CAJ | 학술논문

目的探讨富血小板血浆(PRP)凝胶在人工全膝关节置换手术中应用的效果及可靠性.方法将2011年1月至2013年1月南通大学附属建湖医院关节外科收治的60例退行性膝关节骨性关节炎拟行人工全膝关节置换的患者纳入研究.其中30例术中制备自体PRP和血凝酶并喷涂于人工全膝关节置换术创面(PRP组),30例喷涂同等剂量的生理盐水和血凝酶(生理盐水组).术后两组患者均常规引流以及功能锻炼.对其进行临床评价,包括术后引流量、伤口炎性反应程度、伤口愈合等级,定期随访进行美国特种外科医院(HSS)评分、髌骨评分(Feller评分)及检查膝关节活动度(ROM)评价膝关节的功能.组间比较采用独立样本t检验,等级资料采用秩和检验.结果术后PRP组引流量为(152±22) ml,生理盐水组为(432±35) ml,两组比较差异有统计学意义(t=37.098,P＜0.05).术后第4天,PRP组伤口炎症反应程度无27例,轻2例,中1例;生理盐水组为无24例,轻4例,中2例.PRP组伤口均达甲级愈合,不良反应率为0;生理盐水组甲级愈合29例,乙级愈合1例,伤口出现红肿并有少量渗液,经75％酒精湿敷3d正常愈合,不良反应率为3.3％.两组伤口炎性反应程度、伤口愈合等级比较差异无统计学意义(P＞0.05).患者术后随访10 ～24个月,平均16个月.两组术后3个月HSS评分、髌骨评分、膝前痛分数及ROM比较差异有统计学意义(t=2.288、2.097、2.630及2.104,P值均＜0.05),术后末次随访时比较差异无统计学意义(P＞0.05).结论人工全膝关节置换术中使用PRP凝胶可以减少术后的引流量,利于伤口愈合,同时不增加术后并发症,短期临床效果满意.
목적 탐토부혈소판혈장(PRP)응효재인공전슬관절치환수술중응용적효과급가고성.방법 장2011년1월지2013년1월남통대학부속건호의원관절외과수치적60례퇴행성슬관절골성관절염의행인공전슬관절치환적환자납입연구.기중30례술중제비자체PRP화혈응매병분도우인공전슬관절치환술창면(PRP조),30례분도동등제량적생리염수화혈응매(생리염수조).술후량조환자균상규인류이급공능단련.대기진행림상평개,포괄술후인류량、상구염성반응정도、상구유합등급,정기수방진행미국특충외과의원(HSS)평분、빈골평분(Feller평분)급검사슬관절활동도(ROM)평개슬관절적공능.조간비교채용독립양본t검험,등급자료채용질화검험.결과 술후PRP조인류량위(152±22) ml,생리염수조위(432±35) ml,량조비교차이유통계학의의(t=37.098,P＜0.05).술후제4천,PRP조상구염증반응정도무27례,경2례,중1례;생리염수조위무24례,경4례,중2례.PRP조상구균체갑급유합,불량반응솔위0;생리염수조갑급유합29례,을급유합1례,상구출현홍종병유소량삼액,경75％주정습부3d정상유합,불량반응솔위3.3％.량조상구염성반응정도、상구유합등급비교차이무통계학의의(P＞0.05).환자술후수방10 ～24개월,평균16개월.량조술후3개월HSS평분、빈골평분、슬전통분수급ROM비교차이유통계학의의(t=2.288、2.097、2.630급2.104,P치균＜0.05),술후말차수방시비교차이무통계학의의(P＞0.05).결론 인공전슬관절치환술중사용PRP응효가이감소술후적인류량,리우상구유합,동시불증가술후병발증,단기림상효과만의.
Objective To investigate the effect of platelet-rich plasma (PRP) gel in total knee arthroplasty.Methods From January 2011 to January 2013,30 patients of total knee arthroplasty were received PRP(PRP group) and 30 patients won't received PRP(normal saline group).Routine drainage and functional exercise were applied to the two groups after operation.Postoperative drainage volume,inflammatory reaction,grade of wound healed,Hospital for Special Surgery (HSS) Score for knee,the Feller Score for patella and range of motion(ROM) for knee were evaluated.Independent samples t-test,grade data used rank sum test were used to compared two groups.Results Postoperative drainage volume was (152 ± 22)ml in PRP group and (432 ± 35)ml in normal saline group.Postoperative drainage volume were statistically significant difference between two groups (t =37.098,P ＜ 0.05).At 4 days after operation,no inflammatory reaction was observed in 27 cases of PRP group and in 24 cases of normal saline group,mid inflammatory reaction in 2 cases of PRP group and in 4 cases of normal saline group,moderate inflammatory reaction in 1 cases of PRP group and in 2 cases of normal saline group.Wound healed by first intention in 30 patients of PRP group and in 29 patients of normal saline group (29/30),by second intention after 3 days of dressing change in 1 patient of normal saline group using 75％ alcohol wet compressed.The adverse reaction rate was 3.3％.The average follow-up period was 16 months,ranging from 10 to 24 months.Three months postoperative HSS score for knee,scores of patellar,scores of anterior knee pain and ROM for knee were statistically significant difference in PRP group and normal saline group (t =2.288,2.097,2.630,2.104 ;all P ＜ 0.05).Inflammatory reaction,grade of wound healed,final follow-up HSS score for knee,scores of patellar,scores of anterior knee pain and ROM for knee had no statistically significant difference between PRP group and normal saline group (P ＞ 0.05).Conclusions Using PRP gel in total knee arthroplasty can reduce postoperative drainage volume,accelerate the healing of operation incision with no extra complications.It has good short-term clinical effect.