PRP联合关节镜下肩峰成形术治疗肩峰下撞击综合征的效果及安全性研究

Effect and safety of platelet rich plasma combined with arthroscopic acromioplasty in the treatment of subacromial impingement syndrome

目的探讨富血小板血浆(PRP)联合关节镜下肩峰成形术治疗肩峰下撞击综合征(SIS)的效果及安全性。方法选择2020年1月至2023年1月河南中医药大学第五临床医学院(郑州人民医院)收治的80例SIS患者作为研究对象,按照随机数表法分为观察组和对照组各40例。对照组患者采用关节镜下肩峰成形术治疗,观察组患者在对照组的基础上联合PRP治疗。比较两组患者治疗前、治疗后3个月的肩功能(前屈、外展、内外旋转的活动度)、肩手综合征评估量表(SHSS)评分、上肢Fugl-Meyer运动功能(FMA)评定量表评分、视觉模拟评分法(VAS)评分、炎症因子[白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]的水平变化,并记录治疗后所发生的并发症。结果观察组患者治疗后的肩部前屈、外展、内外旋转的活动度分别为(129.14±11.58)°、(111.02±22.57)°、(67.20±12.55)°、(65.36±13.31)°,明显高于对照组的(122.31±10.62)°、(100.15±15.63)°、(55.09±12.10)°、(54.01±12.14)°,差异均有统计学意义(P<0.05);观察组患者治疗后的SHSS评分、VAS评分分别为(4.63±0.79)分、(3.02±0.74)分,明显低于对照组的(5.78±1.14)分、(3.89±0.83)分,上肢FMA评分为(36.52±3.60)分,明显高于对照组的(31.56±3.18)分,差异均有统计学意义(P<0.05);观察组患者治疗后的血清IL-1、IL-6、TNF-α水平分别为(1.15±0.16)μg/L、(0.64±0.20)μg/L、(2.10±0.44)μg/L,明显低于对照组的(1.63±0.18)μg/L、(0.95±0.24)μg/L、(2.89±0.48)μg/L,差异均有统计学意义(P<0.05);观察组患者的皮下血肿、发热、疼痛的发生率分别为5.00%、2.50%、2.50%,明显低于对照组的20.00%、15.00%、17.50%,差异均有统计学意义(P<0.05)。结论PRP联合关节镜下肩峰成形术能有效改善SIS患者的肩关节功能,促进肢体功能康复,降低炎症的水平表达,安全性高。

Objective To study the efficacy and safety of platelet rich plasma(PRP)combined with arthroscopic acromioplasty in the treatment of subacromial impingement syndrome(SIS).Methods Eighty SIS patients admitted to the Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People's Hospital)from January 2020 to January 2023 were selected and randomly divided into an observation group and a control group using a random number table method,with 40 cases in each group.Patients in the control group were treated with arthroscopic acromioplasty,and those in the observation group were treated with PRP on the basis of the control group.The changes of the shoulder function(range of motion in flexion,abduction,internal and external rotation),Shoulder Hand Syndrome Assessment Scale(SHSS),upper limb Fugl-Meyer motor function assessment(FMA),Visual Analogue Scale(VAS),inflammatory factors[interleukin-1(IL-1),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]before and at 3 months after treatment were compared between the two groups.Complications that occurred after treatment were recorded.Results In the observation group,range of motion in flexion,abduction,internal and external rotation after treatment were(129.14±11.58)°,(111.02±22.57)°,(67.20±12.55)°and(65.36±13.31)°,which were significantly higher than(122.31±10.62)°,(100.15±15.63)°,(55.09±12.10)°and(54.01±12.14)°of the control group(P<0.05).The SHSS score and VAS score of the observation group after treatment were(4.63±0.79)points and(3.02±0.74)points,which were significantly lower than(5.78±1.14)points and(3.89±0.83)points in the control group;the upper limb FMA score was(36.52±3.60)points,which were significantly higher than the control group's(31.56±3.18)points;the differences were statistically significant(P<0.05).The levels of IL-1,IL-6,and TNF-αin the observation group after treatment were(1.15±0.16)μg/L,(0.64±0.20)μg/L,and(2.10±0.44)μg/L,which were significantly lower than(1.63±0.18)μg/L,(0.95±0.24)μg/L,(2.89±0.48)μg/L in the control group(P<0.05).The incidence rates of subcutaneous hematoma,fever,and pain in the observation group were 5.00%,2.50%,and 2.50%,which were significantly lower than the control group's 20.00%,15.00%,and 17.50%(P<0.05).Conclusion PRP combined with arthroscopic acromioplasty can effectively improve the shoulder joint function of SIS patients,promote limb function rehabilitation,and reduce the level of inflammation expression,with high safety,which is worthy of promotion.