【作者】 张挺；

【导师】 林向进；

【作者基本信息】 浙江大学 ， 临床医学七年制（专业学位）， 2017， 硕士

【摘要】 目的:探讨膝关节镜下富血小板血浆应用于前交叉韧带重建术的临床疗效及其对ACL腱骨愈合的促进作用。方法:64例前交叉韧带断裂的患者通过膝关节镜下行前交叉韧带重建术,随机分成两组:A组(采用自体半腱肌和股薄肌重建ACL,在股骨隧道侧注射1ml生理盐水)33例,B组(采用自体半腱肌和股薄肌重建ACL,在股骨隧道侧注射1mlPRP)31例。两组术后的康复训练方案相同。术后1、3、6、12月定期门诊随访并指导功能锻炼。结果:64例患者均获得随访,平均随访时间为12.6±1.7个月。经随访发现,A组IKDC评分从术前的26.1±6.0提高到术后12个月的90.1±5.4(p=0.000);Lysholm评分从术前的42.3±6.9提高到术后12个月的91.9±3.9(p=0.000);VAS评分从术前的4.7±1.5降到术后12个月的1.1±1.3(p=0.000)。B组IKDC评分从术前的28.3±6.3提高到术后12个月的91.7±5.2(p=0.0000);Lysholm评分从术前的44.6±5.5提高到术后12个月的92.5±3.6(p=0.0000);VAS评分从术前的5.1±1.6降到术后12个月的1.2±1.2(p=0.0000)。AB两组间的评分均无显著性差异(p>0.05)。而术后12月的CT显示,A组股骨隧道直径由术前7.2±0.05 mm的扩大到术后的9.4±0.09mm,B组则由术前的7.1±0.06mm扩大到术后的8.55±0.14mm。B组骨隧道的扩大率明显低于A组(19.4±18.0%vs29.7±13.2%,p=.005)。术后1年的MRI显示,A 组移植韧带有 9.1%(3/33)为 Ⅰ 型,54.5%(18/33)为 Ⅱ 型,36.4%(12/33)为 Ⅲ型;B 组移植韧带有 48.4%(15/31)为 Ⅰ 型,38.7%(12/31)为 Ⅱ型,12.9%(4/31)为Ⅲ型。B组Ⅰ型移植韧带显著多于A组(p=0.0005),Ⅲ型显著低于A组(p=0.03)。所有患者在术中及术后均无并发症发生。结论:膝关节镜下前交叉韧带重建术中应用PRP治疗前交叉韧带损伤能改善膝关节功能,可避免前交叉韧带骨隧道扩大,临床短期疗效满意。更多还原

【Abstract】 Purpose:To evaluate the clinical outcomes of the application of platelet rich plasma in arthroscopic anterior cruciate ligament reconstruction.Methods:64 patients with anterior cruciate ligament injury were received arthroscopic anterior cruciate ligament reconstruction.They were randomly assigned to two groups.For group A(n=20),they were received standard anterior cruciate ligament reconstruction with semitendinosus and gracilis,lateral femoral tunnel injection of lml saline.For group B(n=20),they were received standard anterior cruciate ligament reconstruction with semitendinosus and gracilis,lateral femoral tunnel injection of 1ml platelet rich plasma.All patients completed follow-up of 12 months.Clinical outcomes were evaluated using Visual Analogue Score(VAS),International Knee Documentation Committee(IKDC)and Lysholm Scores at different follow-up points(1,3,6,andl2 months).Magnetic resonanace imaging(MRI)and computed tomography(CT)images were performed in all cases at 1,6,and 12 months postoperatively to evaluate the femoral bone tunnel diameter,and the integrity of anterior cruciate ligament.Postoperatively,standard rehabilitation protocol was followed with gradual restoration.Results:All patients were followed-up for at least 12 months,the average follow-up period was 12.6±1.7 months.For group A,the mean IKDC score was significantly increased from 26.1±6.0 preoperatively to 90.1±5.4 at 12 months after surgery(p=0.000).The mean Lysholm score was statistically significantly improved from 42.3±6.9 preoperatively to 91.9±3.9 at 12 months after surgery(p=0.000).In addition,VAS was significantly decreased from 4.7±1.5 preoperatively to 1.1±1.3 at 12 months after surgery(p=0.000).For group B,the mean IKDC score was significantly increased from 28.3±6.3 preoperatively to 91.7±5.2 at 12 months after surgery(p=0.000).The mean Lysholm score was statistically significantly improved from 44.6±5.5 preoperatively to 92.5±3.6 at 12 months after surgery(p=0.000).In addition,VAS was significantly decreased from 5.1±1.6 preoperatively to 1.2± 1.2 at 12 months after surgery(p=0.000).There were no statistically significant difference between two groups.The femoral bone tunnel diameter enlargement rate measured by CT was significant less than that in group A(19.4±18.0%vs 29.7113.2%,p=.005).Type I transplanted ligament rate in group B examined by MRI was significant more than that in group A(p=0.0005).Type III transplanted ligament rate in group B examined by MRI was significant less than that in group A(p=0.03).Finally,there were no intraoperative or postoperative complications.Conclusion:The application of platelet rich plasma in arthroscopic anterior cruciate ligament reconstruction could improve knee joint function and avoid anterior cruciate ligament bone tunnel expanding.The clinical short-term results were satisfactory.更多还原