自体骨髓浓缩物和富血小板血浆治疗膝关节软骨损伤

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摘要目的通过临床前瞻性随机对照试验比较关节镜清理术(arthroscopic debridement，AD)联合骨髓浓缩物(bone marrow aspirate concentrate，BMAC)或富血小板血浆(platele rich plasma，PRP)治疗膝关节软骨损伤的症状和功能改善以及软骨修复效果。方法本研究共纳入2020年7月到2021年8月中国人民解放军联勤保障部队第九二〇医院收治的单侧膝关节软骨损伤患者62例，其中男29例，女33例；年龄18~65岁，平均(32.57±8.58)岁；平均身体质量指数(23.02±1.26)kg／m²；国际软骨修复学会(international cartilage repair society，ICRS)分级，Ｉ级30例，Ⅱ级32例。临床试验患者随机分为三组，AD+BMAC组22例，AD+PRP组18例，AD组22例。采用Lysholm评分、Tegner评分和疼痛数字评分法(numeric rating scales，NRS)评估症状及功能改善情况，采用膝关节MRI及磁共振软骨修复组织观察(magnetic resonance observation of cartilage repair tissue，MOCART)评分评估软骨修复效果。结果患者术后均获得12个月以上随访。三组患者术后Lysholm、Tegner及NRS评分均较术前改善(P＜0.05)，且术后1个月时改善最明显，术后3、6、12个月逐渐降低且仍优于术前。AD+BMAC组术后1、3、6个月的Lysholm、Tegner及NRS评分均优于AD+PRP组和AD组(P＜0.05)，术后12个月与AD+PRP组差异无统计学意义(P＞0.05)，仍优于AD组(P＜0.05)。AD+PRP组术后1、3个月的Lysholm、Tegner及NRS评分均优于AD组(P＜0.05)，术后6、12个月两组差异无统计学意义(P＞0.05)。术后12个月三组MOCART评分与术前比较差异均无统计学意义(P＞0.05)，组间比较差异无统计学意义(P＞0.05)。结论相较于单纯AD，AD联合BMAC或PRP在缓解患者症状、改善膝关节功能方面更佳，均取得满意的短期疗效；AD联合BMAC的疗效更优于AD联合PRP，且作用持续时间更长。AD联合BMAC或PRP均能阻止膝关节损伤进一步恶化，但较单纯AD治疗在软骨修复方面无显著优势。

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	冯玉娇
	周田华
	李明军
	陈志安
	吕晓雨
	王刚
	徐永清
	谭洪波

关键词 ：自体骨髓浓缩物, 富血小板血浆, 膝关节, 软骨损伤, 关节镜清理术

Abstract：

Objective To compare the effects of arthroscopic debridement (AD)combined with bone marrow concentrate (BMAC)or plateletrich plasma (PRP)on symptoms，functional improvement and cartilage repair in patients with knee cartilage injury by a clinical prospective randomized controlled trial.Methods A total of 62 patients with unilateral knee cartilage injury admitted to 920th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army from July 2020 to August 2021 were included in this study，which including 29 males and 33 females.And their age ranged from 18 to 65 years old，with an average of (32.57±8.58)years old.The mean BMI was (23.02±1.26)kg/m2.And among them，there were 30 cases of grade Ｉ and 32 cases of grade Ⅱ according to the international cartilage repair society (ICRS)classification.Next，these clinical trial patients were randomly divided into AD+BMAC group (n＝22)，AD+PRP group (n＝18)，and AD group (n＝22).Lysholm score，Tegner score，and numerical rating scale (NRS)were used to evaluate the improvement of symptoms and function of patients.MRI and magnetic resonance observation of cartilage repair tissue (MOCART)scores were used to evaluate the effect of cartilage repair.Results The follow-up time was 12 months.According to Lysholm，Tegner，and NRS scores，the symptoms and function of the three groups improved after operation (P＜0.05)，and the improvement was most obvious at 1 month after operation.And at 3，6，and 12 months after operation，the knee joint condition gradually decreased，but was still better than that before operation.The Lysholm，Tegner，and NRS scores of the AD+BMAC group were significantly better than those of the AD+PRP group and the AD group at 1，3，and 6 months after operation (P＜0.05)，while there was no significant difference in the relevant scores compared with the AD+PRP group at 12 months after operation (P＞0.05)，but they were still better than those of the AD group (P＜0.05).And the Lysholm，Tegner，and NRS scores of the AD+PRP group were significantly better than those of the AD group at 1 and 3 months after operation (P＜0.05)，but no significant difference was found at 6 and 12 months after operation (P＞0.05).In addition，the MOCART scores of the three groups at 12 months after operation were not significantly different from those before operation (P＞0.05)，and there was no significant difference between the three groups after operation (P＞0.05).Conclusion In general，compared with AD alone，AD combined with BMAC or PRP is better in relieving symptoms and improving knee joint function，and both have achieved satisfactory short-term efficacy.Specifically，the efficacy of AD combined with BMAC is better than that of AD combined with PRP，and the effect lasts longer.Both AD combined with BMAC or PRP can prevent the further deterioration of knee joint injury，but there is no significant advantage in cartilage repair.

Key words： autologous bone marrow concentrate platelet-rich plasma knee cartilage injury arthroscopic debridement

基金资助:云南省骨科与运动康复临床医学研究中心(202102AA310068)

通讯作者: 谭洪波

作者简介: 冯玉娇(1993－ )，女，研究生在读，昆明医科大学，fengyujiao07@163.com

引用本文:

冯玉娇，周田华，李明军，陈志安，吕晓雨，王刚，徐永清，谭洪波. 自体骨髓浓缩物和富血小板血浆治疗膝关节软骨损伤[J]. 实用骨科杂志, 2023, 29(10): 922-.
Feng Yujiao，Zhou Tianhua，Li Mingjun，Chen Zhian，Lv Xiaoyu，Wang Gang，Xu Yongqing，Tan Hongbo. Bone Marrow Aspiration Concentrate Versus Platelet Rich Plasma in the Treatment of Knee Articular Cartilage Injury. sygkzz, 2023, 29(10): 922-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I10/922

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