富血小板血浆治疗部分肩袖损伤的疗效及可能机制  

Effect of platelet-rich plasma treatment for partial rotator cuff injury and possible mechanism

作　　者：薛志兴[1] 虞攀峰 张树[1] 迟成 周建伟[1] Zhixing Xue;Panfeng Yu;Shu Zhang;Cheng Chi;Jianwei Zhou(Department of Orthopedics,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院骨科,北京100730

出　　处：《中华创伤杂志》2022年第4期314-319,共6页Chinese Journal of Trauma

摘　　要：目的比较富血小板血浆(PRP)注射及常规治疗部分肩袖损伤患者的疗效及可能作用机制。方法采用前瞻性随机对照研究分析2019年1月至2020年12月首都医科大学附属北京同仁医院收治的100例部分肩袖损伤患者的临床资料。采用随机数字表法将患者分为观察组(50例)和对照组(50例)。两组均予以常规非手术治疗, 同时观察组接受肩峰下PRP注射治疗, 对照组接受肩峰下激素注射治疗。比较两组治疗前、治疗后3, 6个月肩关节视觉模拟评分(VAS)、肩关节Constant-Murley评分(CMS)和血清炎症因子[白细胞介素-6(IL-6)、IL-1β、肿瘤坏死因子-α(TNF-α)]水平。对比观察组治疗前和治疗后6个月的MRI图像。结果患者男55例, 女45例;年龄40~75岁[(55.9±9.1)岁]。患者均获随访6.0~8.2个月[(6.2±2.9)个月]。治疗前两组VAS、CMS、IL-6、IL-1β、TNF-α差异无统计学意义(P均>0.05)。治疗后3, 6个月观察组VAS分别为(3.5±0.9)分、(1.4±0.4)分, 显著低于对照组的(4.1±0.9)分、(1.8±0.5)分(P均<0.01)。治疗后3, 6个月观察组CMS分别为(59.5±9.4)分、(86.5±7.9)分, 显著高于对照组的(53.5±8.6)分、(78.5±8.4)分(P均<0.01)。治疗后3个月观察组血清IL-6、IL-1β、TNF-α水平分别为(0.69±0.21)μg/L、(2.06±0.55)μg/L、(2.12±0.49)μg/L, 显著低于对照组的(0.92±0.26)μg/L、(2.67±0.48)μg/L、(2.87±0.51)μg/L(P均<0.01);治疗后6个月观察组血清IL-6、IL-1β、TNF-α水平分别为(0.37±0.11)μg/L、(1.14±0.23)μg/L、(1.27±0.25)μg/L, 显著低于对照组的(0.45±0.09)μg/L、(1.36±0.27)μg/L、(1.88±0.26)μg/L(P均<0.01)。组内比较显示, 治疗后3, 6个月两组VAS、CMS及血清炎症因子(IL-6、IL-1β、TNF-α)水平较治疗前显著改善(P均<0.05), 且治疗后6个月各指标与治疗后3个月相比, 差异有统计学意义(P均<0.05)。观察组治疗后6个月MRI显示冈上肌腱下表面高信号消失, 肌腱内部水平高信号减弱。结论 PRP注射治疗�Objective To compare the clinical efficacy of platelet-rich plasma(PRP)injection and conventional treatment for partial rotator cuff tear and analyze the possible mechanism.Methods A prospective randomize control study was performed for clinical data of 100 patients with partial rotator cuff tear admitted to Beijing Tongren Hospital affiliated to Capital Medical University between January 2019 and December 2020.The patients were assigned to observation group(n=50)and control group(n=50)according to the random number table.Both groups were given conventional non-operative treatment,together with PRP injection in observation group and steroid injection in control group.The visual analogue score(VAS),Constant-Murley Score(CMS)and serum levels of inflammatory cytokines[interleukin-6(IL-6),IL-1β,tumor necrosis factor-α(TNF-α)]were measured before and at 3,6 months after treatment.The MRI images were also evaluated in observation group before treatment and at 6 months after treatment.Results There were 55 males and 45 females with the age range of 40-75 years[(55.9±9.1)years].All patients were followed up for 6.0-8.2 months[(6.2±2.9)months].There were no significant differences between the two groups in VAS,CMS,IL-6,IL-1βand TNF-αbefore treatment(all P>0.05).The VAS was(3.5±0.9)points and(1.4±0.4)points]in observation group at 3,6 months after treatment,significant lower than(4.1±0.9)points and(1.8±0.5)points in control group(all P<0.01).The CMS was(59.5±9.4)points and(86.5±7.9)points in observation group at 3,6 months after treatment,significant higher than(53.5±8.6)points and(78.5±8.4)points in control group(all P<0.01).The serum levels of IL-6,IL-1βand TNF-αwere(0.69±0.21)μg/L,(2.06±0.55)μg/L and(2.12±0.49)μg/L in observation group at 3 months after treatment,significant lower than(0.92±0.26)μg/L,(2.67±0.48)μg/L and(2.87±0.51)μg/L in control group(all P<0.01).The serum levels of IL-6,IL-1βand TNF-αin observation group[(0.37±0.11)μg/L,(1.14±0.23)μg/L,(1.27±0.25)μg/L]were also sign

关 键 词：肩 回旋套损伤 富血小板血浆 

分 类 号：R686[医药卫生—骨科学]