透明质酸钠、皮质类固醇、自体富血小板血浆治疗原发性冻结肩的效果对比  

Efficacy comparison of sodium hyaluronate,corticosteroids,and autologous platelet-rich plasma in the treatment of primary frozen shoulder

作　　者：王梓力[1] 沈民仁[1] 吴松[1] WANG Zili;SHEN Minren;WU Song(Department of Orthopedics,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院骨科,长沙410013

出　　处：《中南大学学报（医学版）》2024年第8期1271-1278,共8页Journal of Central South University ：Medical Science

基　　金：湖南省卫生健康委员会一般指导课题(202204073899);湖南省自然科学基金(2024JJ5528)。

摘　　要：目的:原发性冻结肩是一种严重影响患者生活质量的肩关节疾病,关节腔注射是治疗该疾病的常见方式。本研究旨在探究和比较透明质酸钠(sodium hyaluronate,SH)、皮质类固醇(corticosteroids,CS)、自体富血小板血浆(platelet-rich plasma,PRP)对原发性冻结肩的治疗效果。方法:回顾性纳入2020年1月1日至2022年12月31日在中南大学湘雅三医院确诊为原发性冻结肩并在B超引导下进行盂肱关节单次注射SH、CS或PRP的117例患者,分为SH组、CS组和PRP组。收集治疗前和治疗1、3、6个月时患者的患肩疼痛视觉模拟量表(Visual Analogue Scale,VAS)评分、活动范围、Constant评分和上肢功能障碍(Disabilities of Arm,Shoulder,and Hand,DASH)评分等临床资料,比较这3种关节腔注射治疗方法对原发性冻结肩的疗效。结果:与治疗前相比,SH组、CS组、PRP组在治疗6个月时均能改善肩关节VAS疼痛评分、活动范围、Constant评分和DASH评分(均P<0.05)。与SH组和PRP组相比,CS组在治疗1个月时的VAS疼痛评分、活动范围、Constant评分和DASH评分均更好(均P<0.05),而PRP组在治疗6个月时的VAS疼痛评分、Constant评分和DASH评分均优于SH组和CS组(均P<0.05)。结论:B超引导下盂肱关节单次注射SH、CS或PRP均能明显改善原发性冻结肩患者的疼痛程度、活动范围及关节功能。这3种注射治疗方法中,CS可能有更好的早期疗效,而PRP的长期疗效可能更好。Objective:Primary frozen shoulder is a shoulder joint disease that severely impacts the quality of life of patients,and intra-articular injection is a common treatment method.This study aims to evaluate and compare the therapeutic effects of sodium hyaluronate(SH),corticosteroids(CS),and autologous platelet-rich plasma(PRP)in the treatment primary frozen shoulder.Methods:A total of 117 patients diagnosed with primary frozen shoulder and treated with a single injection of SH,CS,or PRP into the glenohumeral joint under ultrasound guidance at the Third Xiangya Hospital of Central South University from January 1,2020,to December 31,2022,were included in the study.The patients were divided into a SH group,a CS group,and a PRP group.Clinical data of patients,including Visual Analogue Scale(VAS)pain score,range of motion,Constant score,and Disabilities of Arm,Shoulder,and Hand(DASH)score were collected before treatment and at 1,3,and 6 months after treatment.The efficacy of these 3 intra-articular injection therapies for primary frozen shoulder was compared.Results:Compared with the baseline,the SH,CS,and PRP groups all showed significant improvements in shoulder VAS pain scores,range of motion,Constant scores,and DASH scores at 6 months after treatment(all P<0.05).Compared with the SH and PRP groups,the CS group showed better VAS pain score,range of motion,Constant score,and DASH score at 1 month after treatment(all P<0.05).However,the VAS pain score,range of motion,Constant score,and DASH score in the PRP group were better than those in the SH and CS groups at 6 months after treatment(all P<0.05).Conclusion:A single ultrasound-guided injection of SH,CS,or PRP into the glenohumeral joint can significantly improve pain degree,range of motion,and function in patients with primary frozen shoulder.Among these 3 injection therapies,CS may provide better short-term efficacy,while PRP may offer better long-term outcomes.

关 键 词：透明质酸钠 皮质类固醇 自体富血小板血浆 原发性冻结肩 

分 类 号：R684[医药卫生—骨科学]