超声引导下富血小板血浆注射治疗肩袖腱内撕裂的疗效分析

Ultrasound guided injection of platelet-rich plasma for intratendinous rotator cuff tear:clinical and radiological outcomes

目的探讨超声引导下自体富血小板血浆(PRP)注射对肩袖腱内撕裂的治疗效果。方法回顾性分析北京大学第三医院运动医学科于2021年7月至2022年3月连续就诊的诊断为肩袖腱内撕裂且行超声引导下PRP注射治疗的43例(46侧肩)门诊患者资料。男23例,女20例;年龄(47.8±13.5)岁。注射前病程6(4,18)个月;左肩22侧,右肩24侧。测定注射前与末次随访时患者疼痛视觉模拟评分(VAS)、美国加州大学肩关节评分(UCLA)和美国肩肘协会评分系统(ASES)评分,并应用MRI检查测量和比较注射前与注射后3~5个月肩袖腱内撕裂大小的变化。结果43例患者治疗后获15(12,17)个月随访。有7侧(15.2%,7/46)恢复到完全正常,对注射效果非常满意,有19侧(41.3%,19/46)对注射后的效果满意,总满意率为56.5%(26/46)。注射PRP后末次随访时VAS评分[3.0(2.0,4.0)分]、ASES评分[80.0(65.0,88.8)分]、UCLA评分[29.0(20.0,32.0)分]均较注射前[5.5(4.0,8.0)、55.0(39.2,65.0)、16.0(12.0,20.3)分]显著改善,差异均有统计学意义(P<0.05)。38侧患肩MRI检查显示注射后撕裂的体积为28.2(12.5,63.6)mm3,较注射前的46.1(20.9,77.5)mm3显著减小,差异有统计学意义(P<0.05)。有13侧(34.2%,13/38)患肩注射后的撕裂体积缩小超过50%。无注射中和注射后并发症发生。结论超声引导下注射PRP治疗肩袖腱内部分撕裂安全、有效,可以作为不愿手术患者或职业运动员的一种治疗选择。

Objective To investigate the clinical and radiological outcomes of ultrasound guided injection of platelet-rich plasma(PRP)in the treatment of intratendinous rotator cuff tear.Methods A retrospective study was conducted to analyze the clinical data of 43 patients(46 shoulders)who had been treated for intratendinous partial-thickness rotator cuff tear by ultrasound guided injection of PRP consecutively from July 2021 to March 2022 at Department of Sports Medicine,Peking University Third Hospital.There were 23 males and 20 females,with an age of(47.8±13.5)years and a course of disease of 6(4,18)months,involving 22 left shoulders and 24 right shoulders.The visual analog scale(VAS)pain score,the University of California at Los Angeles(UCLA)rating scale,and the shoulder index of the American Shoulder and Elbow Surgeons(ASES)were determined before injection and at the last follow-up.The changes in tear size were also evaluated by magnetic resonance imaging(MRI)before PRP injection and 3 to 5 months after PRP injection.Results The 43 patients were followed up for 15(12,17)months after treatment.Of this cohort,7 shoulders(15.2%,7/46)were recovered to complete normal and very satisfied with the injection effects while 19 shoulders(41.3%,19/46)satisfied with the effects after injection,yielding an overall satisfaction rate of 56.5%(26/46).At the last follow-up,the VAS score[3.0(2.0,4.0)points],ASES score[80.0(65.0,88.8)points],and UCLA score[29.0(20.0,32.0)points]were significantly improved compared with those before injection[5.5(4.0,8.0)points,55.0(39.2,65.0)points,and 16.0(12.0,20.3)points](P<0.05).MRI evaluation showed the tear volume was significantly reduced after PRP injection[46.1(20.9,77.5)mm3 before injection versus 28.2(12.5,63.6)mm3 after injection](P<0.05),and a>50%tear volume diminution was observed in 13 shoulders(34.2%,13/38).There were no complications during or after injection.Conclusion As the ultrasound guided injection of PRP into intratendinous lesions is effective and safe for patients with intratendinous partial-thickness rotator cuff tear,it can be an alternative treatment for the patients or professional athletes who are unwilling to undergo surgery.