摘要
目的 探究关节镜下肩袖修补术中单次注射富血小板血浆(plate-richplasma,PRP)治疗肩袖滑囊面部分撕裂的临床疗效.方法 回顾性分析2016年7月至2018年7月肩关节镜下肩袖修补术治疗的Ellman Ⅲ级肩袖滑囊面部分撕裂患者54例.按术中是否联合使用PRP治疗分为两组.其中有27例患者行肩袖修补手术及单次注射PRP治疗(试验组),另有27例行肩袖修补手术治疗且未予以注射PRP(对照组).两组患者在术前和末次随访时分别用视觉模拟评分(visual analogue scale,VAS),美国肩肘外科协会评分(American shoulder and elbow surgeons'form,ASES),Constant-Murley肩关节评分(constant shoulder score,CSS)和洛杉矶加利福尼亚大学评分(University of California,Los Angeles,UCLA)评测患侧肩关节疼痛和功能,同时评估患者肩关节前屈、外展、体侧外旋及内旋活动度.末次随访时,根据肩关节MRI影像依照Sugaya评定标准评估肩袖的完整性,并进一步探讨分析两组患者的术后疗效及肩袖再撕裂率.结果 54例患者均获得成功随访.术前两组患者VAS、ASES、CSS和UCLA评分,肩关节活动度差异均无统计学意义(P＞0.05).末次随访时,两组患者VAS评分均较术前降低,同一组内术前与末次随访时差异具有统计学意义(P＜0.05),其中,试验组患者VAS评分明显低于对照组,组间差异具有统计学意义(P＜0.05).末次随访时,两组患者ASES、CSS和UCLA评分,肩关节活动度均分别较术前提升,同一组内术前与末次随访时差异均具有统计学意义(P＜0.05),而组间差异均无统计学意义(P＞0.05).按UCLA评分评定疗效:试验组优良率96.3％;对照组优良率92.6％.根据患者肩关节MRI影像评估肩袖完整性:试验组肩袖再撕裂率为7.4％;对照组肩袖再撕裂率为18.5％.试验组患者肩袖再撕裂率低于对照组,试验组有降低术后肩袖再撕裂的趋势,但差异无统计学意义(P＞0.05).结论 临床上采用关节镜下肩袖修补术中单次注射PRP治疗Ellman Ⅲ级肩袖滑囊面部分撕裂可获得满意的疗效,优良率达95％以上,PRP的应用能够明显缓解患者术后肩关节疼痛,改善肩关节功能,提高肩关节活动度,具有降低术后肩袖再撕裂的趋向性.
Abstract
Background Partial-thickness rotator cuff tears(PTRCTs)are one of the leading causes of shoulder pain and dysfunction in middle/older patients.Ellman classified PTRCTs arthroscopically according to the location(articular,bursal,or interstitial)and depth of the tear.Ellman grade Ⅲ tears,which involve more than 6 mm or 50％of the tendon thickness,are also known as high-grade PTRCTs.Most of these tears require rotator cuff repair surgery.There is no consensus on the optimal treatment of Ellman gradeⅢ tears under arthroscopy.How to effectively promote tenon-bone healing,reduce rotator cuff retear rate,and improve clinical efficacy is still the focus of attention.Platelet-rich plasma(PRP)has received increasing attention in musculoskeletal system research in recent years.PRP contains essential growth factors that promote tenon-bone healing and can promote tendon healing.However,few clinical studies have reported PRP's potential role in treating bursal-side PTRCTs,and even fewer studies have reported the combined use of PRP in arthroscopic rotator cuff repair.Objective To explore the clinical effect of a single injection of PRP during arthroscopic rotator cuff repair to treat bursal-side PTRCTs.Methods From July 2016 to July 2018,54 patients of Ellman grade Ⅲ bursal-side PTRCTs were treated by arthroscopic rotator cuff repair,and the data was collected and retrospectively analyzed.According to whether PRP was combined with intraoperative treatment,it was divided into two groups.The experimental group(27 cases)received arthroscopic rotator cuff repair combined with PRP treatment,while the control group(27 cases)received arthroscopic rotator cuff repair without PRP injection.Before the operation and at the last follow-up,the visual analog scale(VAS)was used to assess the pain,American shoulder and elbow surgeons score(ASES),the Constant-Murley shoulder score(CSS),University of California at Los Angeles scores(UCLA)were used to evaluate the pain and functional recovery of the affected shoulder.Meanwhile,the range of motion of anteflexion,abduction,lateral external rotation,and internal rotation were assessed and compared between the two groups.At the final follow-up,the integrity of the rotator cuff was evaluated according to the MRI image of the shoulder,and the postoperative efficacy and rotator cuff retear rate of the two groups were further discussed and analyzed.Results All the patients were followed up.There were no significant differences in VAS score,ASES score,CSS score,UCLA score,and the shoulder range of motion between the two groups before operation(P＞0.05).At the final follow-up,the two groups'VAS score was lower than before the operation,and the difference between the preoperative and last follow-up in the same group was statistically significant(P＜0.05).The VAS score of the patients in the experimental group was significantly lower than that of the control group,and the difference between the groups was statistically significant(P＜0.05).At the last follow-up,the ASES score,CSS score,UCLA score,and shoulder range of motion of the two groups were higher than that before the operation,and the differences between the same group before the operation and at the last follow-up were statistically significant(P＜0.05).In contrast,the difference between the groups was insignificant(P＞0.05).Due to the UCLA grading evaluation of the curative effect,the excellent and good rate was 96.3％in the experimental group,and the acceptable rate was 92.6％in the control group.At the final follow-up,MRI showed retears in 7.4％of the experimental group and 18.5％of the control group.The rate of rotator cuff retearing in the experimental group was lower than that in the control group,and there was a trend of reducing postoperative rotator cuff retearing in the experimental group.However,the difference was not statistically significant(P＞0.05).Conclusions A single injection of PRP during arthroscopic rotator cuff repair to treat Ellman grade Ⅲ bursal-side PTRCTs can achieve satisfactory clinical efficacy,with an excellent and good rate of more than 95％.The application of platelet-rich plasma can significantly relieve postoperative shoulder pain,improve shoulder joint function,promote shoulder range of motion,and reduce postoperative rotator cuff retear.
基金项目
上海中医药大学第二十二期课程建设项目(2023SHUTCMKCJS144)
上海市卫生健康委员会科研课题(202040151)
维普
万方数据