| Objective: To evaluate the specific clinical efficacy of arthroscopic surgery combined with platelet rich plasma(PRP)in treating patients with grade StollerIII meniscus injury of the knee,in order to provide some help for clinical medicine.Materials and Methods: Choose 223 cases of Stoller Ⅲ level of patients from September 2015 to January 2018 to our hospital with injury of meniscus,randomly divided into groups of AT group(pure arthroscopic treatment,72cases),AT + HA group(arthroscopic treatment + of intra-articular injection of hyaluronic acid,75 cases),AT + PRP group(arthroscopic treatment + platelet rich plasma treatment,76 cases);The mean age of the patients(43.5 ±10.8);Specific treatment method: AT group: simple arthroscopic suture repair;AT+HA group: immediately,1 week,2 weeks,3 weeks and 4 weeks after arthroscopic suture repair,2.5ml hyaluronic acid injection was injected via the medial or lateral human pathway of patellar ligament,5 times in total.Hyaluronic acid was distributed evenly in the articular cavity of the patient with flexion and extension knee joint.The knee elastic bandage was applied for compression dressing,and the patient had fluid in the articular cavity.AT+PRP group: on the basis of arthroscopic suture repair,platelet-rich plasma injection was injected into the medial or lateral human pathway of patellar ligament immediately,1 week and 2 weeks after the operation,with a total of 3.5ml,for 3times.The patient’s flexion and extension knee joint made platelet-rich plasma distribute evenly in its articular cavity.The knee elastic bandage was applied for compression dressing,and the patient had fluid in the articular cavity.The three groups of patients were re-examined before treatment and 1,3 and 6 months after all injections were completed.VAS score,Lysholm score,KOOS score before and after treatment were recorded in detail.To observe the different manifestations of the three groups of patients in the first month,3 months and 6months after the operation,such as the degree of joint swelling,the degree of quadriceps atrophy and the range of joint activity.MRI images were used to evaluate the efficacy of the three groups of patients before and 6 months after surgery.IL-1,TNF-and IL-6 levels were detected by ELISA assay at 6 months after surgery.Western-blot assay was used to detect the expressions of inflammatory proteins IL-1β,Atg5 and LC3-II in the three groups 6 months aftersurgery.Results: General situation analysis: social data: the study suggested that the average age of patients in the three groups,the score of knee joint pain before treatment and the range of motion of knee joint before treatment were more balanced,P=0.335,0.435 and 0.388,all greater than 0.05,and the difference was not statistically significant,which made a good foundation for the subsequent experiment.Meniscus injury site: the study suggested that the anterior meniscus injury,body injury and posterior Angle injury of the three groups of patients,P=0.730,0.566,0.818,the difference was not statistically significant.Clinical effect evaluation: VAS score: the VAS knee pain score was analyzed before and immediately after surgery,1 month after surgery,3 months after surgery and 6 months after surgery.There was a certain difference in the VAS score between the three groups at 1 month after surgery,P=0.045,and the difference was statistically significant.The three groups at 3 months after surgery were respectively,P=0.0,30,and the difference was statistically significant.At 6 months after surgery,the differences of the VAS scores of the three groups were statistically significant.Lysholm score: P=0.707 was analyzed by Lysholm before arthroscopic surgery,and the difference was not statistically significant.Immediately after surgery,P=0.669,the difference was not statistically significant.1 month after arthroscopic surgery,the score gap gradually widened,P=0.050,and the difference was statistically significant.At the same time,the data of AT+HA group,AT+PRP group compared with AT group,as well as AT+PRP group compared with AT+HA group and AT group showed that P was all less than 0.05,and the difference was statistically significant.At group 3 and 6 months after surgery,the knee of patients in the AT+PRP group had the best recovery,and the differences in Lysholm scores between the groups were statistically significant.KOOS scores: the differences in KOOS scores between the three groups were gradually widened before surgery,immediately after surgery and 1 month after surgery,and the differences were statistically significant.AT group 3 months after surgery and 6months after surgery,the knee recovery of patients in the AT+PRP group was optimal,and the differences between the groups were statistically significant.Joint swelling degree: immediately before and after the operation,P=0.707,0.604,greater than 0.05,and the difference was not statistically significant.After 1 month of arthroscopic surgery,the gap of joint swelling degree was gradually widened between the three groups,and the score of AT+PRP group was the lowest,P=0.040.The difference was statistically significant.AT 3months and 6 months after surgery,the knee recovery of patients in the AT+PRP group was optimal,and the differences were statistically significant.Quadriceps trivial: before surgery,postoperative immediate and postoperative 1 month between the three groups of quadriceps,disturbing degree score gap is gradually expanding,the AT + PRP group lowest score,P = 0.038,the difference is statistically significant,At the same time the AT + HA group,the AT + PRP group compared with AT group,as well as the AT+PRP group compared with AT+HA group and AT group,visible data comparative analysis of P were less than 0.05,the difference is statistically significant.AT+PRP group had the smallest degree of atrophy in the quadriceps muscle at 3 months after surgery and 6 months after surgery.The differences of the scores of the three groups were statistically significant.Range of joint activity: the gap of joint mobility score between the three groups was gradually widened before surgery,immediately after surgery and 1 month after surgery,with the lowest score in the AT+PRP group.The AT + HA group,the AT + PRP group compared with AT group,as well as the AT+PRP group compared with AT+HA group and AT group were all less than 0.05,and the difference was statistically significant.3months after surgery and 6 months after surgery,the differences were statistically significant.MRI image analysis: before arthroscopic surgery,the images showed the contusion of meniscus on the medial side of the two groups without any laceration,and the condition of meniscus injury was similar in the two groups.MRI images showed the high-signal shadow region between the posterior horn of the lateral meniscus of the sagittal plane PDWI and the adjacent femoral ligament,showing its rupture status and plenty of liquid signal shadow in the articular cavity.After arthroscopic surgery,hyaluronic acid injection and PRP injection,the patient had no obvious tear in the meniscus immediately after the operation.MRI images after 6 months after surgery suggested that the meniscus was normal,flocculus high signal shadow was still visible in the AT+HA group,and flaky PDWI hyperlipidemia signal was still visible between the patient and the lateral platform of the tibia and the lateral ankle of the femur,while the medial bone signal was still somewhat elevated.MRI showed that the meniscus was normal in the AT+PRP group,the swelling degree of the medial collateral ligament was significantly reduced,and the amount of hydrops in the articular cavity was significantly reduced.Arthroscopic images suggested that the meniscus was normal.Analysis of inflammatory effects: inflammatory factors IL-1,TNF-α,and IL-6 concentrations: 6 months after surgery,the expression of il-1 concentrationin the three groups was compared as AT+PRP < AT+HA < AT,and the difference was statistically significant(P<0.05)in the AT+HA group and AT+PRP group compared with AT group.The difference was statistically significant(P<0.05)in the AT+PRP group compared with AT+HA group and AT group.6 months after surgery,the expression of il-6 concentration was compared as AT+PRP < AT+HA < AT.AT+HA group,AT+PRP group and AT group had a P<0.05,and the difference was statistically significant.6 months after surgery,the expression of TNF was compared as AT+PRP < AT+HA <AT.In addition,compared with the AT group,the AT+HA group and AT+PRP group showed statistically significant differences(P<0.05),and the AT+PRP group showed statistically significant differences(P<0.05)compared with AT+HA group and AT group.The expression rate of IL-1β was AT+PRP <AT+HA < AT 6 months after the operation,and P<0.05 was statistically significant in the AT+HA group and AT+PRP group compared with AT group,and P<0.05 was statistically significant in the AT+PRP group compared with AT+HA group and AT group.6 months after surgery,the concentration expression rate of Atg5 was AT+PRP < AT+HA < AT.At the same time,P<0.05 was statistically significant in the AT+HA group and AT+PRP group compared with the AT group,and P<0.05 was statistically significant in the AT+PRP group compared with AT+HA group and AT group.The expression rate of autophagy protein LC3-II was AT+PRP < AT+HA < AT 6 months after the operation,and P<0.05 was statistically significant in the AT+HA group and AT+PRP group compared with AT group,and P<0.05 was statistically significant in the AT+PRP group compared with AT+HA group and AT group.Conclusions: Combined with arthroscopic surgery,PRP combined with arthroscopic surgery can better recover the meniscus injury process,fully reduce the knee joint pain process of patients,and effectively reduce the expression of inflammatory factors and inflammatory proteins after surgery.The patients have high postoperative satisfaction,which is worthy of further recommendation in clinical practice. |
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