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中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (02) : 111 -116. doi: 10.3877/cma.j.issn.2095-5790.2023.02.003

论著

肩袖修补术联合足印区注射富血小板血浆的疗效分析
胡国政, 刘飞(), 徐丛, 吕剑, 王巍   
  1. 066000 秦皇岛市第一医院关节镜骨科
  • 收稿日期:2023-04-04 出版日期:2023-05-05
  • 通信作者: 刘飞

Analysis of the curative effect of rotator cuff repair combined with injection of platelet-rich plasma into footprints

Guozheng Hu, Fei Liu(), Cong Xu, Jian Lyu, Wei Wang   

  1. Department of Arthroscopy Orthopaedics,The First Hospital of Qinhuangdao, Qinhuangdao 066000, China
  • Received:2023-04-04 Published:2023-05-05
  • Corresponding author: Fei Liu
引用本文:

胡国政, 刘飞, 徐丛, 吕剑, 王巍. 肩袖修补术联合足印区注射富血小板血浆的疗效分析[J/OL]. 中华肩肘外科电子杂志, 2023, 11(02): 111-116.

Guozheng Hu, Fei Liu, Cong Xu, Jian Lyu, Wei Wang. Analysis of the curative effect of rotator cuff repair combined with injection of platelet-rich plasma into footprints[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(02): 111-116.

目的

分析肩袖修补术联合足印区注射富血小板血浆(platelet-richplasma, PRP)的疗效。

方法

回顾性研究2021年3月至2022年3月于秦皇岛市第一医院关节镜骨科行手术治疗的40例肩袖全层撕裂患者。患者术中使用PRP治疗为PRP组,未使用PRP治疗为对照组,每组20例患者。使用SPSS 26.0软件对两组患者术后各类评分进行统计分析,使用MRI及肌骨超声进行术后评价。

结果

对40例患者进行为期1年的随访。术后两组各类评分均优于术前,且PRP组术后6个月视觉模拟评分(visual analogue scale,VAS)(Z=-2.071,P<0.05)、术后3个月Constant评分(t=2.827,P<0.05)、术后3个月美国肩肘外科协会评分(American shoulder and elbow surgeons'form, ASES)(t=2.210,P<0.05)显著提高,与对照组之间差异具有统计学意义。两组之间的再撕裂率差异无统计学意义。术后3个月肩关节MRI与肌骨超声检查提示PRP组术后肩袖愈合情况更好且血运增多。

结论

肩袖修补术联合足印区注射PRP与单纯的肩袖修补相比,可以改善术后短期内肩关节疼痛以及肩关节功能,促进术后愈合。

Background

The rotator cuff is a complex composed of four tendons: the supraspinatus and infraspinatus muscles. Nowadays, more and more people pay attention to the injury and pain of the shoulder joint. There are many reasons for shoulder joint pain, among which rotator cuff tear is the most common injury. For patients with clinical symptoms of acute rotator cuff injury or who do not respond to non-surgical treatment after three months of injury, surgery is required as soon as possible. However, according to domestic and foreign studies, the quality and integrity of postoperative tendon healing are still not ideal. Due to the influence of age, injury time, injury degree, and treatment method, postoperative complications such as pain, limited movement, and retear are still high. Rotator cuff tears surgically repaired the tending-osseous transitional zone. Still, the previously bone-tendon solid tissue connection was replaced by a relatively poor fibrovascular scar, resulting in poor mechanical properties of the repaired tendon after surgery. Nowadays, surgery combined with biological means has made significant progress in promoting tissue healing after rotator cuff repair surgery. In recent years, PRP has been widely applied in various orthopedic diseases, and the effectiveness of PRP in treating orthopedic conditions has been proved in domestic and foreign studies. The application of PRP in rotator cuff injury is still a hot research topic. Still, there is no consensus on PRP's effectiveness in treating rotator cuff injury. Therefore, whether rotator cuff repair combined with PRP positively affects the healing of the rotator cuff and the reduction of postoperative complications remains doubtful.

Objective

To analyze the curative effect of rotator cuff repair combined with the injection of platelet-rich plasma into footprints.

Methods

A retrospective study was conducted on 40 patients with rotator cuff tears who underwent arthroscopic surgery in the First Hospital of Qinhuangdao from March 2021 to March 2022. All patients treated with PRP during the operation were divided into the PRP group (n=20) and the control group without PRP treatment (n=20). Various postoperative scores of the two groups were statistically analyzed using the SPSS 26.0 software, and postoperative evaluation was performed using MRI and musculoskeletal ultrasound.

Results

Forty patients were followed up for one year. All kinds of scores of the two groups were better than those before surgery. The VAS score of 6 months after surgery (Z=-2.071, P < 0.05), Constant score of 3 months after surgery (t=2.827, P < 0.05), ASES score of 3 months after surgery (t=2.210, P < 0.05) were significantly increased in PRP group. The difference between the two groups was statistically significant. The rate of retear between the two groups was not statistically significant. MRI and musculoskeletal ultrasonography of shoulder joints three months after surgery indicated that rotator cuff healing improved and blood flow increased in the PRP group.

Conclusion

Compared with rotator cuff repair alone, rotator cuff repair combined with platelet-rich injection in the footprint can improve shoulder joint pain and function in the short term after surgery and promote postoperative healing

图1 MRI提示冈上肌完全断裂
图2 PRP制备(图A)及PRP的抽取备用(图B)注:PRP为富血小板血浆
图3 生理盐水排空后足印区注射
图4 PRP激活成凝胶注:PRP为富血小板血浆
表1 两组患者VAS评分结果与比较
表2 两组患者Constant评分结果与比较(分,±s
表3 两组患者ASES评分结果与比较(分,±s
表4 两组患者UCLA评分结果与比较(分,±s
图5 与对照组(图A)相比,术后3个月肩关节MRI提示PRP组(图B)肱骨头内骨髓水肿面积小,关节周围软组织水肿程度轻;冈上肌肌腱T2WI少量高信号,纤维走形顺畅注:PRP为富血小板血浆
图6 对照组术后3个月肌骨超声检查,可见肌腱连续性欠佳,回声不均匀,血流信号较少
图7 PRP组术后3个月肌骨超声检查:可见均匀条索状回声,肌腱组织连续性良好,局部可见点状血流信号注:PRP为富血小板血浆
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