快速康复外科理念联合富含血小板血浆于关节镜下治疗肩袖损伤的临床疗效

Clinical Efficacy of ERAS Combined with PRP in the Treatment of Rotator Cuff Injury under Shoulder Arthroscopy

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念联合自体富血小板血浆(platelet-rich plasma,PRP)于肩关节镜下治疗肩袖损伤的临床疗效。方法前瞻性地选取2018年1月至2019年12月于新疆维吾尔自治区人民医院骨科关节与运动医学病区明确诊断为肩袖损伤并拟行肩关节镜下治疗的120例病人为研究对象,随机分为三组,每组40例。A组男16例,女24例,年龄为(57.60±12.09)岁,采用单纯肩关节镜治疗;B组男17例,女23例,年龄为(56.85±8.32)岁,采用ERAS+肩关节镜治疗;C组男20例,女20例,年龄为(55.90±11.98)岁,采用ERAS+PRP+肩关节镜治疗。记录并比较三组术前、术后6周、术后6个月的美国加州大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节评分、疼痛视觉模拟量表(visual analogue scale,VAS)评分、Constant-Murle评分、并发症等。结果120例病人手术顺利,未出现切口感染及血管、神经损伤等手术相关并发症;三组肿胀、关节僵硬发生率比较,差异均无统计学意义(P均>0.05)。术后6周、6个月时,三组的UCLA总分、ConstantMurley评分均较术前明显逐步上升,C组得分最高,且三组间比较,差异均有统计学意义(P均<0.05);三组的VAS评分均较术前明显逐步递减,C组得分最低,但三组间比较,差异无统计学意义(P>0.05)。结论ERAS理念联合PRP于肩关节镜下治疗肩袖损伤疗效明确,可明显提高病人预后,降低术后并发症发生率,改善功能评分,患肩功能恢复理想。

Objective To investigate the clinical efficacy of the enhanced recovery after surgery(ERAS)combined with autologous platelet⁃rich plasma(PRP)for the treatment of rotator cuff injury under shoulder arthroscopy.Methods Totally,120 patients who were clearly diagnosed with rotator cuff injury in People􀆳s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were prospectively selected and planned to undergo shoulder arthroscopic treatment as the research objects.They were randomly divided into 3 groups,40 cases in each group.There were 16 males and 24 females in group A,aged(57.60±12.09)years old,and they were given shoulder arthroscopy;In group B,there were 17 males and 23 females,aged(56.85±8.32)years old,and they were subjected to ERAS+shoulder arthroscopy;In group C,there were 20 males and 20 females,aged(55.90±11.98)years old,and they were treated with ERAS+PRP+shoulder arthroscopy.University of California Los Angeles(UCLA)shoulder joint scores,visual analogue scale(VAS)scores,Constant⁃Murley score and complications were recorded and compared among three groups before and 6 weeks,6 months after surgery.Results There was no significant difference in the incidence of swelling and joint stiffness among three groups(P>0.05).At 6th week and 6th month after surgery,the total UCLA shoulder joint score and Constant⁃Murley score in the three groups were significantly increased gradually as compared with those before surgery,with the highest score in group C,and the differences among the three groups were statistically significant(P<0.05).The VAS scores in the three groups before surgery decreased significantly gradually as compared with those before surgery,and the score of group C was the lowest,but there was no statistically significant difference among the three groups(P>0.05).Conclusion The combination of ERAS and PRP in the treatment of rotator cuff injury under shoulder arthroscopy has a significant effect,which can significantly improve the prognosis of rotator cuff injury,reduce the incidence of postoperative complications,improve the functional score and prognosis,and make the functional recovery of the affected shoulder ideal.