骨髓干细胞富血小板血浆增强镜下肩袖修复△

Arthroscopic rotator cuff repair augmented with bone marrow stem cell and platelet-rich plasma

摘要:

[目的] 评估骨髓间质细胞 (bone marrow mesenchymal stem cells, BMSCs) 联合富血小板血浆 (platelet-rich plasma， PRP) 治疗肩袖损伤的临床疗效。[方法] 回顾性分析 2019 年 7 月—2021 年 10 月行关节镜下肩袖修复术 160 例患者的临床资料。其中，缝合组 80 例仅给予镜下肩袖修复术，联合组 80 例予以镜下肩袖修复联合局部 BMSCs 与 PRP 注射。比较两组围手术期、随访和影像资料。[结果] 两组患者均顺利完成手术，围手术期无并发症。两组手术时间、切口总长度、术中失血量、 主动活动时间、切口愈合等级和住院时间的差异均无统计学意义 (P＞0.05)。随时间推移两组早期 VAS 评分均显著降低 (P＜ 0.05)。随访时间平均(13.6±0.8) 个月。与术前相比，术后 3 个月两组前屈上举、外展上举与体侧外旋 ROM 均显著减少(P＜ 0.05)，而 UCLA 评分显著增加(P＜0.05)，末次随访时，上述指标较术前均显著增加(P＜0.05)。相应时间点，两组间上述指标的差异均无统计学意义(P＞0.05)。影像方面，随时间推移，两组 AHI 和 MRI 评级较术前均显著改善(P＜0.05)。术前和术后 3 个月两组 AHI 和 MRI 评级的差异均无统计学意义 (P＞0.05)。末次随访时，联合组 AHI 和 MRI 评级均显著优于缝合组 (P＜ 0.05)。末次随访时，缝合组再撕裂率 32.5% (26/80)，联合组再撕裂率 15.0% (12/80)。[结论] BMSCs 与 PRP 显著改善了肩袖损伤修复术后愈合，降低了再撕裂率。

Abstract:

[Objective] To evaluate the clinical efficacy of bone marrow mesenchymal stem cells (BMSCs) combined with platelet-rich plasma (PRP) augmented arthroscopic rotator cuff repair. [Methods] A retrospective study was conducted on 160 patients who underwent arthroscopic rotator cuff repair for rotator cuff tear in our department from July 2019 to October 2021. Among them, 80 patients in the su- ture group received arthroscopic rotator cuff repair only, while the remaining 80 patients in the combined group received arthroscopic rota- tor cuff repair combined with local injection of BMSCs and PRP. The perioperative period, follow-up and imaging data were compared be- tween the two groups. [Results] All patients in both groups had operation done successfully without serious complications. There were no significant differences in operation time, total incision length, intraoperative blood loss, postoperative active motion time, incision healing and hospital stay between the two groups (P＞0.05), whereas the VAS scores in both groups were significantly decreased over time in the ear- ly stage after operation (P＜0.05). All of them were followed up for (13.6±0.8) months on an average. Compared with those preoperatively, the forward flexion, abduction and internal-external rotation range of motions (ROMs) significantly reduced in both groups 3 months after operation (P＜0.05), while the UCLA score was significantly increased (P＜0.05), whereas which all significantly increased at the last followup (P＜0.05). However, there was no significant difference in the above items between the two groups at any corresponding time points (P＞ 0.05). Radiographically, the acromiohumeral interval (AHI) and Sugaya MRI classification significantly improved postoperatively compared with those before surgery (P＜0.05). Although there were no significant differences between the two groups before and 3 months after surgery (P＞0.05), the combined group proved significantly superior to the suture group in AHI and MRI classification at the latest follow-up (P＜ 0.05). At the last interview, the rate of rotator cuff re-rupture was 32.5% (26/80) in the suture group, while 15.0% (12/80) in the combined group. [Conclusion] The BMSCs and PRP do significantly improve postoperative healing of rotator cuff tear and reduce the chance of re- tear.