摘要
目的 探讨富血小板血浆(PRP)注射与封闭注射治疗肩袖部分撕裂(PTRCT)的中期对比疗效.方法 根据纳入标准选择肩袖部分撕裂患者50例,分为实验组和对照组,各25例.实验组接受PRP注射治疗,对照组接受封闭治疗.采用肩关节屈伸活动范围(ROM)、视觉模拟评分(VAS)、Constant-Murley肩部评分(CMS)及美国肩肘外科协会评分(ASES)评价肩关节功能,分别于注射前、注射后1、3、6、12、24、36个月记录肩关节ROM、VAS、CMS及ASES评分,肩关节MRI评价肩袖愈合情况.结果 50例患者在(36±7.50)个月随访中,无感染等并发症发生.两组患者注射后临床疗效随时间推移均优于注射前,封闭组在注射后1个月ROM、VAS、CMS、ASES均优于PRP组(P<0.01).注射后3个月两组疗效接近,但外展及外展位内外旋、VAS、CMS、ASES有统计学差异(P<0.05),封闭组优于PRP组.注射后6个月PRP组及封闭组无差异,注射后12、24、36个月两组间无差异,但PRP组VAS、CMS、ASES略优于封闭组(P>0.05).注射后12、24、36个月,肩关节MRI显示部分撕裂的肩袖愈合情况PRP组优于封闭组,CMS评分中PRP组肌力略优于封闭组,部分撕裂的肩袖愈合良好与更好的功能体现出一定的相关性.结论 PRP可以促进PTRCT的愈合,结合康复治疗可以增加关节活动度、缓解疼痛改善功能.对比于肩关节封闭,PRP注射中期的随访结果体现出更好的肩袖愈合率及更佳的功能评分,超声引导下精准注射可以提升临床疗效.
Abstract
Objective To explore the comparative study and mid-term efficacy of platelet-rich plasma (PRP)in-jection and block injection in the treatment of partial-thickness rotator cuff tears (PTRCT).Methods According to the inclusion criteria,50 patients with partial rotator cuff tears were selected and divided into experimental group and control group,with 25 cases in each group.The experimental group received PRP injection treatment,and the control group received block injection treatment.Shoulder joint flexion and extension range of motion (ROM),visual analogue scale (VAS),Constant-Murley shoulder score (CMS)and American Shoulder and El-bow Surgeons'form (ASES )were used to evaluate the shoulder function.For joint function,shoulder joint ROM,VAS,CMS and ASES scores were recorded before injection and at 1,3,6,12,24 and 36 months after injection.The rotator cuff healing status was evaluated by MRI of shoulder joint.Results No complications such as infection occurred in 50 patients during the (36±7.50)months follow up.The clinical efficacy of the two groups of patients after injection was better than that before injection over time.The ROM,VAS,CMS,and AS-ES of the block injection group were better than those of the PRP group 1 month after injection (P<0.01).The curative effects of the two groups were similar 3 months after injection,but there were statistical differences in abduction and internal rotation,VAS,CMS,and ASES in the abduction position (P<0.05).The block injec-tion group was better than the PRP group.There was no difference between the PRP group and the block injec-tion group 6 months after injection,and there was no difference between the two groups at 12,24,and 36 months after injection,but the VAS,CMS,and ASES of the PRP group were slightly better than those of the block injection group (P>0.05).At 12,24,and 36 months after injection,MRI of the shoulder joint showed that the partially torn rotator cuff healed better in the PRP group than in the block injection group.In the CMS score,the muscle strength of the PRP group was slightly better than that in then block injection group.The par-tially torn rotator cuff healed well compared with the block injection group,and better functionality showed some relevance.Conclusion PRP can promote the healing of PTRCT,and combined with rehabilitation therapy can in-crease joint mobility,relieve pain and improve function.Compared with shoulder joint block injection treatment,the mid-term follow-up results of PRP injection showed better rotator cuff healing rate and better functional score. Precise injection under ultrasound guidance can improve clinical efficacy.
维普
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