超声下注射不同白细胞浓度富血小板血浆治疗冈上肌腱损伤的疗效比较研究  

Comparative study on effectiveness of injecting platelet-rich plasma with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury

作　　者：李旭 李军 戴莹 郭孝菊 徐永清 谷永正 赵麒麟 LI Xu;LI Jun;DAI Ying;GUO Xiaoju;XU Yongqing;GU Yongzheng;ZHAO Qilin(Graduate School of Kunming Medical University,Kunming Yunnan,650500,P.R.China;Department of Orthopaedics,920th Hospital of Joint Logistics Support Force of Chinese PLA,Kunming Yunnan,650032,P.R.China)

机构地区：[1]昆明医科大学研究生院,昆明650500 [2]中国人民解放军联勤保障部队第九二〇医院骨科,昆明650032

出　　处：《中国修复重建外科杂志》2024年第12期1445-1450,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：云南省科技厅科技计划项目(202102AA310068)。

摘　　要：目的探讨超声引导下多次注射不同白细胞浓度富血小板血浆(platelet-rich plasma,PRP)治疗冈上肌腱损伤的临床疗效。方法回顾分析2022年12月—2023年12月收治且符合选择标准的30例冈上肌腱损伤患者临床资料,分别注射贫白细胞PRP(leukocyte-poor PRP,LP-PRP)10例、富白细胞PRP(leukocyte-rich PRP,LR-PRP)11例、曲安奈德9例治疗,共注射4次,每2次注射间隔7~10 d。3组患者年龄、性别、病程、患肩侧别、Ellman分型以及术前疼痛视觉模拟评分(VAS)、Constant评分、上肢功能障碍评定量表(DASH)评分、美国肩肘外科评分(ASES)等基线资料比较,差异均无统计学意义(P>0.05)。注射后1、3、6个月,采用VAS评分、Constant评分、DASH评分、ASES评分评价肩关节疼痛及功能;MRI复查观察冈上肌腱愈合情况。结果3组治疗过程无严重不良反应发生。患者均获随访,随访时间6~7个月,平均6.5个月。LR-PRP组、LP-PRP组注射后ASES评分、Constant评分逐渐增高,VAS评分、DASH评分降低,与注射前差异均有统计学意义(P<0.05);注射后除LR-PRP组3、6个月间差异无统计学意义(P>0.05)外,上述评分其余时间点间差异均有统计学意义(P<0.05)。曲安奈德组注射后1个月Constant评分较注射前增高、VAS评分降低(P<0.05),其余时间点间各项评分差异均无统计学意义(P>0.05)。除注射后1个月3组Constant评分、VAS评分差异无统计学意义(P>0.05)外,其余时间点各项评分LR-PRP组和LP-PRP组均优于曲安奈德组(P<0.05);LR-PRP组和LP-PRP组间差异均无统计学意义(P>0.05)。MRI复查示仅LP-PRP组4例患者注射后6个月冈上肌腱损伤部位较前有修复痕迹,其余患者均未观察到明显肌腱修复迹象。结论与曲安奈德治疗相比,超声引导下多次注射LP-PRP及LR-PRP均可促进冈上肌腱损伤患者肩关节功能恢复,有效缓解疼痛,且LP-PRP治疗后可见影像学改善。Objective To compare effectiveness of injecting platelet-rich plasma(PRP)with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury.Methods A clinical data of 30 patients with supraspinatus tendon injury,who met the selection criteria and were admitted between December 2022 and December 2023,was retrospectively analyzed.Thirty patients were treated with 4 injections of leukocyte-poor PRP(LP-PRP,n=10),leukocyte-rich PRP(LR-PRP,n=11),and triamcinolone(n=9),with an interval of 7-10 days between each injection.There was no significant difference between groups(P>0.05)in the age,gender,disease duration,affected shoulder side,Ellman classification,preoperative visual analogue scale(VAS)score,Constant score,Disabilities of the Arm,Shoulder,and Hand(DASH)score,and American Shoulder and Elbow Surgeons(ASES)score.At 1,3,and 6 months after injection,the shoulder pain and function were evaluated by using the VAS score,Constant score,DASH score,and ASES score.MRI was conducted to observe supraspinatus tendon healing.Results No severe adverse reactions was observed in all groups.All patients were followed up 6-7 months,with an average of 6.5 months.After injection,the ASES score and Constant score gradually increased in the LR-PRP group and LP-PRP group,while the VAS score and DASH score decreased,with significant differences compared to before injection(P<0.05).Except for no significant difference between 3 and 6 months after injection in LR-PRP group(P>0.05),the above scores showed significant differences between different time points(P<0.05).At 1 month after injection,the Constant score in triamcinolone group significantly increased compared to before injection,while the VAS score significantly decreased(P<0.05).There was no significant difference in all scores between other time points in the triamcinolone group(P>0.05).Except for 1 month after injection,there was no significant difference in Constant score and VAS score between groups(P>0.05).At all other time points,the LR-PR

关 键 词：贫白细胞富血小板血浆 富白细胞富血小板血浆 冈上肌腱 肩袖损伤 

分 类 号：R686[医药卫生—骨科学]