膝关节镜下前交叉韧带重建术联合富血小板血浆关节腔注射治疗前交叉韧带损伤的临床疗效研究

Clinical efficacy of anterior cruciate ligament reconstruction under knee arthroscopy combined with platelet rich plasma intra-articular injection for the treatment of anterior cruciate ligament injury

摘要:

目的 观察膝关节镜下前交叉韧带重建术（ACLR）联合富血小板血浆（PRP）关节腔注射治疗前交叉韧带（ACL）损伤的效果。方法 选取2022年1月－2023年1月该院ACL损伤患者70例，按随机数表法分为对照组（35例，采用膝关节镜下ACLR）和研究组（35例，采用膝关节镜下ACLR联合PRP关节腔注射）。比较两组患者肢体功能、股骨隧道直径和腱骨愈合情况，并检测机体应激指标、胰岛素样生长因子-1（IGF-1）、骨钙素和基质金属蛋白酶-1（MMP-1）水平。结果 术后4周，两组患者丙二醛和一氧化氮（NO）低于术前，且研究组低于对照组，超氧化物歧化酶（SOD）高于术前，且研究组高于对照组，差异均有统计学意义（P < 0.05）。术后24周，两组患者Lysholm评分和国际膝关节文献委员会（IKDC）评分高于术前，且研究组高于对照组，差异均有统计学意义（P < 0.05）。术后24周，两组患者IGF-1高于术前，且研究组高于对照组，骨钙素和MMP-1低于术前，且研究组低于对照组，差异均有统计学意义（P < 0.05）。术后24周，两组患者股骨隧道直径大于术前，但研究组小于对照组，差异均有统计学意义（P < 0.05）。研究组整体腱骨愈合情况优于对照组，差异有统计学意义（Z = -2.22，P = 0.026）。结论 膝关节镜下ACLR联合PRP关节腔注射，可改善ACL损伤患者的肢体功能，缓解机体应激反应，预防股骨隧道直径扩大，促进腱骨愈合，升高IGF-1，以及降低骨钙素和MMP-1水平。

Abstract:

Objective To observe the clinical efficacy of anterior cruciate ligament reconstruction (ACLR) and platelet rich plasma (PRP) intra-articular injection under knee arthroscopy for the treatment of anterior cruciate ligament (ACL) injury.Methods From January 2022 to January 2023, 70 patients with ACL injury were randomly divided into control group (35 cases, using ACLR under knee arthroscopy) and study group (35 cases, using ACLR under knee arthroscopy combined with PRP intra-articular injection) using a random number table method. The limb function, femoral tunnel diameter, tendon bone healing, body stress indicators, insulin-like growth factor-1 (IGF-1), osteocalcin, and matrix metalloproteinase-1 (MMP-1) were compared between the two groups.Results At 4 weeks after operation, the levels of malondialdehyde and nitric oxide (NO) in both groups were lower than those before surgery, and the study group was lower than the control group, the levels of superoxide dismutase (SOD) in both groups were higher than those before surgery, and the study group was higher than the control group, the differences were all statistically significant (P < 0.05). At 24 weeks after operation, Lysholm score and International Knee Documentation Committee (IKDC) score of both groups were higher than those before operation, and the study group was higher than the control group, the differences were all statistically significant (P < 0.05). At 24 weeks after operation, the levels of IGF-1 in both groups were higher than those before operation, and the study group was higher than the control group, the levels of osteocalcin and MMP-1 in both groups were lower than those before operation, and the study group was lower than the control group, the differences were all statistically significant (P < 0.05). At 24 weeks after surgery, the femoral tunnel diameter in both groups was greater than before surgery, however, the study group was smaller than the control group, the differences were all statistically significant (P < 0.05). The overall tendon bone healing in the study group was better than that in the control group, the difference was statistically significant (Z = -2.22, P = 0.026).Conclusion ACLR under knee arthroscopy combined with PRP intra-articular injection can improve the limb function of patients with ACL injury, alleviate body stress, prevent the expansion of femoral tunnel diameter, promote tendon bone healing, increase IGF-1 and reduce osteocalcin, and MMP-1.