探究关节腔内注射富血小板血浆（PRP）联合关节镜手术治疗膝骨关节炎（KOA）疗效及对血清Toll样受体4（TLR-4）、基质金属蛋白酶-3（MMP-3）的影响。

选取2024年1月至2025年1月邢台医学院第二附属医院骨二科收治的100例KOA患者为研究对象，按照随机数表法分为研究组与对照组，每组50例。对照组行关节镜微创处理并注射透明质酸，研究组行关节镜微创清理联合PRP关节腔注射治疗。治疗后3个月进行疗效评估。建立4级评估体系，进行有效率计算。通过膝关节疼痛数字评价量表（NRS）比较2组患者疼痛情况；采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）比较膝关节功能损伤情况。比较关节活动度（ROM）、Lysholm评分及术后7 d血清TLR-4、MMP-3水平。

研究组总有效率90.00%高于对照组70.00%（χ²=6.250，P<0.05）；2组疼痛NRS评分治疗后均有所降低 （t研究组=20.944、t_对照组=17.821，P均<0.001），且研究组NRS评分低于对照组（t=9.909，P<0.001）；2组WOMAC治疗后均有所降低（t研究组=13.900、t_对照组=9.266，P均<0.001），且研究组评分低于对照组（t=4.416，P<0.05）；治疗后，2组膝关节活动度均改善（t研究组= 22.921、t_对照组=16.993，P均<0.001）、Lysholm评分均上升（t研究组=14.637、t_对照组=7.975，P均<0.001），且研究组高于对照组（t_膝ROM=3.273，P=0.002；t_{Lysholm评分}=5.718， P<0.001）；治疗后，2组MMP-3（t研究组=8.063，P<0.001；t_对照组=3.108，P=0.003）、TLR-4水平均有降低（t研究组= 20.640、t_对照组=16.492，P均<0.001），且研究组低于对照组（t_MMP-3=5.788、t_TLR-4=4.669，P均<0.001）；2组并发症发生率比较差异无统计学意义（χ²=0.400，P>0.05）。

关节腔内注射PRP联合关节镜清理术治疗KOA具有显著临床价值，患者疼痛程度显著减轻，疾病病理进程得到有效延缓，膝关节功能评分亦明显提高，在降低TLR-4水平和调节MMP-3水平方面更具有优势。

To explore the clinical effect of intra-articular injection of platelet-rich plasma （PRP） combined with arthroscopic surgery and its influences on serum Toll-like receptor 4 （TLR-4） and matrix metalloproteinase-3 （MMP-3） in knee osteoarthritis （KOA）.

A total of 100 patients with KOA treated in the Second Department of Orthopedics, the Second Affiliated Hospital of Xingtai Medical College were enrolled as the research objects between January 2024 and January 2025. According to random number table method， they were divided into control group （arthroscopic minimally invasive debridement + injection of hyaluronic acid） and study group （arthroscopic minimally invasive debridement + intra-articular injection of PRP）， 50 cases in each group. The curative effect was compared between the two groups， and evaluation of curative effect was performed at 3 months after treatment. According to 4-level evaluation system， effective rate was calculated. The pain degree was compared between the two groups by numerical rating scale for pain （NRS）, the impairment of knee function was compared by Western Ontario and McMaster universities osteoarthritis index （WOMAC）, the range of motion （ROM）， Lysholm score， levels of serum TLR-4 and MMP-3 7 days after surgery were compared.

The total response rate of study group was higher than that of control group （90.00% vs 70.00%， χ²=6.250， P<0.05）. After treatment， NRS scores were decreased in both groups （t_{study group}=20.944， t_{control group}=17.821； both P<0.001）， which were lower in study group than control group （t=9.909， P<0.001）. After treatment， WOMAC scores were decreased in both groups （t_{study group}=13.900， t_{control group}=9.266； both P<0.001）， which were lower in study group than control group （t=4.416， P<0.05）. After treatment， range of motion and Lysholm score were increased in both groups （range of motion： t_{study group}=22.921， t_{control group}=16.993， both P<0.001； Lysholm score： t_{study group}=14.637， t_{control group}=7.975， both P<0.001）， which were higher in study group than control group （t_{range of motion}=3.273， P=0.002， t_{Lysholm score}=5.718， P<0.001）. After treatment， levels of MMP-3 and TLR-4 were decreased in both groups （MMP-3： t_{study group}=8.063， P<0.001， t_{control group}=3.108， P=0.003； TLR-4： t_{study group}=20.640， t_{control group}=16.492， both P<0.001）， which were lower in study group than control group （t_MMP-3=5.788， t_TLR-4=4.669，both P<0.001）. There was no significant difference in the incidence of complications between the two groups （χ²=0.400， P>0.05）.

Curative effect of intra-articular injection of PRP combined with arthroscopic debridement is significant in KOA patients， which can significantly relieve pain， delay disease progression， improve knee function and has more advantages in reducing TLR-4 level and regulating MMP-3 level.