富血小板血浆（PRP）联合髓心减压改善早期股骨头坏死患者的功能预后并延迟疾病进展

发表者：李志昌人已读

关节置换杂志（JOA）最新研究报道了联合富血小板血浆（PRP）与髓心减压治疗早期股骨头坏死患者，能够显著改善患者的躯体功能并延缓疾病进展。

股骨头坏死常常发展到股骨头塌陷、关节破坏而需要行人工关节置换手术。髓心减压是早期股骨头坏死有效治疗手段之一，但其效果仍待提高。Aggarwal等人对比了单纯髓心减压与联合PRP和髓心减压治疗早期股骨头坏死的效果。发现在4.5-6年后的随访时，PRP联合髓心减压治疗组患者的疼痛评分、功能评分和Harris髋关节评分均显著高于单纯髓心减压治疗组。治疗时病变为I期的患者均未发生疾病进展；II期的患者在PRP治疗组有24%的发生了疾病进展，而单纯髓心减压组则有43%的患者发生了疾病进展。两组患者未发生股骨头塌陷的比例为84%与68%，接受再次手术的比例为24%与43%，接受全髋置换的比例分别为8%和22%，联合PRP治疗组均优于单纯髓心减压组。

因而该研究得出结论，在髓心减压手术治疗早期股骨头坏死术中联合应用PRP能够显著改善疼痛、获得更好的中期功能预后，并能够延迟疾病的进展，让更多的患者免于发生股骨头塌陷，或接受关节置换手术。

Combining Platelet Rich Plasma instillation with Core decompression improves functional outcome and delays progression in early-stage Avascular Necrosis of femoral head A 4.5- to 6-year Prospective Randomized Comparative Study

Aditya K. Aggarwal, MS Orth, DNB Orth, D Orth ????•

Poornalingam K, MS Orth ??•

A. Jain, MD •

Mahesh Prakash, MD

Published:July 11, 2020•DOI:https://doi.org/10.1016/j.arth.2020.07.010

Abstract

Background

Avascular necrosis of femoral head is a debilitating disease frequently progressing to femoral head collapse and joint destruction. The efficacy of core decompression remains controversial.

Methods

40 consecutive age- and sex-matched patients (53 hips) were randomized into two groups by computer generated algorithm table in a prospective randomized double blinded comparative study. Group A (platelet rich plasma with core decompression) included 19 patients (25 hips) and group B (core decompression only) 21 (28 hips). Postoperative Harris Hip score and MRI to quantify the necrotic area by using modified Kerboul angle were done and evaluated. Mean follow-up was 64.3 months (range: 54 to 72) and 63.7 months (range: 56 to 72) in group A and B respectively.

Results

There was statistically signi??cant difference between PRP and control groups in pain score (p=0.00), functional score (p=0.02) and Harris Hip score (p=0.00) at final follow up. There was no progression in stage 1 disease. Stage 2 showed 24% progression in group A and 43% progression in group B. The difference was statistically significant (p= 0.025). Survivorship from femoral head collapse, any procedure, and THA was 84% / 68% (p= 0.00), 76% / 57% (p= 0.02), and 92% / 78% (p= 0.01) in two groups which was statistically significant.

Conclusions

PRP use following core decompression provides significant pain relief, better mid-term functional outcome, retards the progression and enhances the survivorship free from reoperation for hip arthroplasty and femoral head collapse in early stages of avascular necrosis of hip than core decompression alone.