Has platelet-rich plasma any role in partial tears of the anterior cruciate ligament?Prospective comparative study

BACKGROUND Partial tears of the anterior cruciate ligament(ACL)are frequent,and there is still considerable controversy surrounding their diagnosis,natural history and treatment.AIM To examine patient-reported outcomes,physical examination and magnetic resonance imaging(MRI)findings of partial ACL tears treated with an intraarticular injection of platelet-rich plasma(PRP)compared to a control group.METHODS From January 2015 to November 2017,consecutive patients from a single institution with partial ACL tears treated nonoperatively were prospectively evaluated.Partial tears were defined as a positive Lachman test with a clear endpoint,a negative pivot-shift and less than 3 mm of side-to-side difference using the KT1000 arthrometer.Patients in group 1 were treated with one intraarticular injection of PRP and specific physical therapy protocol.Control group consisted of patients treated only with physical therapy.Prospective analyzed data included physical examination,Tegner activity level and Lysholm and International Knee Documentation Committee scores.Baseline MRI findings and at 6 mo follow-up were reviewed.Failure was defined as those patients with clinical instability at follow-up that required a subsequent ACL reconstruction.RESULTS A total of 40 patients where included,21 treated with PRP injection with a mean follow-up of 25 mo[standard deviation(SD):3.6]and 19 in the control group with a mean follow-up of 25 mo(SD:5.68).Overall failure rate was 32.0%(n=13).No significant differences were observed between groups regarding subjective outcomes,return to sport and failure rate.MRI findings revealed an improvement in the ACL signal in half of the patients of both groups.However,we did not find a significant relationship between MRI findings and clinical outcomes.CONCLUSION Overall,95.0%of patients returned to sports at a mean follow-up of 25 mo.Mean time to return to sports was 4 mo.Out of these patients,almost 30.0%in each group had a new episode of instability and required surgery at a median time of 5 mo in group 1 and 8 mo in group 2.The addition of PRP alone was not sufficient to enhance any of the outcome measures evaluated,including MRI images,clinical evaluation and failure rate.

Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique

Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.

Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors

AIM:To evaluate the effect of the application of plasma rich in growth factors(PRGF)-Endoret to the remaining intact bundle in partial anterior cruciate ligament(ACL)tears.METHODS:A retrospective review of the rate of return to play in football players treated with the application of PRGF-Endoret in the remaining intact bundle in partial ACL injuries that underwent surgery for knee instability.Patients with knee instability requiring revision surgery for remnant ACL were selected.PRGF was applied in the wider part of posterolateral bundle and the time it took patients to return to their full sporting activities at the same level before the injury was evaluated.RESULTS:A total of 19 patients were reviewed.Three had a Tegner activity level of 10 and the remaining 16level 9.The time between the injury and the time of surgery was 5.78 wk(SD 1.57).In total,81.75%(16/19)returned to the same pre-injury level of sport activity(Tegner 9-10).17 males and 2 females were treated.The rate of associated injury was 68.42%meniscal lesions and 26.31%cartilage lesions.The KT-1000 values were normalized in all operated cases.One patient was not able to return to sport due to the extent of their cartilage lesions.The 15 patients with Tegner activity level 9 returned to play at an average of 16.20 wk(SD1.44)while the 3 patients with Tegner activity level 10did so in 12.33 wk(SD 1.11).CONCLUSION:With one remaining intact bundle the application of PRGF-Endoret in instability cases due to partial ACL tear showed high return to sport rates at pre-injury level in professional football players.

Evaluation of the Early Functional Outcome Following Arthroscopic Partial Meniscectomy for Meniscal Tears

Meniscal tears are among the common knee pathologies which affect activities of daily living if not managed properly. Arthroscopic knee surgery is an evolving procedure in our environment and patient satisfaction with this procedure needs to be evaluated. This was a prospective study carried out between June 2017 and May 2018 with the aim to determine the effectiveness of Arthroscopic Partial Meniscectomy in the management of meniscal tears in our environment. The Western Ontario Meniscal Evaluation Tool (WOMET) Knee Score was used to assess patient satisfaction with this procedure. A total of thirty-one patients were recruited into the study consisting of eighteen males and thirteen females with an average age of thirteen years (17 - 48 years) who underwent arthroscopic partial meniscectomy. Preoperative and postoperative knee scores at 6 weeks and 12 weeks were compared using the Western Ontario Meniscal Evaluation Tool. At the end of the study period, data collated were analyzed using the specified tools. In terms of clinical outcomes, arthroscopic partial meniscectomy showed statistically significant improvement of symptoms as evidenced by a mean knee score of 75.6 (SD 9.3) at 6 weeks, 87.7 (SD 4.7) at 12 weeks compared with a preoperative knee score of 46.7. Medial meniscal tears were more common than lateral meniscal tears in all age groups and both sexes recruited into the study. The most common type of meniscal tear seen was the longitudinal type of tear while complex tear is the least type of tear seen. The surgery (arthroscopic partial meniscectomy) is an evolving area of sports medicine that requires sub-specialization, however solves the problem of increased mobility following open surgery. This study will tend to add to existing knowledge as patients who are mostly sports inclined can return to play very early with better outcome scores as regards pain and function.

超声引导下富血小板血浆注射治疗肩袖部分撕裂的临床疗效观察

目的:观察超声引导下富血小板血浆注射治疗肩袖部分撕裂的临床疗效。方法:42例肩袖部分撕裂患者随机分为观察组和对照组各21例,2组各有1例脱落,最终各20例完成研究。观察组给予超声引导下富血小板血浆注射治疗,对照组给予超声引导下玻璃酸钠注射治疗。2组均每周治疗1次,共3次。分别于治疗前、治疗后1、3及6个月,采用视觉模拟评分(VAS)、Constant-Murley评分(CMS)和美国肩肘外科医师评分(ASES)对2组患者的肩关节疼痛及功能情况进行评估,并记录不良事件发生情况。同时,于治疗前和治疗后6个月对所有患者进行超声检查记录撕裂大小以评估肌腱结构完整性。结果:在治疗后1个月,2组的VAS、CMS、ASES评分差异无统计学意义。在治疗后3个月和6个月,观察组的VAS评分较对照组降低、CMS和ASES评分较对照组升高(均P<0.05),在治疗后6个月,观察组的撕裂尺寸较对照组降低(均P<0.05);在治疗后随访的任何时期,2组患者的VAS均较治疗前降低、CMS和ASES评分均较治疗前升高(均P<0.05);观察组的撕裂尺寸较治疗前降低(P<0.05),而对照组的改变无统计学意义。结论:超声引导下富血小板血浆注射不仅可显著改善肩袖部分厚度撕裂患者肩关节疼痛和功能,而且减小撕裂尺寸,促进撕裂肌腱组织再生。

Rotator cuff tears: An evidence based approach

Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, costeffective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.

Chronic Partial Rupture of Distal Biceps Tendon in an Adolescent―A Case Report

Distal biceps tendon rupture accounts for only 3% - 10% of all biceps tendon injuries. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the distal biceps tendon. Our case profiles a chronic partial tear of the distal biceps tendon in a pediatric patient.

Comparison with Surgical Findings for the Accuracy of Routine MRI in Rotator Cuff Tears

Objective: To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) for the detection of partial-thickness rotator cuff tears (PTT) and full-thickness rotator cuff tears(FTT) by comparing its findings with surgical findings as the gold standard and to improve the previous MRI accuracy in diagnosing rotator cuff tears (RCT) considering more variables. Methods: In 45 months, 804 patients underwent MRI shoulder joint. Among them, only 95 cases had undergone both MRI imaging and surgery accordingly. The patient records were evaluated retrospectively if MRI and surgery were performed within 40 days of MRI. MRI findings were categorized into PTT, FTT and no tears which were further divided into different types according to four main nominal data as variables viz. site, size, shape and muscle involvement in RCT and were correlated with surgical findings for statistical calculation by using Kappa coefficient and McNemar Bowker test. Results: 81 patients (86 RCTs) underwent surgery within 40 days. On the basis of site as variable, MRI correctly depicted 100% of full thickness tears(FTT), 85% of bursal partial thickness tears(PTT), 80.4% of articular partial thickness tears(PTT). The consistency in diagnosis of RCT between MRI and surgery was moderate (Kappa coefficient 0.645). Overall sensitivity, specificity and accuracy of MRI for diagnosing PTT was 87.3%, 53.3% and 81.3%;and that for FTT was 100%, 98.7% and 98.8% respectively. Likewise on the basis of size, shape and muscles involved, the consistency between MRI and surgery was poor for size and shape and moderate for muscles involved;and the difference in diagnosing RCT by MRI and surgery was significant for shape (P = 0.002) only, but not significant for size (P = 0.16) and for muscles involved (P = 0.206) respectively. The agreement between MRI and surgery in diagnosing calcific tendinitis and shoulder joint hematoma with Kappa coefficient is (0.577) and (0.556) respectively. Conclusion: MRI has better accuracy for detecting FTT and has high sensitivity and positive predictive value in diagnosing both PTT and FTT. Combining more others variables in addition to RCT, MRI offers a great value in diagnosing RCT.

两种术式修复肩袖滑囊面部分撕裂的疗效对比

目的对比单排张力带技术和缝合桥技术修复肩袖滑囊面部分撕裂的疗效。方法回顾性分析2017-03至2018-03武警江西总队医院骨科经关节镜穿肌腱原位修复的高级别肩袖滑囊面部分撕裂患者46例的临床资料。其中,25例采用单排张力带技术修复(张力带组),21例采用缝合桥技术修复(缝合桥组)。对比两组手术时间、肩关节疼痛视觉模拟(VAS)评分、肩关节Constant评分及美国肩肘外科协会(ASES)评分、按照Sugaya放射学分型标准评估肩袖再撕裂情况。结果46例均顺利完成手术,术中均未出现重要血管、神经损伤,术后均获得24~36个月的随访。张力带组手术时间为(55.52±8.21)min,明显短于缝合桥组的(69.10±8.85)min,差异有统计学意义(P<0.05)。末次随访时,张力带组及缝合桥组患者的肩关节疼痛VAS评分、肩关节Constant评分、ASES评分,与术前比较均明显改善,差异均有统计学意义(P<0.05),但两组对比,差异无统计学意义。37例患者成功获得影像学随访。张力带组术后再撕裂率15.0%(3例);缝合桥组术后再撕裂率11.7%(2例),差异无统计学意义。结论两种术式临床疗效均显著,但单排张力带技术较缝合桥技术用时更短,值得临床推广。

Lp–PRP和皮质类固醇注射治疗冈上肌部分撕裂临床结局的比较

目的:比较肌腱内贫白细胞的富血小板血浆(Lp–PRP)注射治疗与肩峰下皮质类固醇注射治疗对冈上肌部分撕裂后疼痛缓解、功能改善的效果以及并发症情况。方法:选取2020年4月至2022年3月深圳大学第一附属医院收治的60例冈上肌部分撕裂的患者,随机分为观察组(接受Lp–PRP注射)和对照组(接受皮质类固醇注射),各30例。在注射治疗前和注射治疗后1、6、12个月,评价两组患者的肩关节疼痛缓解、功能改善以及并发症发生情况,并进行比较。结果:两组患者治疗后的视觉模拟评分量表(VAS)评分均较治疗前显著降低,且观察组患者治疗后的VAS评分则呈持续下降趋势,改良版加州大学肩关节评分量表(UCLA)评分均较治疗前升高,差异均具有统计学意义(P<0.05)。治疗后6个月及12个月,观察组患者的VAS评分均较对照组更低,UCLA评分均较对照组更高,差异均具有统计学意义(P<0.05)。两组患者在随访的12个月期间均未出现严重并发症。结论:对冈上肌部分撕裂的患者使用皮质类固醇或Lp–PRP注射治疗后1个月的疼痛和功能改善效果情况相似,但治疗后6个月和12个月时,Lp–PRP治疗的临床结局优于皮质类固醇。

超声引导下注射富血小板血浆联合冲击波治疗肩袖部分撕裂的临床效果

目的:评价超声引导下注射富血小板血浆(platelet rich plasma,PRP)联合冲击波对肩袖部分撕裂的治疗效果。方法:选取2019年10月—2021年12月于威海市中心医院确诊的肩袖部分撕裂的患者120例,根据患者的治疗意愿分为A组(保守治疗)、B组(超声引导下注射PRP)、C组(冲击波治疗)及D组(超声引导下注射PRP联合冲击波治疗),每组30例。比较四组治疗前与治疗后1、3、6个月时的视觉模拟评分法(visual analogue scale,VAS)评分、加州大学肩关节评分(University of California at Los Angeles shoulder score,UCLASS)。结果:治疗前四组VAS评分、UCLASS比较,差异均无统计学意义(P>0.05);治疗后1、3、6个月,四组VAS评分比较,差异均有统计学意义(P<0.05),且D组均优于B组与C组(P<0.05);治疗后1个月,C组及D组的VAS评分均低于A组,差异均有统计学意义(P<0.05);治疗后3、6个月,B组、C组及D组的VAS评分均优于A组,且C组均优于A组与B组,差异均有统计学意义(P<0.05)。治疗后1、3、6个月,四组UCLASS比较,差异均有统计学意义(P<0.05),且B组、C组及D组的UCLASS均优于A组,C组及D组均优于B组,D组均优于C组,差异均有统计学意义(P<0.05)。结论:超声引导下注射PRP与冲击波治疗肩袖部分撕裂具有协同作用,能有效缓解疼痛并且改善肩关节功能,是一种微创、精准、有效并且远期效果明确的治疗方法。

关节镜下半月板成形术联合运动疗法对比单纯运动疗法在退行性半月板撕裂中的meta分析

目的退行性半月板撕裂的最佳治疗方案仍有争议,通过荟萃分析探讨关节镜下半月板成形术联合运动疗法对比单纯运动疗法治疗退行性半月板撕裂的临床疗效。方法依据PICOS原则,检索公开发表于PubMed、EMBASE、Web of science、中国知网、中国万方数据数据库关于对比半月板成形术联合运动疗法和单纯运动疗法治疗退行性半月板撕裂的前瞻性随机对照试验(RCT)文献,检索时间由建库至2022年9月30日。根据Cochrane手册进行系统评价的文献筛选和数据提取,并进行文献质量评价。根据是否有异质性选择固定效应或者随机效应模型行meta分析,结果用森林图显示。结果最终纳入了12项RCT,包含1306名患者。总体偏倚风险都被评定为低风险,漏斗图和Egger检验显示无明显偏移风险。对于疼痛评分,两组在2月、6月、12月和24月的差异均无统计学意义(P>0.05)。而对于功能评分,结果显示在2月时,关节镜下半月板成形术联合运动疗法比单纯运动疗法更高(MD=3.31;95%CI:1.60~5.03;P<0.01)。而在6月、12月、24月和5年时,两组的功能评分也无显著差异。结论在早期的功能评分方面,关节镜下半月板成形术联合运动疗法效果更优。然而在中长期随访中疼痛和功能评分均没有差异。因此临床工作中应重视运动疗法在治疗退行性半月板撕裂方面的潜能。

穿肌腱修补与转为全层修补治疗肩袖关节侧部分损伤临床疗效和安全性的Meta分析

目的系统评价穿肌腱修补与转为全层修补治疗肩袖关节侧部分损伤的临床疗效和安全性。方法计算机检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库和中文科技期刊全文数据库(维普)自建库起至2022年3月收录的穿肌腱修补与转为全层修补治疗肩袖关节侧部分损伤的相关研究文献。由两位研究者独立进行文献筛选、资料提取和文献质量评价后,采用RevMan 5.4软件进行Meta分析。结果共纳入8篇文献共计389例患者,其中穿肌腱修补组194例,转为全层修补组195例。Meta分析结果显示,术后两组患者疼痛VAS评分、肩关节ASES评分、Constant评分、UCLA评分以及术后关节粘连、肩袖再撕裂率比较,差异均无统计学意义(MD=0.41,95%CI:-0.38~1.19,P=0.31;MD=0.98,95%CI:-0.59~2.54,P=0.22;MD=-0.68,95%CI:-2.21~0.86,P=0.39;MD=0.47,95%CI:-0.15~1.08,P=0.14;MD=1.13,95%CI:0.32~3.94,P=0.85;MD=0.39,95%CI:0.05~2.74,P=0.34)。结论穿肌腱修补与转为全层修补治疗肩袖关节侧部分损伤临床疗效和安全性相当,术者可结合自身关节镜技术及患者具体情况进行选择,其远期效果仍需进一步研究证实。

超声与MRI在肩袖损伤中的临床应用价值

目的探讨超声(US)和磁共振成像(MRI)在肩袖损伤的临床应用价值。方法收集2016年1月~2018年2月川北医学院附属医院肩关节镜确诊为肩袖损伤的患者38例,术前均同时行US和MRI检查。以肩关节镜为金标准,将US与MRI对肩袖撕裂的检查结果进行McNemer检验,并采用Kappa检验评价US与MRI对肩袖损伤及并发症诊断的一致性。结果关节镜显示26根全层撕裂肌腱,23根部分撕裂肌腱。US对全层撕裂诊断的敏感度、特异性、准确性分别为92.31%、100.00%、98.24%,而MRI分别为96.15%、100.00%、99.12%,US对部分撕裂诊断的敏感度、特异性、准确性分别为78.26%、97.80%、93.85%,而MRI分别为86.96%、96.70%、94.74%。两种检测方法诊断肩袖全层撕裂和部分撕裂比较,差异无统计学意义(P>0.05),且超声与MRI对肩袖全层撕裂和部分撕裂的诊断均具有很好的一致性(κ=0.922、0.811),但对肩袖撕裂后并发症显示的一致性较差(κ=-0.068)。结论US可以作为临床肩袖损伤的初筛诊断及常规随访的首选检查方法,当肩关节US诊断不明确或外科手术前需要更详细的并发症信息时需进一步行MRI检查。

前交叉韧带部分断裂后加强性单束重建术与保守治疗的疗效比较

目的:研究前交叉韧带(ACL)部分断裂后加强性单束重建手术与保守治疗的疗效差异,以指导临床治疗。方法:回顾性收集48名ACL部分断裂患者,根据治疗方法分成保守治疗组(21例)与加强性单束重建术组(27例)两组,所有患者随访两年,评价指标包括IKDC评分、Lysholm评分、Tegner评分、膝关节活动度(ROM)和kneelax关节动度测量仪测量结果。结果:保守治疗组两年随访结束时膝关节功能评分显著高于受伤时(P<0.05),kneelax测量结果与受伤时差异无统计学意义(P>0.05);加强性单束重建术组膝关节功能评分及kneelax测量结果术后较术前显著提高(P<0.05),随访两年结束时kneelax测量结果显著高于保守治疗组(P<0.05),而膝关节功能评分结果及ROM较保守治疗组差异无统计学意义(P>0.05)。结论:ACL部分断裂后采用加强性单束重建手术治疗比保守治疗更有利于患膝稳定性的恢复。

磁共振肩关节造影在肩袖部分撕裂诊断的临床应用

目的探讨MRA检查对肩袖部分撕裂的诊断价值。方法回顾性分析79例肩袖部分撕裂的MRA及MRI表现,与肩关节镜手术结果对照。结果 79例肩袖部分撕裂病例,MRI诊断的敏感度、特异度及准确度分别是94.74%、76.12%和95.18%;MRA仅能对肩袖部分撕裂中的32例内层(关节面)撕裂明确显示,其敏感度、特异度及准确度分别为96.88%、100%、98.73%,明显高于常规MRI诊断,与关节镜结果对比,其一致性极佳(Kappa=0.970),差异均有统计学意义(P<0.05);而对于部分撕裂中的外层(滑囊面)撕裂和中间层(肌腱内)撕裂,MRA均不能显示。结论 MRA能准确判断肩袖内层撕裂范围及程度,是MRI诊断肩袖部分撕裂的有效补充,为临床诊断和治疗能提供更准确的依据,而对于肩袖外层撕裂和中间层撕裂,MRA均不能显示其损伤部位及程度,无法对其进行诊断。

肩袖损伤的MR诊断进展

肩袖损伤是引起肩部疼痛和功能障碍的常见原因,可表现为全层撕裂或部分撕裂。MRI具有较高的软组织分辨力,可直接显示肩袖损伤部位及相关病理改变。本文复习肩袖的解剖结构,总结肩袖撕裂的MR诊断标准和主要表现及与X线平片、CT、B超相比的优越性、敏感性。研究表明,高场强MRI能更好地显示肌腱未受损部分与撕裂的对比,为临床制定正确的治疗方案提供帮助。

肩关节镜辅助下小切口肩峰成形及肩袖修补

目的 探讨肩关节镜辅助下小切口肩袖修补手术的临床应用价值。方法 本组 2 6例患者 ,在关节镜下完成肩峰成形 ,然后在小切口内对肩袖完全破裂的 18例患者行肌腱 骨隧道缝合 ,对部分破裂的 8例患者行肌腱 肌腱缝合。结果 术后随访 2 1～ 4 8个月 (平均 37.5个月 ) ,所有患者均无术后感染及肩关节粘连发生 ,肩关节疼痛 ,特别是夜间痛明显改善 ,手术疗效满意。UCLA评分由术前平均 2 0 .1分改善至术后 31.6分。结论 本术式可确定肩关节面一侧肩袖破裂的部位及深度 ,且不破坏三角肌的连续性。手术效果好 ,患者可较早进行功能煅练 ,功能恢复快。

温度敏感的水凝胶与富血小板血浆复合体对大鼠前交叉韧带部分损伤愈合的作用

目的:探讨温度敏感的水凝胶与富血小板血浆(platelet-rich plasma,PRP)对大鼠前交叉韧带(anterior cruciate ligament,ACL)部分损伤的愈合是否有促进作用。方法:按照既往文献报道的方法制备PRP,将其与温度敏感的水凝胶——单甲氧基聚乙二醇-聚乳酸乙醇酸嵌段共聚物(m PEG-PLGA)在特定条件下混合,制备成复合体。共采用110只12周龄雄性Sprague-Dawley大鼠右侧膝关节,其中10只作为完整对照组(n=10,ACL无损伤),其余100只随机分为2组:损伤对照组(n=60,ACL部分损伤后用生理盐水处理损伤部位)、实验组(n=40,ACL部分损伤后将m PEG-PLGA-PRP复合体注射于损伤部位)。共观察三个时间点:手术后即刻、术后2周和术后6周。观察并比较组间与组内的组织学与生物力学变化。结果:组织学结果表明,实验组术后6周组织学观察可见ACL损伤已出现部分愈合,炎性细胞减少,出现新生纤维组织,但走行与正常ACL组织仍有差异,可见新生血管形成。韧带成熟度评分,实验组显著高于损伤对照组(20.6±4.9 vs 4.7±1.0,P<0.01)。生物力学实验结果表明,术后6周拉断强度实验组显著高于对照组(52.7±11.2 vs 30.3±8.8,P<0.05)。结论:在大鼠模型下采用m PEG-PLGA-PRP复合体治疗ACL部分损伤,术后6周在组织学与生物力学方面与对照组相比均有显著改善,但是尚未恢复到损伤前的水平。

关节镜下两种技术治疗肩袖关节侧部分撕裂的疗效比较

目的探讨关节镜下经肌腱修补术和转全层撕裂修补术治疗肩袖关节侧部分撕裂的临床疗效。方法将46例肩袖关节侧部分撕裂患者采用随机数字表法分为经肌腱修补组(采用经肌腱修补术,23例)和转全层修补组(采用转全层撕裂修补术,23例)。比较两组末次随访时疼痛VAS评分、UCLA评分、ASES评分、肩关节活动度以及术后恢复活动时间。结果患者均获得随访,时间12~22个月。术中及术后均无神经血管损伤、锚钉脱出及深部感染、肩关节功能明显受限等并发症发生。术后MRI和彩超复查肩袖肌腱再撕裂情况:转全层修补组发现2例,经肌腱修补组未发现。疼痛VAS评分、UCLA评分、ASES评分:末次随访时两组均较术前明显改善(P<0.05),两组间比较差异均无统计学意义(P>0.05)。末次随访时肩关节活动度两组比较差异均无统计学意义(P>0.05)。术后恢复日常活动时间转全层修补组早于经肌腱修补组(P<0.05)。结论关节镜下经肌腱修补术和转全层撕裂修补术治疗肩袖关节侧部分撕裂,均可显著改善患者肩关节功能,但经肌腱修补术的患者术后肩关节功能恢复较慢。