富血小板血浆局部注射治疗肱骨外上髁炎的疗效

Efficacy of local injection of autologous platelet rich plasma in treatment of lateral epicondylitis

目的探讨自体富血小板血浆局部注射治疗肱骨外上髁炎的效果及可靠性,为临床治疗提供参考。方法 2013年01月至2015年01月,将南通大学附属建湖医院骨科60例拟定行局部注射治疗的患者随机分为两组:富血小板血浆组(注射应用自体富血小板血浆) 30例;糖皮质激素组(使用同等剂量的醋酸泼尼松龙注射液和利多卡因) 30例。两组治疗后康复训练方案相同。术后1、3、12个月随访并临床评价,包括注射部位炎性反应程度、疼痛视觉模糊评分(VAS)、Mayo肘关节功能评分系统(MEPS)及臂、肩、手功能障碍(DASH)评分。组间比较采用独立样本t检验,等级资料采用秩和检验,VAS评分、DASH评分及MEPS评分的总体差异分析采用重复测量资料的方差分析,各时间点的组间差异采用独立样本t检验。结果治疗后第4天,富血小板血浆组注射部位炎性反应程度无28例,轻1例,中1例,糖皮质激素组为无27例,轻2例,中1例;富血小板血浆组VAS评分由治疗前的(75±9)分降为治疗后1个月时的(64±8)分、3个月时(42±9)分及12个月时的(21±9)分,DASH评分由治疗前的(138±10)分将降为治疗后1个月时的(113±10)分、3个月时的(82±10)分及12个月时的(52±10)分,MEPS评分由治疗前的(25±4)分提高为治疗后1个月时的(45±4)分、3个月时的(63±4)分及12个月时的(82±4)分;糖皮质激素组VAS评分由治疗前的(74±9)分降为治疗后1个月时的(53±9)分、3个月时的(45±8)分及12个月时的(55±9)分,DASH评分由治疗前的(133±11)分将降为治疗后1个月时的(99±10)分、3个月时的(85±10)分及12个月时的(98±10)分,MEPS评分由治疗前的(27±4)分提高为治疗后1个月时的(54±4)分、3个月时的(62±4)分及12个月时的(47±5)分。两组注射部位炎性反应程度比较差异无统计学意义(P> 0. 05)。两组VAS评分、DASH评分及MEPS评分的总体差异有统计学意义(组间VAS:F=15. 98,P <0. 01; DASH:F=15. 00,P <0. 01; MEPS:F=68. 98,P <0. 01),两组组间比较治疗后1个月、12个月VAS评分、DASH评分及MEPS评分比较差异有统计学意义(1个月VAS:t=5. 0034,1个月DASH:t=5. 4442,1个月MEPS:t=8. 7142,P <0. 05; 12个月VAS:t=14,6313,12个月DASH:t=17. 8157,12个月MEPS:t=29. 9390,P <0. 05),而治疗后3个月VAS评分、DASH评分及MEPS评分比较差异无统计学意义(VAS:t=1. 3646,DASH:t=1. 1619,MEPS:t=0. 9682,P> 0. 05)。结论自体富血小板血浆及糖皮质激素局部注射治疗肱骨外上髁炎均能缓解疼痛,恢复肘关节功能;但糖皮质激素早期起效快,后期治疗效果缓和,自体富血小板血浆治疗效果逐渐提高,同时不增加治疗后的并发症,从长远看值得推广。

Objective To investigate the effect of local injection of autologous platelet rich plasma in the treatment of lateral epicondylitis.Methods From January 2013 to January 2015,60 patients with lateral epicondylitis undergent local injection therapy were randomly divided into two groups:PRP group(30 patients received autologous PRP)and glucocorticoid group(30 patients received prednisolone acetate and lidocaine).All the patients had the same accelerated rehabilitation protocol and were followed up in one,three,and 12 months.Evaluation consisted of inflammatory reaction,visual analogue scale(VAS),Mayo elbow performance score(MEPS)and disablities of the arm shoulder and hand(DASH)score.Independent samples t test was used to compared two groups,grade data used rank sum test.Overall differences in VAS,MEPS,DASH scores were analyzed by variance for repeated measurement data,differences at each time point were analyzed by independent samples t test.Results After the operation,no inflammatory reaction was in 28 cases of the PRP group and in 27 cases of the glucocorticoid group,mid inflammatory reaction in one case of PRP group and in two cases of glucocorticoid group,moderate inflammatory reaction in one case of PRP group and in one case of glucocorticoid group.In PRP group,the pretreatment,one month,three months and 12 months post-treatment VAS scores were(75±9),(64±8),(42±9),(21±9);DASH scores were(138±10),(113±10),(82±10),(52±10),MEPS scores were(25±4),(45±4),(63±4),(82±4).In glucocorticoid group,the pretreatme,1month,3 months and 12 months post-treatment VAS scores were(74±9),(53±9),(45±8),(55±9),DASH scores were(133±11),(99±10),(85±10),(98±10),MEPS scores were(27±4),(54±4),(62±4),(47±5).Inflammatory reaction was not statistically significant different between the two groups(P>0.05).The total difference of VAS,DASH,MEPS score between the two groups were statistically significant(VAS F=15.98,P<0.01;DASH F=15.00,P<0.01 MEPS;F=68.98,P<0.01).One month and three months postoperative VAS,MEPS,DASH were statistically significant different in the PRP group and the glucocorticoid group(one month VAS t=5.0034,one month DASH t=5.4442,one month MEPS t=8.7142,P<0.05;12 months VAS t=14.6313,12 months DASH t=17.8157,12 months MEPS t=29.9390,P<0.05),but three months postoperative VAS,DASH,MEPS differences were not statistically significant between the two groups(VAS t=1.3646,DASH t=1.1619,MEPS t=0.9682,P>0.05).Conclusions Antologous PRP and glucocorticoid local injection in the treatment of external humeral epicondylitis can alleviate pain,restore the function of elbow joint.Glucocorticoid may be better at the begining and then the effect will decline,whereas PRP can progressively improve effects without adverse effects,which is worthy of promotion in the clinic.