【摘要】：目的:探討PRP對前交叉韌帶重建后骨隧道擴大化的影響。方法:隨機選取31例自體移植物重建前交叉韌帶患者,隨機分成實驗組(16例)以及對照組(15例)。實驗組術(shù)中及術(shù)后第2、3、4、5、6、7周返院,制作PRP約10ml后打入膝關(guān)節(jié)囊內(nèi),對照組在相同的時間用生理鹽水代替。所有患者分別進行隨訪,隨訪內(nèi)容為包括:體格檢查:膝關(guān)節(jié)活動度(ROM)、Lachman試驗;膝關(guān)節(jié)功能評分:術(shù)前及末次隨訪采用Lysholm評分表評價膝關(guān)節(jié)功能;影像學(xué)方面:所有患者在末次隨訪時行膝關(guān)節(jié)三維CT檢查。骨隧道口測量:通過三維CT,檢查骨隧道2個位置點(脛骨內(nèi)口、股骨內(nèi)口)。結(jié)果:PRP組CT:股骨骨道內(nèi)口擴大程度2.062±0.814mm,發(fā)生率25%(4/16);脛骨骨道內(nèi)口擴大程度1.969±0.884mm,發(fā)生率均為25%(4/16)。對照組CT:股骨骨道內(nèi)口擴大程度2.433±1.193mm,發(fā)生率為33.33%(5/15);脛骨骨道內(nèi)口擴大程度2.167±1.080mm,發(fā)生率均為33.33%(5/15)。PRP組與對照組骨隧道口擴大值比較結(jié)果(F=4.064,t=-1.133,P=0.0480.05)有統(tǒng)計學(xué)意義。膝關(guān)節(jié)活動度(ROM):術(shù)后隨訪未發(fā)現(xiàn)關(guān)節(jié)屈伸活動障礙者,PRP組以及對照組患側(cè)關(guān)節(jié)活動度兩者間差異無統(tǒng)計學(xué)意義(t=-1.844,P=0.069)。PRP組患者術(shù)前Lys holm評分為(41.937±3.991)分,術(shù)后為(95.875±2.363)分,兩者差異有統(tǒng)計學(xué)意義(t=-46.516,P=0.0030.05);術(shù)前IKDC評分為(55.14±3.12)分,術(shù)后(85.91±3.17)分,兩者差異有統(tǒng)計學(xué)意義(t=-24.07,P0.001)。對照組患者術(shù)前Lysholm評分為(43.60±3.776)分,術(shù)后為(95.333±2.500)分,兩者差異有統(tǒng)計學(xué)意義(t=-44.258,P=0.0440.05);術(shù)前IKDC評分為(51.232±7.98)分,術(shù)后(83.76±4.37)分,兩者差異有統(tǒng)計學(xué)意義(t=-27.38,P0.001)。PRP組與空白組術(shù)前術(shù)后Lysholm評分比較,P0.05,差異沒有統(tǒng)計學(xué)意義,兩組術(shù)前及術(shù)后IKDC評分比較,P0.05,差異沒有統(tǒng)計學(xué)意義。結(jié)論:在交叉韌帶重建中使用PRP可以促進腱骨愈合,減小骨隧道擴大化的程度。
[Abstract]:Objective: to investigate the effect of PRP on the expansion of bone tunnel after anterior cruciate ligament reconstruction. Methods: Thirty-one patients with anterior cruciate ligament reconstruction were randomly divided into experimental group (n = 16) and control group (n = 15). The patients in the experimental group returned to hospital 7 weeks after the operation and the second trimester, and the PRP was made about 10ml into the capsule of the knee joint. The control group was replaced by normal saline at the same time. All the patients were followed up, including: physical examination: knee motion (ROM), Lachman test; knee function score: Lysholm scale was used to evaluate knee function before and after the last follow-up. Imaging: three-dimensional CT examination of knee joint was performed in all patients at the last follow-up. Measurement of bone tunnel orifice: 2 position points of bone tunnel (tibia and femur) were examined by three dimensional CT,. Results: in the PRP group, the degree of expansion of the femoral meatus was 2.062 鹵0.814 mm, the incidence rate was 25% (4 / 16), and the degree of expansion of the tibial bone canal was 1.969 鹵0.884mm, the incidence rate was 25% (4 / 16). In the control group, the degree of enlargement of the femoral meatus was 2.433 鹵1.193mm, the incidence rate was 33.33% (5 / 15), and the degree of the expansion of the tibial canal was 2.167 鹵1.080mm, the incidence rate was 33.33% (F _ (4.064) ~ 1.133P0.0480.05) in the 5 / 15). PRP group compared with the control group (F _ (4.064) ~ 1.133P0.0480.05). There was no significant difference in the range of motion of the knee joint between the PRP group and the control group after (ROM):. The preoperative Lys holm score was (41.937 鹵3.991) in the PRP group and (95.875 鹵2.363) in the control group (P < 0.05). The IKDC score was (55.14 鹵3.12) before operation and (85.91 鹵3.17) after operation. The Lysholm score was (43.60 鹵3.776) before operation and (95.333 鹵2.500) after operation in the control group, the difference was statistically significant (t _ (44.258) P _ (0.044), the preoperative IKDC score was (51.232 鹵7.98), the postoperative IKDC was (83.76 鹵4.37). There was no significant difference between the two groups in Lysholm score before and after operation (P 0.05). There was no significant difference in IKDC score before and after operation between the two groups (P 0.05). Conclusion: the use of PRP in cruciate ligament reconstruction can promote tendon bone healing and reduce the extent of bone tunnel enlargement.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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