on early metaphase knee osteoarthritis (KOA). Methods From January 2020 to January 2021, totally 40 patients with KOA were enrolled from the 940th Hospital of Joint Logistics Support Center of Chinese People′s Liberation Army. Patients were divided into PRP group and sodium hyaluronate group according to the sequence of admission. All patients underwent arthroscopic debridement, the PRP group was treated with PRP knee intra-articular injection, and the sodium hyaluronate group was treated with sodium hyaluronate knee intra-articular injection. The knee joint visual analog scale (VAS) score, Lysholm knee score, brief health status survey scale (SF-36) physical health score, SF-36 mental health score, and synovial thickness and effusion of knee joint were compared between the two groups before operation and 3, 6 and 12 months after operation. Results During follow-up, 5 patients withdrew or lost. Twenty cases were enrolled in PRP group, including 12 cases with Kellgren-Lawrence (K-L) grading 2 and 8 cases with K-L grading 3. Fifteen cases were enrolled in sodium hyaluronate group, including 10 cases with K-L grading 2 and 5 cases with K-L grading 3. After 3, 6, 12 months of operation, VAS scores in both groups were lower than those before operation, and the scores in PRP group were lower than those in sodium hyaluronate group 3 and 6 months after operation ［（2.41±0.53） vs （3.54±0.41）,（0.84±0.31） vs （1.58±0.28）］; after 3, 6, 12 months of operation, Lysholm knee scores and SF-36 mental health scores in both groups were higher than those before operation, and the scores in PRP group were higher than those in sodium hyaluronate group (all P<0.05). In patients with K-L grading 2 and 3, the above differences were also reflected. After 3 and 6 months of operation, synovial thickness of knee joint in both groups were lower than those before operation (all P<0.05), while there were no differences between the two groups (both P>0.05). Before operation and after 3, 6, 12 months of operation, there were no differences in effusion of knee joint between the two groups (all P>0.05). Conclusion Arthroscopic debridement combined with PRP injection has good clinical effect on improving symptoms in patients with early metaphase KOA, while the effect on synovial hyperplasia and effusion of knee joint is not obvious.