Abstract:Objective To investigate the clinical effect of microfracture combined with injection of platelet-rich plasma into the joint cavity in the treatment of patellofemoral arthritis.Methods A total of 86 patients (98 knees) with patellofemoral arthritis were selected from Wendeng Osteopathic Hospital of Shandong from February 2017 to February 2020,including 15 males (16 knees) and 71 females (82 knees),The patients aged 40~70 years,with an average age of (58.53±7.46)years.Platelet rich plasma was injected into the articular cavity 1 week after surgery.Visual analogue scale(VAS),Kujala score and Lysholm knee function score were compared before treatment and at 3,6 and 12 months after treatment to evaluate the efficacy.Results 81 cases (91 knees) were followed up for 12 to 19 months,with an average of (14.20±2.14)months.Compared with that before treatment,the VAS score decreased significantly after 12 months of treatment (P<0.01),while Kujala score and Lysholm score increased significantly (P<0.01).After treatment,pain symptoms were relieved and the joint function was improved.Conclusion Arthroscopic microfracture combined with injection of platelet-rich plasma into the joint cavity for the treatment of patellofemoral arthritis has a good clinical effect,can effectively relieve symptoms and improve quality of life,without obvious adverse reactions,and is a safe and effective treatment option.
[1]中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):11.
[2]Davies AP,Vince AS,Shepstone L,et al.The radiologic prevalence of patellofemoral osteoarthritis[J].Clin Orthop Relat Res,2002(402):206-212.
[3]Kobayashi S,Pappas E,Fransen M,et al.The prevalence of patellofemoral osteoarthritis:a systematic review and meta-analysis[J].Osteoarthritis Cartilage,2016,24(10):1697-1707.
[4]Strickland SM,Bird ML,Christ AB.Advances in Patellofemoral Arthroplasty[J].Current Rev Musculoskelet Med,2018,11(2):221-230.
[5]秦伟凯,张宽,吴林,等.针刺股四头肌肌腹筋结点治疗髌股关节炎疗效观察[J].中国针灸,2020,40(8):4.
[6]岳强,王大麟,蒋维海.髌股关节炎的治疗研究进展[J].中华骨与关节外科杂志,2020,13(11):5.
[7]李钦宗,信金党.关节镜下微骨折术修复关节软骨缺损的研究进展[J].中国内镜杂志,2015,21(2):5.
[8]Truong MD,Chung JY,Kim YJ,et al.Histomorphochemical comparison of microfracture as a first-line and a salvage procedure:is microfracture still a viable option for knee cartilage repair in a salvage situation?[J].J Orthop Res,2014,32(6):802-810.
[9]Martínez CE,Smith PC,Alvarado VAP,et al.The influence of platelet-derived products on angiogenesis and tissue repair:a concise update[J].Front Physiol,2015(6):290.
[10]Samadi P,Sheykhhasan M,Khoshinani HM.The use of plateletrich plasma in aesthetic and regenerative medicine:A comprehensive review[J].Aesthetic Plast Surg,2019,43(3):803-814.
[11]Kon E,Mandelbaum B,Buda R,et al.Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology:From early degeneration to osteoarthritis[J].Arthroscopy,2011,27(11):1490-1501.
[12]黄野.坚持膝关节骨关节炎的阶梯化治疗[J].实用骨科杂志,2020,26(12):1057-1058.
[13]刘文渤,陈博鉴,林跃玮,等.富血小板血浆治疗膝关节髌骨软化症的短期疗效观察[J].实用骨科杂志,2020,26(12):1135-1138;1147.
[14]胥少汀,葛宝丰,徐印坎.实用骨科学[M].第4版.北京:人民军医出版社,2012:2158-2159.
[15]Wewers ME,Lowe NK.A critical review of visual analogue scales in the measurement of clinical phenomena[J].Res Nurs Health,1990,13(4):227-236.
[16]Kujala UM,Jaakkola LH,Koskinen SK,et al.Scoring of patellofemoral disorders[J].Arthroscopy,1993,9(2):159-163.
[17]郝建桥,刘洁,杨延涛,等.Lysholm评分系统评价髌股关节的应用研究[J].中国骨与关节损伤杂志,2016,31(12):3.
[18]Davies AP,Vince AS,Shepstone L,et al.The radiologic prevalence of patellofemoral osteoarthritis[J].Clin Orthop Relat Res,2002(402):206-212.
[19]Ackermann J,Cole BJ,Gomoll AH.Cartilage restoration in the patellofemoral joint:Techniques and outcomes[J].Operative Techniques Sports Medicine,2019,27(4):150692.
[20]Guney A,Yurdakul E,Karaman I,et al.Mediumterm outcomes of mosaicplasty versus arthroscopic microfracture with or without platelet-rich plasma in the treatment of osteochondral lesions of the talus[J].Knee Surg Sports Traumatol Arthrosc,2015,24(4):1293-1298.
[21]Lützner J,Kasten P,Günther KP,et al.Surgical options for patients with osteoarthritis of the knee[J].Nature Reviews Rheumatology,2009,5(6):309.
[22]付昌马,钱春生,章有才.微骨折术联合玻璃酸钠注射修复膝关节软骨损伤[J].实用骨科杂志,2013,19(02):109-111.
[23]Xu M,Feng M,Peng H,et al.Epigenetic regulation of chondrocyte hypertrophy and apoptosis through Sirt1/P53/P21 pathway in surgery-induced osteoarthritis[J].Biochem Biophys Res Commun,2020,528(1):179-185.
[24]朱瑜琪,王智耀,张帅,等.细胞因子与膝骨关节炎关节软骨损伤的修复[J].中国组织工程研究,2017,21(36):6.
[25]Kruger JP,Hondke S,Endres M,et al.Human platelet-rich plasma stimulates migration and chondrogenic differentiation of human subchondral progenitor cells[J].J Orthop Res,2012,30(6):845-852.
[26]Khatab S,Buul GV,Kops N,et al.Intra-articular injections of platelet-rich plasma releasate reduce pain and synovial inflammation in a mouse model of osteoarthritis[J].Am J Sports Med,2018,46(4):977-986.
[27]Bellisari FC,Marino LD,Arrigoni F,et al.T2-mapping MRI evaluation of patellofemoral cartilage in patients submitted to intra-articular platelet-rich plasma (PRP) injections[J].Radiol Med,2021,126(8):1085-1094.
[28]高文香,王明君,李晓峰,等.关节镜下微骨折术联合富血小板血浆与纤维蛋白凝胶覆盖微骨折创面治疗膝骨关节炎软骨退变缺损[J].中医正骨,2019,31(11):21-25;34.
[29]尤彬,林志国,李存佳,等.PRP联合关节腔清理射频去神经化治疗膝骨关节炎疗效观察[J].实用骨科杂志,2021,27(10):895-899.
[30]汪庚申,王世中,牛存良,等.自体骨植骨联合浓缩骨髓移植在全膝关节置换术中修复骨缺损[J].实用骨科杂志,2021,27(3):272-276.