摘要
目的评估在机器人辅助全膝关节置换术(TKA)术中应用富血小板血浆(PRP)对术后康复的影响。方法采用前瞻性随机对照研究纳入2023年2月~9月于解放军总医院第一医学中心行机器人辅助TKA的患者162名,按随机数表法分为观察组(81例)和对照组(81例),观察组术中接受PRP注射,对照组患者接受常规治疗,不使用PRP注射。评估两组患者手术指标包括健康状况调查简表(SF-36)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、SF-36评分、5次起坐试验等;并于术后2周、6周、3个月和6个月门诊随访评估两组患者不良反应发生情况。结果随访6个月,观察组1例失访,1例因术后早期假体周围感染排除;对照组1例失访,共159例(观察组79例,对照组80例)纳入研究。两组患者手术时间比较[(71.94±11.06)vs.(69.55±12.12)],差异无统计学意义(t=1.193,P=0.235)。术后2周、6周、3个月和6个月时,两组间膝关节协会评分(KSS)评分差异无统计学意义(P>0.05)。WOMAC评分中,观察组术后2和6周僵硬评分显著优于对照组[(2.70±1.26)vs.(3.39±1.45)、(2.47±1.27)vs.(3.19±1.20)],差异有统计学意义(t=-2.387、-2.740,P<0.05);观察组术后3个月活动困难评分方面优于对照组[(7.83±7.10)vs.(11.49±7.78)],差异有统计学意义(t=-2.226,P=0.028)。SF-36评分中,观察组术后2周的躯体痛评分[(55.24±22.78)vs.(47.70±15.36)]和术后第3个月的社会功能评分[(86.60±12.23)vs.(76.71±22.03)]方面优于对照组,差异有统计学意义(t=2.226、2.252,P<0.05)。观察组和对照组各有1例患者分别出现术后切口渗液和切口局部血肿,均通过门诊处理后痊愈,两组患者不良事件发生率差异无统计学意义(P>0.05)。结论机器人辅助TKA术中应用PRP注射可部分改善术后膝关节功能,并在改善术后疼痛方面短期内可能存在益处。术中注射PRP对机器人辅助TKA是一种潜在的辅助手段。
Objective To evaluate the impact of intraoperative platelet-rich plasma(PRP)application on postoperative rehabilitation in robot-assisted total knee arthroplasty(TKA).Methods A prospective randomized controlled trial was conducted,enrolling 162 patients who underwent robot-assisted TKA at the First Medical Center of the PLA General Hospital between February 2023 and September 2023.Patients were randomly assigned to the experimental group(n=81,receiving PRP injection)and the control group(n=81).Outcome measures included the knee society score(KSS),the Western Ontario and McMaster Universities Osteoarthritis index(WOMAC),Short Form-36(SF-36)score,five-time sit-to-stand test,and incidence of adverse events.Follow-up assessments were performed at 2 weeks,6 weeks,3 months,and 6 months postoperatively.Results There was no significant difference in operative time between the two groups[(71.94±11.06)vs.(69.55±12.12),t=1.193,P=0.235].There was no significant difference of KSS score between the two groups at any follow-up time point.The WOMAC score in the experimental group were significantly lower at 2 weeks[(2.70±1.26)vs.(3.39±1.45),t=-2.387,P<0.05]and at 6 weeks[(2.47±1.27)vs.(3.19±1.20),t=-2.740,P<0.05].At 3 months,the physical function score in the experimental group was lower than that in the control group[(7.83±7.10)vs.(11.49±7.78),t=-2.226,P=0.028].The SF-36 score in the experimental group was higher at 2 weeks(55.24±22.78)vs.(47.70±15.36),and the social functioning scores at 3 months was also higher than that in the control group(86.60±12.23)vs.(76.71±22.03)(t=2.226、2.252,P<0.05).Regarding adverse events,one patient in each group experienced postoperative incision exudation(PRP group)or localized hematoma(control group),both of which resolved after outpatient treatment.There was no significant difference in adverse event rates between the two groups(P>0.05).Conclusion The findings suggest that intraoperative PRP injection in robot-assisted TKA may improve certain aspects of postoperative knee function,though overall functional improvement is limited.Short-term benefits in pain relief may exist.PRP injection appears to be a potential adjunctive therapy for robot-assisted TKA.
作者
任海潮
赵润凯
庄远
陈继营
张国强
Ren Haichao;Zhao Runkai;Zhuang Yuan;Chen Jiying;Zhang Guoqiang(Department of Orthopedics,1st Medical Center of PLA General Hospital,Beijing 100853,China)
出处
《中华保健医学杂志》
2025年第3期471-476,共6页
Chinese Journal of Health Care and Medicine
基金
解放军总医院首批青年自主创新科学基金项目(22QNCZ013)。
