Radiofrequency combined with platelet-rich plasma for repair of white meniscal tears

doi:10.3969/j.issn.2095-4344.2017.20.002

Abstract

Abstract:

BACKGROUND: Both biological and physical methods contribute to the repair of white meniscal tears, so the combined use will be better.
OBJECTIVE: To study the influence of radiofrequency combined with platelet-rich plasma (PRP) on the repair of white meniscal tears.
METHODS: Forty-eight adult New Zealand white rabbits were randomly divided into four groups, including simple suture, radiofrequency, PRP, and combination groups, and then the model of medial meniscus posterior root tears was established in all experimental animals. The simple suture group underwent interrupted mattress suture; the radiofrequency group was treated with radiofrequency (20 W, 45 ℃) after suture; the PRP group received the intra-articular injection of PRP after suture; the combination group was firstly treated with radiofrequency after suture, and then underwent the intra-articular injection of PRP. The gross and histological changes of the meniscus were observed, and the expression levels of transforming growth factor β1, vascular endothelial growth factor and platelet-derived growth factor were detected at 3 and 12 weeks postoperatively.
RESULTS AND CONCLUSION: At 12 weeks after operation, the simple suture group showed no healing; the radiofrequency and PRP groups healed partially; and the combination group healed completely, and chondrocytes and collagen fibers arranged regularly. There was a significant difference in the healing rate between combination and simple suture groups (P=0.003). At 3 weeks postoperatively, the expression levels of vascular endothelial growth factor in the radiofrequency, PRP and combination groups were obviously higher than that in the simple suture group, which decreased markedly at the 12th week. At 3 weeks postoperatively, the expression level of platelet-derived growth factor was increased in all groups, especially in the PRP and combination groups. The PRP group showed the highest level of transforming growth factor β1 at 12 weeks postoperatively. These results manifest that the combination of radiofrequency and PRP promotes the repair of white meniscal tears by increasing the cell proliferation, cell mitosis and angiogenesis.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Menisci, Tibial, Cather, Ablation, Platelet-Rich Plasma, Lacerations, Tissue Engineering

CLC Number:

R318

Zhou Wei-feng, Zhu Lin, Jiang Xue-feng, Wang Ya-bin. Radiofrequency combined with platelet-rich plasma for repair of white meniscal tears[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(20): 3123-3128.

Figures/Tables 1

2.1 实验动物数量分析实验选用新西兰大白兔48只，分为4组，实验过程无脱失，全部进入结果分析。 2.2 标本大体观察术后观察4组兔膝关节滑膜不同程度增生，均无切口感染；单纯缝合组12周后半月板裂口均未愈合，创口内充满滑液，未见组织填充，半月板表面变粗糙，探针探查无任何连接；射频组12周后半月板伤口部分被组织填充，裂口较术前变窄；富血小板血浆组12周后半月板伤口均已基本被组织填充，探针可挑开创口，愈合组织的颜色比正常半月板组织深，裂口较术前变窄，其表面稍向内凹陷；射频联合富血小板血浆组12周后伤口基本愈合。 2.3 组织学观察术后12周，如图1所示：单纯缝合组的半月板裂口仍然未见愈合，裂口边缘的软骨细胞处于不活跃、低代谢状态，细胞体积小，细胞死亡，软骨囊消失，胶原纤维进一步减少，半月板变薄，颜色变苍白，韧性和弹性下降；射频组半月板创口被部分填塞，镜下见半月板组织愈合呈瘢痕样愈合；富血小板血浆组半月板创口被填塞，创口粘合，镜下见半月板组织愈合呈瘢痕样愈合；射频联合富血小板血浆组半月板创口闭合，愈合组织内可见软骨细胞，有软骨囊形成，胶原纤维排列较前规则。 2.4 各组愈合效果的评级比较术后12周将各组半月板愈合情况，按Henning CE的评价标准对愈合效果进行评级，具体结果见表1。对4组愈合效果采用秩和检验进行比较(P=0.002)，差异有显著性意义，因此可以认为各组间愈合效果不同。再进行组间两两比较，发现仅在单纯缝合组与射频联合富血小板血浆组之间差异有显著性意义(P=0.001)，其余各组之间愈合效果没有差别。因此，可以认为射频联合富血小板血浆治疗半月板白区撕裂与单纯缝合比较，更有利于半月板的愈合。 2.5 单位质量半月板组织中转化生长因子、血管内皮生长因子、血小板衍生生长因子的含量见表2-4。在术后第3周和第12周，如表2所示：各实验组转化生长因子β1含量较单纯缝合组均增加(P < 0.05)。在相同组别，与3周时相比单位质量半月板组织中转化生长因子β1含量在12周时均明显下降(P < 0.01)。从表3可以看出在3周时射频组、富血小板血浆组及射频联合富血小板血浆组血管内皮生长因子的表达较单纯缝合组明显增高(P < 0.01)；在12周时，仅富血小板血浆组和射频联合富血小板血浆组血管内皮生长因子含量较单纯缝合组明显增加(P < 0.01)。12周时各组血管内皮生长因子含量已明显下降(P < 0.01)。表4说明在3周时各实验组，尤其是富血小板血浆组和射频联合富血小板血浆组，血小板衍生生长因子的表达较单纯缝合组增高。12周时各组血小板衍生生长因子表达均明显下降(P < 0.01)。"

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