本文選題：前交叉韌帶撕裂 + 富血小板血漿　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:探討膝關(guān)節(jié)鏡下富血小板血漿應(yīng)用于前交叉韌帶重建術(shù)的臨床療效及其對(duì)ACL腱骨愈合的促進(jìn)作用。方法:64例前交叉韌帶斷裂的患者通過(guò)膝關(guān)節(jié)鏡下行前交叉韌帶重建術(shù),隨機(jī)分成兩組:A組(采用自體半腱肌和股薄肌重建ACL,在股骨隧道側(cè)注射1ml生理鹽水)33例,B組(采用自體半腱肌和股薄肌重建ACL,在股骨隧道側(cè)注射1mlPRP)31例。兩組術(shù)后的康復(fù)訓(xùn)練方案相同。術(shù)后1、3、6、12月定期門診隨訪并指導(dǎo)功能鍛煉。結(jié)果:64例患者均獲得隨訪,平均隨訪時(shí)間為12.6±1.7個(gè)月。經(jīng)隨訪發(fā)現(xiàn),A組IKDC評(píng)分從術(shù)前的26.1±6.0提高到術(shù)后12個(gè)月的90.1±5.4(p=0.000);Lysholm評(píng)分從術(shù)前的42.3±6.9提高到術(shù)后12個(gè)月的91.9±3.9(p=0.000);VAS評(píng)分從術(shù)前的4.7±1.5降到術(shù)后12個(gè)月的1.1±1.3(p=0.000)。B組IKDC評(píng)分從術(shù)前的28.3±6.3提高到術(shù)后12個(gè)月的91.7±5.2(p=0.0000);Lysholm評(píng)分從術(shù)前的44.6±5.5提高到術(shù)后12個(gè)月的92.5±3.6(p=0.0000);VAS評(píng)分從術(shù)前的5.1±1.6降到術(shù)后12個(gè)月的1.2±1.2(p=0.0000)。AB兩組間的評(píng)分均無(wú)顯著性差異(p0.05)。而術(shù)后12月的CT顯示,A組股骨隧道直徑由術(shù)前7.2±0.05 mm的擴(kuò)大到術(shù)后的9.4±0.09mm,B組則由術(shù)前的7.1±0.06mm擴(kuò)大到術(shù)后的8.55±0.14mm。B組骨隧道的擴(kuò)大率明顯低于A組(19.4±18.0%vs29.7±13.2%,p=.005)。術(shù)后1年的MRI顯示,A 組移植韌帶有 9.1%(3/33)為 Ⅰ 型,54.5%(18/33)為 Ⅱ 型,36.4%(12/33)為 Ⅲ型;B 組移植韌帶有 48.4%(15/31)為 Ⅰ 型,38.7%(12/31)為 Ⅱ型,12.9%(4/31)為Ⅲ型。B組Ⅰ型移植韌帶顯著多于A組(p=0.0005),Ⅲ型顯著低于A組(p=0.03)。所有患者在術(shù)中及術(shù)后均無(wú)并發(fā)癥發(fā)生。結(jié)論:膝關(guān)節(jié)鏡下前交叉韌帶重建術(shù)中應(yīng)用PRP治療前交叉韌帶損傷能改善膝關(guān)節(jié)功能,可避免前交叉韌帶骨隧道擴(kuò)大,臨床短期療效滿意。
[Abstract]:Objective: to investigate the clinical effect of platelet-rich plasma in anterior cruciate ligament reconstruction (ACL) under knee arthroscopy and its promoting effect on ACL tendon bone healing. Methods 64 patients with anterior cruciate ligament rupture underwent anterior cruciate ligament reconstruction under knee arthroscopy. They were randomly divided into two groups: group A (using autogenous semitendinosus muscle and gracilis muscle to reconstruct ACLs) and group B (33 cases of femoral tunnel side treated with 1ml normal saline) (autogenous semitendinosus muscle and gracilis muscle were used to reconstruct ACLs and 1mlPRP)31 cases were injected into femur tunnel side). The rehabilitation training program was the same between the two groups. The patients were followed up regularly for 12 months to guide functional exercise. Results all 64 cases were followed up, the average follow-up time was 12.6 鹵1.7 months. The IKDC score of group A was increased from 26.1 鹵6.0 before operation to 90.1 鹵5.4p0.000m at 12 months after operation from 42.3 鹵6.9 before operation to 91.9 鹵3.9p0.000 after operation from 4.7 鹵1.5 before operation to 28.3 鹵6.3 before operation in 1.1 鹵1.3(p=0.000).B group. At 12 months after operation, the Lysholm score increased from 44.6 鹵5.5 to 92.5 鹵3.6 after operation, and decreased from 5.1 鹵1.6 before operation to 1.2 鹵1.2(p=0.0000).AB at 12 months postoperatively. There was no significant difference between the two groups (p 0.05). 12 months after operation, the diameter of femoral tunnel in group A expanded from 7.2 鹵0.05mm before operation to 9.4 鹵0.09mm in group B from 7.1 鹵0.06mm before operation to 8.55 鹵0.14mm.B after operation. The rate of expansion of bone tunnel in group A was significantly lower than that in group A (19.4 鹵18.0%vs29.7 鹵13.2mm). One year after the operation, MRI showed that there were 9.1% of the grafted ligaments in group A (9.1% 33) as type 鈪，

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