目的:探讨富血小板血浆(PRP)关节腔注射联合踝关节融合术治疗老年踝关节炎的临床疗效及其对抗瓜氨酸蛋白抗体(ACPA)、细胞间黏附分子-1(ICAM-1)及类风湿因子(RF)的影响。方法:选取2023年5月—2025年5月本院骨科收治的112例老年踝关节炎患者，按随机数字表法随机分为观察组(踝关节融合术+PRP注射，n=56)与对照组(踝关节融合术，n=56)。PRP注射方案:术中注射4 mL，术后第4、6、8周分别在超声引导下注射3 mL自体PRP(血小板浓度≥4倍基线)。比较两组术后12周总有效率(OMERACT-OARSI标准)、踝关节活动度、踝关节Kofoed功能评分；血清ACPA、ICAM-1、RF水平及术后不良反应。结果:观察组总有效率显著高于对照组(91.07% vs 76.79%，P =0.040)。术后12周观察组踝关节背伸(40.03°±4.56° vs 36.05°±5.91°)、跖屈(38.83°±5.97° vs 35.03°±4.82°)及Kofoed总分(84.49±9.22 vs 72.63±8.92)均优于对照组(P <0.001)。炎症指标方面，观察组ACPA[(43.72±6.93)RU/mL vs (50.03±7.92)RU/mL]、ICAM-1[(174.23±19.92)μg/L vs (190.51±21.12)μg/L]和RF[(96.50±11.41)IU/L vs (108.09±12.25)IU/L]水平显著低于对照组(P <0.001)。两组不良反应率差异无统计学意义(14.29% vs 8.93%，P =0.376)。结论:PRP联合踝关节融合术可显著改善老年踝关节炎患者的关节功能，其机制可能与下调ACPA、ICAM-1、RF相关炎症因子表达相关，且未增加治疗风险，尤其适用于活动需求较多的老年患者。
Effect of platelet rich plasma intra articular injection combined with ankle arthrodesis on senile ankle arthritis and the levels of inflammatory factors
CUI Xiao-wei,LI Bao-kun,SUN Di
Orthopedics Department of Qinhuangdao Military Hospital, Qinhuangdao 066000, China
Abstract:
Objective To evaluate the efficacy of platelet-rich plasma (PRP) intra-articular injection combined with ankle arthrodesis for senile ankle arthritis and its effects on anti-citrullinated protein antibody (ACPA), intercellular adhesion molecule-1 (ICAM-1), and rheumatoid factor (RF). Methods A prospective randomized controlled design was adopted. A total of 112 elderly patients with ankle arthritis from May 2023 to May 2025 were included and randomly divided into the observation group (ankle arthrodesis+PRP injection, n=56) and the control group (simple arthrodesis, n=56). PRP protocol: Inject 4 mL during the operation. At the 4th, 6th, and 8th weeks after the operation, inject 3 mL of autologous PRP under ultrasound guidance respectively (platelet concentration ≥4 times the baseline). The total effective rate (OMERACT-OARSI standard), ankle range of motion and Kofoed function score of the ankle joint at 12 weeks after surgery were compared between the two groups. Serum ACPA, ICAM-1, RF levels and postoperative adverse reactions. Results The combined group showed significantly higher response rate (91.07% vs 76.79%, P =0.040) and superior ankle function: dorsiflexion (40.03°±4.56° vs 36.05°±5.91°), plantarflexion (38.83°±5.97° vs 35.03°±4.82°), and Kofoed total score (84.49±9.22 vs 72.63±8.92) (all P <0.001). Key inflammatory markers were lower in the combined group: ACPA [(43.72±6.93)RU/mL vs (50.03±7.92)RU/mL], ICAM-1[(174.23±19.92)μg/L vs (190.51±21.12)μg/L], and RF [(96.50±11.41)IU/L vs (108.09±12.25)IU/L] (P <0.001). No significant difference in adverse events was observed (14.29% vs 8.93%, P =0.376). Conclusion PRP combined with ankle arthrodesis can significantly improve the joint function of elderly patients with ankle arthritis. The mechanism may be related to the down-regulation of the expression of ACPA, ICAM-1, and RF-related inflammatory factors, and does not increase the treatment risk. It is particularly suitable for elderly patients with high activity requirements.
