关节镜下肩峰成形术联合富血小板血浆与关节镜下肩峰成形术治疗肩峰下撞击综合征的疗效比较  

Arthroscopic acromioplasty combined with platelet‑rich plasma and arthroscopic acromioplasty alone in the treatment of subacromial impingement syndrome:a comparison of clinical efficacie

作　　者：程强 骆虎 孙文爽 孟嘉 Cheng Qiang;Luo Hu;Sun Wenshuang;Meng Jia(Department of Orthopedics,General Hospital of Chinese PLA Eastern Theater Command,Nanjing 210002,China)

机构地区：[1]中国人民解放军东部战区总医院骨科,南京210002

出　　处：《中华创伤杂志》2023年第9期793-800,共8页Chinese Journal of Trauma

基　　金：中国博士后科学基金(2017M623359,2018T111167);江苏省卫健委老年健康科研项目(LKZ2022011)。

摘　　要：目的比较关节镜下肩峰成形术联合富血小板血浆(PRP)与关节镜下肩峰成形术治疗肩峰下撞击综合征(SAIS)的临床疗效。方法采用回顾性队列研究分析2020年1月至2021年12月东部战区总医院收治的30例SAIS患者的临床资料,其中男9例,女21例;年龄24~48岁[(34.3±9.8)岁]。左肩19例,右肩11例。15例仅行关节镜下肩峰成形术(单纯肩峰成形组);15例行关节镜下肩峰成形术,术后向肩峰下间隙注入4 ml PRP(肩峰成形联合PRP组)。比较两组术前及术后6周、3个月及末次随访时视觉模拟评分(VAS)、Constant⁃Murley评分和肩关节主动前屈、外展、内旋及外旋活动度。观察术后并发症发生情况。结果患者均获随访3~12个月[(9.0±2.6)个月]。术前、术后3个月及末次随访时两组VAS、Constant⁃Murley评分比较,差异无统计学意义(P均>0.05);术后6周肩峰成形联合PRP组VAS为(1.5±0.5)分,Constant⁃Murley评分为(80.3±6.2)分,低于或高于单纯肩峰成形组的(2.5±0.7)分、(58.1±7.6)分(P<0.05或0.01);两组术后不同时间点VAS、Constant⁃Murley评分较术前显著降低或提高(P<0.05或0.01)。术前、术后3个月及末次随访时两组肩关节主动前屈、外展、内旋比较,差异无统计学意义(P均>0.05);术后6周肩峰成形联合PRP组肩关节主动前屈为(158.1±26.3)°,外展为(146.2±27.4)°,内旋为(54.2±11.8)°,大于单纯肩峰成形组的(128.8±29.6)°、(111.0±28.6)°、(35.7±12.3)°(P<0.05或0.01);两组术后不同时间点肩关节主动前屈、外展、内旋较术前显著提高(P<0.05或0.01)。两组间和组内不同时间点肩关节主动外旋比较,差异无统计学意义(P均>0.05)。肩峰成形联合PRP组无切口感染、肩峰骨折等并发症发生;单纯肩峰成形组1例出现切口延期愈合,经换药处理后痊愈。结论与关节镜下肩峰成形术相比,关节镜下肩峰成形术联合PRP治疗SAIS可早期减轻疼痛、促进肩关节功能恢复、改善关节主Objective To compare the clinical efficacies of arthroscopic acromioplasty combined with platelet⁃rich plasma(PRP)and acromioplasty alone in the treatment of subacromial impingement syndrome(SAIS).Methods A retrospective cohort study was conducted to analyze the clinical data of 30 patients with SAIS.The patients,who were admitted to the General Hospital of Chinese PLA Eastern Theater Command from January 2020 to December 2021,included 9 males and 21 females,with the age range of 24⁃48 years[(34.3±9.8)years].There were 19 left shoulders and 11 right shoulders.All the patients underwent arthroscopic acromioplasty.A total of 15 patients were injected with 4 ml of PRP after surgery(acromioplasty+PRP group),while the remaining 15 patients received nothing(acromioplasty group).Visual analogue score(VAS),Constant⁃Murley score,and active forward flexion,abduction,internal rotation,and external rotation of the shoulder joint were compared between the two groups before and at 6 weeks,3 months after surgery and at the last follow⁃up.The postoperative complications were also observed.Results All the patients were followed up for 3⁃12 months[(9.0±2.6)months].There was no significant difference in VAS or Constant⁃Murley score between the two groups before surgery,at 3 months after surgery,and at the last follow⁃up(all P>0.05).At 6 weeks after surgery,the VAS and Constant⁃Murley score were(1.5±0.5)points and(80.3±6.2)points in the acromioplasty+PRP group,which was lower or higher than those in the acromioplasty group[(2.5±0.7)points,(58.1±7.6)points](P<0.05 or 0.01).The VAS showed gradual decrease and the Constant⁃Murley score showed gradual increase in both groups after surgery(P<0.05 or 0.01).There were no significant differences in active forward flexion,abduction,or internal rotation of the shoulder joint between the two groups before surgery,at 3 months after surgery,and at the last follow⁃up(all P>0.05).At 6 weeks after surgery,the active forward flexion,abduction and internal rotation of the sh

关 键 词：肩撞击综合征 富血小板血浆 关节镜检查 肩峰成形术 

分 类 号：R687.3[医药卫生—骨科学]