肩峰下注射富血小板血浆治疗部分肩袖损伤研究

Impact of platelet -rich plasma on partial thickness rotator cuff injuries a prospective randomized study

目的探讨肩峰下注射富血小板血浆(PRP)对部分肩袖损伤的修复作用。方法32例经肩关节磁共振确诊为肩袖部分损伤的患者按随机数字表法随机分为PRP组及对照组,其中PRP组16例,在B超定位下经肩峰下间隙注入自体PRP 8 ml,对照组(16例)在B超定位下经肩峰下间隙注入自体静脉血8 ml。分别记录术前及术后6周、6个月的视觉模拟评分(VAS)、Constant-Murley评分(CMS)及肩关节活动度(ROM)包括主被动前屈、外展、内旋及外旋活动度。结果全部32例患者获得随访,两组患者之间性别、侧别及年龄的差异无统计学意义;术前两组患者的VAS评分、CMS评分及肩关节主被动前屈、外展、内旋及外旋ROM的差异无统计学意义,两组患者具有可比性。PRP组患者的VAS由术前的(6.8±2.1)分降低到术后6周及6个月的(4.2±2.5)及(3.4±1.8)分;PRP组患者的CMS由术前的(46.2±8.9)分提高到术后6周及6个月的(78.8±18.2)及(89.8±18.0)分;对照组患者术前的VAS及CMS分别为:(6.5±1.6)及(48.0±10.0)分,对照组患者术后6周及6个月的VAS及CMS分别为(6.3±2.8)、(52.8±14.5)及(5.9±2.5)、(60.3±12.1)分(P<0.01)。与对照组比较,PRP组患者术后6周及术后6个月的VAS评分明显降低、CMS评分明显升高,肩关节主动前屈、外展及内旋活动度明显提高,差异有统计学意义;PRP组患者术后6周及术后6个月肩关节被动活动度及主动外旋活动度与对照组的差异无统计学意义(P>0.05)。结论B超定位下肩峰下注射富血小板血浆后6个月内可以减轻部分肩袖损伤患者的肩关节疼痛、改善其肩关节功能。

Objective This prospective randomized study was conducted to assess impact of platelet-rich plasma on partial thickness rotator cuff injuries.Methods Thirty-two patients with partial thickness rotator cuff injuries were randomly assigned to receive ultrasound-navigated subacromial injection of Platelet-Rich Plasma (n=16) or autologous blood (n=16). All patients were assessed before injection, 6 weeks, 6 months after injection, using the Constant-Murley Score (CMS), a Visual Analog Scale (VAS) for pain and active and passive range of motion (ROM) of shoulder.Results The clinical effect of the platelet-rich plasma injection was superior to the blood injection from six weeks to six months after initial injection. At six weeks and six months the mean VAS and CMS was 4.2±2.5, 78.8±18.2 and 3.4±1.8, 89.8±18 in the platelet-rich plasma group versus 6.3±2.8, 52.8±14.5 and 5.9±2.5, 60.3±12.1 in the control group (P<0.01). Active ranges of motion of shoulder including active flexion, abduction, internal rotation in the platelet-rich plasma group were superior to the control group at six weeks and six months after injection.Conclusion Autologous platelet-rich plasma injections lead to a progressive reduction in the pain and disability on partial thickness rotator cuff injuries.