贫白细胞富血小板血浆与富白细胞富血小板血浆在关节镜下肩袖修补术中的短期疗效比较

AShort⁃term efficacy analysis of platelet⁃rich plasma in arthroscopic rotator cuff repair by comparison of LP⁃PRP and LR⁃PRP

目的通过对比单纯行关节镜下肩袖修补术,探究贫白细胞富血小板血浆(LP-PRP)与富白细胞富血小板血浆(LR-PRP)在关节镜下肩袖修补术中应用的疗效及差异。方法纳入2021年10月至2022年9月在华北理工大学附属医院收治肩袖全层撕裂并行关节镜下肩袖修补术的60例患者,随机分入对照组(n=20)、LP-PRP组(n=20)、LR-PRP组(n=20),其中对照组(n=20)仅行关节镜下肩袖修补术,LP-PRP(n=20)组在行相同术式后向已缝合的撕裂肌腱处注射贫白细胞富血小板血浆(LP-PRP),LR-PRP组(n=20)以相同方法注射富白细胞富血小板血浆(LR-PRP)。3组患者术后康复训练计划相同,术后跟踪随访1年并评估,包括疼痛评分(VAS评分),肩关节功能评分(CMS、UCLA、ASES评分)、再撕裂率及相关并发症。结果所有患者均获得随访。(1)VAS评分:LP-PRP组与LR-PRP组、对照组比较,仅在术后1、3、6周时的结果差异有统计学意义(P<0.05);LR-PRP组与对照组比较,术后1、3、6周、3、6、12个月时的结果差异均无统计学意义(P>0.05)。(2)CMS、UCLA、ASES评分:对照组与LP-PRP组、LR-PRP组相比在术后各个随访时间点比较差异有统计学意义(P<0.05);LP-PRP组与LR-PRP组比较,在术后3、6、12个月差异均无统计学意义(P>0.05)。(4)再撕裂率:LP-PRP组中无肩袖再撕裂患者,LR-PRP组中再撕裂1例(撕裂率5%),对照组中再撕裂3例(撕裂率15%),3组间比较差异无统计学意义(P>0.05)。(4)60例患者术后均未出现并发症。结论与单纯行关节镜下肩袖修补术相比,应用LP-PRP与LR-PRP虽未能降低再撕裂率,但可明显改善患者肩关节功能,且LP-PRP可显著减轻肩袖损伤患者术后早期(6周内)疼痛,术后也均未出现并发症,患者短期临床效果满意。

Objective By comparing with arthroscopic rotator cuff repair alone,to explore the efficacy and difference of leukocyte poor platelet-rich plasma(LP-PRP)and leukocyte rich platelet-rich plasma(LR-PRP)in arthroscopic rotator cuff repair.Methods Sixty patients with total rotator cuff tear accompanied by arthroscopic rotator cuff repair admitted to the Affiliated Hospital of North China University of Science and Technology from October 2021 to September 2022 were included and randomly divided into control group(n=20),LP-PRP group(n=20)and LR-PRP group(n=20).The control group only received arthroscopic rotator cuff repair.The LP-PRP group was injected with leukocyte poor platelet-rich plasma(LP-PRP)into the sutured torn tendon after the same operation,and the LR-PRP group was injected with leukocyte rich platelet-rich plasma(LR-PRP)into the sutured torn tendon after the same operation.The postoperative rehabilitation training plan of the three groups was the same,and the postoperative follow-up and evaluation were conducted for 1 year.It included pain score(VAS score),shoulder joint function score(CMS,UCLA,ASES score),retear rate and related complications.Results All patients were followed up.(1)VAS score:Compared with the LR-PRP group and the control group,the results 19were statistically significant only at 1,3 and 6 weeks after surgery(P<0.05);There was no statistical significance between the LR-PRP group and the control group at 1 week,3 weeks,6 weeks,3 months,6 months and 12 months after surgery(P>0.05).(2)CMS,UCLA and ASES scores:There were no significant differences between the LP-PRP group and the LR-PRP group at 3 months,6 months and 12 months after surgery(P>0.05);Compared with LP-PRP group and LR-PRP group,there were significant differences in each follow-up time point of control group(P<0.05).(3)Retear rate:In the LP-PRP group,there was 1 retear in the LR-PRP group(tear rate 5%),and 3 in the control group(tear rate 15%).There was no statistically significant difference between the three groups(P>0.05).(4)There were no postoperative complications in 60 patients.Conclusions Compared with arthroscopic rotator cuff repair alone,although the application of LP-PRP and LR-PRP could not reduce the rate of retear,it could significantly improve the shoulder joint function of patients,and LP-PRP could significantly reduce the pain of patients with rotator cuff injury in the early postoperative period(within 6 weeks),with no postoperative complications,and the short-term clinical results of patients were satisfactory.