富血小板血浆并肱骨大结节成形在肩袖修复中的应用

Platelet-rich plasma and tuberoplasty for surgical repair of rotator cuff tears

[目的]探讨富血小板血浆(Platelet-rich plasma,PRP)并肱骨大结节成型在肩袖修复中的应用价值。[方法]回顾性分析2013年8月~2015年6月本科手术治疗的肩袖全层撕裂患者31例,肩袖修复术中应用PRP并行肱骨大结节成形。男19例,女12例,年龄49~65岁;左肩9例,右肩22例。其中合并Bankart损伤3例,SLAP损伤2例,合并肱二头肌肌腱长头损伤5例。通过比较手术前后术前疼痛视觉模拟评分(VAS)及美国加州大学肩关节功能评分(UCLA)评估手术疗效。[结果]27例患者获得随访,随访时间14~32个月,平均(23.20±6.11)个月。末次随访时,VAS评分(0.72±0.71)分,较术前(5.92±0.78)分差异具有统计学意义(t=24.374,P<0.001),UCLA评分(32.40±1.59)分,较术前(20.63±2.14)分差异具有统计学意义(t=-23.760,P<0.001),术后复查X线片显示肱骨大结节平滑,MRI显示肩袖愈合良好。[结论]PRP注射并大结节成型修复全层肩袖撕裂效果肯定,能有效缓解患者肩关节疼痛、恢复肩关节功能,是一种治疗全层肩袖撕裂的有效手段。

[Objective] To investigate the clinical outcome of local injection of platelet-rich plasma （PRP） combined with tuberoplasty of great tubercle in surgical procedure of rotator cuff repair. [Methods] A retrospective study was conducted on 31 patients with full-thickness rotator cuff tears, which were arthroscopically repaired by anchor suture along with local injection of PRP and tuberoplasty in our department from August 2013 to June 2015. The patients included 19 men and 12 women, aged from 49 to 65 years. The lesion involved the left shoulder in nine patients and the right in twenty-two, and was complicated with the Bankart injury in three patients, the SLAP injury in two, as well as the injury of long head of biceps tendon in five. Visual analogue score （VAS） and the University of California shoulder function score （UCLA） were used to assess the outcomes. [Results] Of them, 27 patients were followed up for14 to 32 months with an average of 23.2 months. VAS score decreased from （5.92±0.75） preoperatively to （0.72±0.71） at the latest follow-up, with a statistical difference （t=24.37g, P 〉 0.001 ） . Additionally, UCLA score increased from （20.63±2.1g） preoperatively to （32.40± 1.59） at the final follow up, associated with a significant difference between the two time points （t=-23.760, P 〉 0.001） . Moreover, X-ray and MR examinations at the follow up showed a smooth contour of the great tubercle and fine healing of repaired rotator cuff. [Conclusion] PRP injection and tuberoplasty in rotator cuff repair do significantly reduce postoperative shoulder pain and improve joint functions, maybe an effective management for full-thickness rotator cuff tears.