肩关节镜手术联合富血小板血浆注射对肩袖损伤患者炎症因子水平及腱-骨愈合的影响

Effects of shoulder arthroscopy combined with PRP injection on inflammatory factor levels and tendon-bone healing in patients with rotator cuff injury

目的探讨肩关节镜手术联合富血小板血浆(PRP)治疗肩袖损伤患者的效果。方法采取前瞻性研究,选取2019年1月至2021年2月泸州市中医医院收治的116例肩袖损伤患者,按照随机数字表法将其分为联合组和对照组,各58例,联合组患者资料方法为肩关节镜手术+PRP注射治疗,对照组患者仅采取肩关节镜手术方法治疗。比较两组患者治疗前后不同时间点的视觉模拟评分(VAS)、肩关节Constant评分、关节活动度、腱-骨愈合指标、血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)及临床疗效差异。结果手术后1、3个月,两组患者的VAS评分均较手术前显著降低,且联合组VAS评分显著低于对照组,差异均有统计学意义(P<0.05)。手术后3个月,两组患者的疼痛评分、活动功能影响评分、肩关节活动范围评分、肌力恢复评分、Constant总分均较手术前显著降低,且联合组患者的肩关节活动范围评分、肌力恢复评分、Constant总分显著高于对照组,差异均有统计学意义(P<0.05)。手术后3个月,两组患者的CRP、TNF-α、TGF-β1水平较手术前降低,且联合组患者的CRP、TNF-α、TGF-β1水平均低于对照组,差异均有统计学意义(P<0.05)。手术后3个月,两组患者的螺钉隧道扩大程度较手术前升高,腱-骨节点T2值较手术前降低,但两组患者的腱-骨愈合指标比较,差异均无统计学意义(P>0.05)。手术后3个月,联合组患者的总体临床疗效优于对照组,差异有统计学意义(P<0.05)。结论肩关节镜手术联合PRP治疗肩袖损伤患者的效果优于单纯使用肩关节镜手术治疗,更有利于减轻患者疼痛程度、促进肩关节功能恢复、降低患者的炎症反应程度。

Objective To investigate the effect of shoulder arthroscopic surgery combined with platelet-rich plasma(PRP)in the treatment of patients with rotator cuff injury.Methods In a prospective research study,116 patients with rotator cuff injury admitted to Luzhou Traditional Chinese Medicine Hospital from April 2019 to April 2021 were selected and divided into a combined group and a control group with 58 patients each according to the random number table.The data of patients in the combined group were treated by shoulder arthroscopy+PRP injection,while the data of patients in the control group were only treated by shoulder arthroscopy.The visual analog scale(VAS)score,shoulder constant score,joint range of motion,tendon bone healing index,serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),transforming growth factor-β1(TGF-β1)at different time points before and after treatment,and the difference of clinical efficacy were compared between the two groups.Results At 1,3 months after the operation,the VAS scores of the two groups were significantly lower than those before the operation,and the VAS scores of the combined group were significantly lower than those of the control group,the differences were statistical significance(P<0.05).At 3 months after operation,the pain score,activity function influence score,shoulder joint range of motion score,muscle strength recovery score,and total Constant score of patients in the two groups were significantly lower than those before the operation,and the shoulder joint range of motion score,muscle strength recovery score,and total Constant score of patients in the combined group were significantly higher than those in the control group(P<0.05).At 3 months after operation,the level of CRP and TNF-α,TGF-β1 of patients in both groups were lower than those before operation,and the level of CRP and TNF-α,TGF-β1 in the combined group were lower than those in the control group,and the differences were statistically significant(P<0.05).At 3 months after operation,the expansion of screw tunnel in the two groups was higher than that before the operation,and the T2 value of tendon bone node point was lower than that before the operation,but there was no significant difference between the two groups in tendon bone healing index(P>0.05).At 3 months after operation,the overall clinical efficacy of the combined group was better than that of the control group,and the difference was statistically significant(P<0.05).Conclusion The effect of shoulder arthroscopy combined with PRP in the treatment of patients with rotator cuff injury is better than that of shoulder arthroscopy alone.