富血小板血浆和干针疗法治疗肩袖部分撕裂的临床研究

Platelet rich plasma with dry needling for partial rotator cuff tears: a clinical study

目的:探讨超声引导下自体血提取富血小板血浆(PRP)注射结合干针疗法(DN)治疗肩袖部分撕裂的效果。方法:选取肩袖肌腱部分撕裂患者120例,按照数字随机法分为4组:玻璃酸钠(SH)组、PRP组、DN组、PRP+DN组,每组30例。SH组、PRP组、PRP+DN组均在超声引导下分别注射SH、PRP、PRP+DN,DN组仅进行针刺治疗。4组患者治疗后均进行基础运动康复治疗。治疗前及治疗后1个月、3个月、6个月通过超声于肌腱长轴测量损伤部位肌腱肿胀程度和撕裂范围,采用视觉模拟评分法(VAS)、美国加州大学肩关节评分表(UCLA)对4组患者进行评价。结果:相较于治疗前,治疗后各时间点PRP组、DN组、PRP+DN组患者表现为肌腱厚度减少、撕裂的范围减少(P<0.05),治疗后3个月、6个月,PRP+DN组肌腱厚度及撕裂范围较其它3组减少(P<0.05)。相较于治疗前,治疗后各时间点4组VAS评分均降低(P<0.05),UCLA评分均升高(P<0.05),治疗后3个月与6个月,PRP+DN组VAS评分低于、UCLA评分高于其它3组(P<0.05)。结论:超声引导下PRP注射结合DN治疗,肩袖部分撕裂可明显缓解患者肩部疼痛,促进肩功能快速恢复,具有良好的临床应用价值。

Objective:To investigate the effect of ultrasound-guided autologous blood extraction and platelet rich plasma(PRP)injection combined with dry needling(DN)in the treatment of partial rotator cuff tear.Methods:A total of 120 patients with partial rotator cuff tendon tear were selected and divided into 4 groups by the numerical randomization:sodium hyaluronate(SH)group,PRP group,DN group,and PRP+DN group,with 30 cases in each group.The SH group,PRP group,and PRP+DN group were injected with SH,PRP,and PRP+DN under the ultrasound guidance,while the DN group only received dry needling treatment,respectively.All patients received basic exercise rehabilitation intervention after treatment.The degree of tendon swelling and tear range at the injured site were measured by ultrasound on the long axis of the tendon before and 1 week,1 month and 3 months after treatment,and the 4 groups were evaluated by visual analog scale(VAS)score and the University of California at Los Angeles shoulder rating scale(UCLA).Results:Compared with before treatment,the thickness of tendon and the range of tear in DN group,PRP group and PRP+DN group decreased(P<0.05).After 3 and 6 months of treatment,the thickness of tendon and the range of tear in PRP+DN group were lower than the other 3 groups(P<0.05).Compared with before treatment,the VAS scores of all 4 groups decreased(P<0.05)and the UCLA scores increased(P<0.05)after treatment.After 3 and 6 months of treatment,the VAS scores in the PRP+DN group were lower and the UCLA scores were higher than the other 3 groups(P<0.05).Conclusion:Ultrasound guided autologous PRP injection combined with DN in the treatment of partial rotator cuff tear can significantly alleviate shoulder pain and promote the rapid recovery of shoulder function,which has good clinical value.