富血小板血浆对改良 Broström-Gould 手术后慢性外侧踝关节不稳的疗效：一项随机、单盲、前瞻性对照试验
Efficacy of Platelet-Rich Plasma for Chronic Lateral Ankle Instability After Modified Broström-Gould surgery: A Randomized, Single-Blinded, Prospective Controlled Trial.
作者信息
Sabaghzadeh Amir, Zarei Kurdkandi Hooshmand, Ebrahimpour Adel, Biglari Farsad, Jafari Kafiabadi Meisam
机构信息
Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
Foot Ankle Orthop. 2023 Apr 26;8(2):24730114231168633. doi: 10.1177/24730114231168633. eCollection 2023 Apr.
BACKGROUND
Modified Broström-Gould (MBG) surgery is frequently used for chronic lateral ankle instability (CLAI). However, conventional postoperative management (CPOM) due to prolonged immobilization may have adverse effects on tendons, ligaments, and joints, causing stiffness. This prospective, randomized controlled trial aimed to determine outcomes among patients randomized to receive CPOM plus ultrasonography-guided triple injections of leukocyte-rich platelet-rich plasma (LR-PRP) compared to patients who receive only CPOM after MBG surgery.
METHODS
The present study included 40 patients with symptomatic CLAI who were candidates for the MBG surgery. The patients were randomized into 2 groups of 20, the control and PRP groups. In the PRP group, patients were injected with 3 doses of LR-PRP solution using ultrasonographic guidance. In the first injection, 2 mL of LR-PRP was injected near the injury site, and in the second and third injections, 4 mL of LR-PRP was injected in the tibiotalar joint. All patients received a short leg splint for 2 weeks, followed by 4 weeks in a walking boot. The primary outcome measure was the visual analog scale (VAS), and the secondary outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and ankle total range of motion (total ROM). The assessment was performed at baseline and 3 and 6 months after surgery.
RESULTS
The mean VAS and AOFAS scores improved significantly in both groups 6 months after surgery ( < .001). However, the PRP group did not significantly improve in VAS or AOFAS scores compared with the control group. No clinically significant difference was observed between the 2 groups regarding the total ROM scores at month 3.
CONCLUSION
The application of LR-PRP after MBG surgery did not show any superior clinical or functional improvement over CPOM.
LEVEL OF EVIDENCE
Level II, prospective randomized trial.
背景
改良 Broström-Gould（MBG）手术常用于慢性外侧踝关节不稳（CLAI）。然而，由于长期固定的传统术后管理（CPOM）可能会对肌腱、韧带和关节产生不良影响，导致僵硬。本前瞻性随机对照试验旨在确定与仅接受 MBG 手术后 CPOM 的患者相比，随机接受 CPOM 加超声引导下三次注射富含白细胞的富血小板血浆（LR-PRP）的患者的治疗效果。
方法
本研究纳入了 40 例有症状的 CLAI 患者，他们均为 MBG 手术的候选者。患者被随机分为两组，每组 20 例，即对照组和 PRP 组。在 PRP 组中，患者在超声引导下注射 3 剂 LR-PRP 溶液。第一次注射时，在损伤部位附近注射 2 mL LR-PRP，第二次和第三次注射时，在胫距关节注射 4 mL LR-PRP。所有患者均接受短腿夹板固定 2 周，随后穿步行靴 4 周。主要结局指标为视觉模拟量表（VAS），次要结局指标为美国矫形足踝协会（AOFAS）踝后足量表和踝关节总活动范围（总 ROM）。在基线以及术后 3 个月和 6 个月进行评估。
结果
两组患者术后 6 个月时，平均 VAS 和 AOFAS 评分均显著改善（<0.001）。然而，与对照组相比，PRP 组的 VAS 或 AOFAS 评分并未显著改善。在术后 3 个月时，两组之间的总 ROM 评分未观察到临床显著差异。
结论
MBG 手术后应用 LR-PRP 与 CPOM 相比，并未显示出任何更优的临床或功能改善。
证据水平
II 级，前瞻性随机试验。
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