Objective:To investigate the effect of platelet rich plasma combined with high tibial osteotomy in the treatment of knee osteoarthritis.Methods:Sixty-one patients with knee osteoarthritis admitted to Hebei Eighth People's Hospital from April 2017 to October 2020 were selected as research subjects, which all met the relevant diagnostic criteria of knee osteoarthritis; grade Ⅱ~Ⅳof Kellgren-Lawrence grading scale (K-L) for osteoarthritis; normal meniscus function and lateral cartilage of the knee joint, etc.. Exclusion criteria: instable knee joint, multiple compartment cartilage lesions, loose body in knee joint, other arthritis diseases, severe cerebral-cardiovascular diseases or hepatic-renal insufficiency, severe osteoporosis. The patients were divided into two groups according to the random number table method: 31 cases in the combined group were treated by high tibial osteotomy combined with platelet-rich plasma, while the other 30 cases in the osteotomy group were treated by high tibial osteotomy. Perioperative indicators and postoperative complication rates between the two groups were compared. Repeated measurement analysis of variance was used to analyze the American Hospital for Special Surgery (HSS) scores, Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, visual analogue scale (VAS), the femoral tibial angle (FTA), the posterior tibial slope (PTS), the proximal medial tibial angle (MPTA), and the knee varus angle (KVA) of the two groups before operation, at one month and six months after operation; fibrinogen (FIB), D-dimer (D-D), thromboxane (TXA2) and the expression of miR-140 and miR-155 in knee joint fluid before and one month after operation were also analyzed.Results:There was no statistically significant difference in the operating time, intraoperative blood loss, postoperative drainage and the ambulant time between the two groups (t=1.095, 0.900, 0.313, 0.698, all P>0.05). Six months after surgery, the HSS score and WOMAC score in the combined group were higher than those in the osteotomy group, and the VAS score was lower than those in the osteotomy group, and the differences were statistically significant (F=6.426, 6.514, 6.552, all P<0.05). Compared with preoperative data, both groups showed a significant decrease in FTA and PTS at one and six months after surgery, while MPTA and KVA increased significantly (F=5.528, 5.556, 5.506, 5.223, all P<0.05). There was no statistically significant difference in FIB, D-D, and TXA2 between the two groups before and one month after surgery (all P>0.05). At six months after surgery, the miR-155 in the knee joint fluid of the combined group was lower than that of the osteotomy group, and the expression of miR-140 was higher than that of the osteotomy group, with statistically significant differences (t=2.198, 4.622, both P<0.05). The difference in complication incidence between the two groups was not statistically significant (χ2=0.601, P>0.05).Conclusion:High tibial osteotomy combined with platelet-rich plasma in the treatment of knee osteoarthritis can improve the coagulation function of patients, regulate the expression of miR-140 and miR-155 in knee joint fluid, improve knee joint function and relieve pain, and is worthy of clinical promotion and application.

目的 探讨不同截骨方法联合关节镜治疗内侧膝骨关节炎的疗效.方法 选取2019年1月至2021年1月河北省第八人民医院124例内侧膝骨关节炎患者,按随机数字表法分为双平面组(62例)和单平面组(62例),两组均行关节镜+胫骨高位截骨术(high tibial osteotomy,HTO),双平面组采取双平面截骨,单平面组采取单平面截骨.统计两组围手术期指标、并发症、膝关节功能恢复优良率,比较术前、术后6个月下肢力线相关指标[膝关节内翻角(knee varus angle,KVA)、股胫角(femur tibia angle,FTA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)]、美国特种外科医院膝关节评(hospital for special surgery knee score,HSS)、疼痛视觉模拟评分(visual analogue scale,VAS).结果 (1)术后6个月双平面组骨性愈合时间短于单平面组(P＜0.05);(2)术后6个月双平面组MPTA高于单平面组,FTA、KVA低于单平面组(P＜0.05);(3)术后6个月双平面组HSS评分高于单平面组,VAS评分低于单平面组(P＜0.05);(4)双平面组并发症发生率1.61％与单平面组8.06％比较,差异无统计学意义(P＞0.05);(5)术后6个月双平面组膝关节功能恢复优良率88.71％高于单平面组的74.20％(P＜0.05).结论 关节镜联合双平面截骨在膝关节功能、疼痛评分、下肢力线、骨折愈合方面改善效果优于关节镜联合单平面截骨,可作为治疗内侧膝骨关节炎的有效手段之一.