巨大肩袖撕裂肱二头肌腱转位是否注射PRP的比较

Long head of biceps tendon transposition with or without platelet-rich plasma injections for massive rotator cuff tear

摘要:

[目的] 比较肱二头肌长头腱（long head of biceps tendon transfer, LHBT）转位术治疗巨大肩袖损伤（massive rotator cuff tears, MRCTs）是否注射富血小板血浆（platelet-rich plasma, PRP）的临床效果。[方法] 回顾性分析2020年1月—2024年8月于本院行镜下LHBT转位治疗MRCTs 40例患者的资料。根据手术时间顺序，2020年1月—2022年6月的18例术中未注射PRP，2022年7月—2024年8月手术的22例术中局部注射PRP，比较两组围手术期、随访及影像资料。[结果] 两组手术均顺利完成，术中无严重并发症。与术前相比，两组患者术后VAS评分均显著降低（P<0.05）。术后3、7、14 d，PRP组VAS评分均显著低于无PRP组[分, (6.1±1.0) vs (6.8±1.1), P=0.039; (4.9±1.1) vs (6.0±1.3), P=0.005; (3.7±1.2) vs (4.6±1.4), P=0.016]。随访12~16个月，与术前相比，两组患者术后3个月及末次随访时UCLA、Constant-Murley、ASES评分，以及前屈上举、外展上举ROM均显著改善（P<0.05），术后3个月时，PRP组UCLA[分, (25.1±4.3) vs (22.3±4.0), P=0.039]、Constant-Murley[分, (64.4±7.3) vs (58.8±8.3), P=0.029]、ASES评分[分, (77.3±9.3) vs (70.6±8.3), P=0.024]及前屈上举ROM[°, (108.5±13.2) vs (95.4±12.8), P=0.003]、外展上举ROM[°, (115.5±11.2) vs (103.2±12.3), P=0.002]均显著优于无PRP组。影像方面，与术前相比，术后3个月及末次随访时，两组肩肱距离（acromiohumeral distance, AHD）、Seebauer和Sugaya分级均显著改善（P<0.05），相应时间点两组间上述影像指标的差异均无统计学意义（P>0.05）。[结论] PRP注射联合LHBT转位术治疗MRCTs能够加速术后早期疼痛缓解与功能恢复，具有良好的安全性。

Abstract:

[Objective] To compare the clinical efficacy of long head of biceps tendon (LHBT) transposition with or without platelet-rich plasma (PRP) injection in the treatment of massive rotator cuff tears (MRCTs). [Methods] A retrospective study was conducted on 40 patients who underwent LHBT transposition for MRCTs at our hospitals from January 2020 to August 2024. According to the chronological order of the surgeries, 18 cases from January 2020 to June 2022 did not receive PRP injection during the operation, while 22 cases from July 2022 to August 2024 received PRP injection locally during the operation. The perioperative, follow-up, and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures performed successfully without serious complications. The VAS score in both groups significantly decreased after surgery (P<0.05). The PRP group were significantly lower than the non-PRP group in VAS score 3, 7, and 14 days after surgery [points, (6.1±1.0) vs (6.8±1.1), P=0.039; (4.9±1.1) vs (6.0±1.3), P=0.005; (3.7±1.2) vs (4.6±1.4), P=0.016]. The patients were followed up from 12 to 16-month, and the UCLA, Constant-Murley, and ASES scores, as well as the flexion-elevation and abduction-elevation ROM in both groups significantly improved at 3 months and the last follow-up compared with those preoperatively (P<0.05). At 3 months after surgery, the PRP group were significantly better than the non-PRP group in terms of UCLA score [points, (25.1±4.3) vs (22.3±4.0), P=0.039], Constant- Murley score [points, (64.4±7.3) vs (58.8±8.3), P=0.029], and ASES score [points, (77.3±9.3) vs (70.6±8.3), P=0.024]. As for imaging, the acromiohumeral distance (AHD), Seebauer and Sugaya grades in both groups significantly improved at 3 months and the last follow-up compared with those preoperatively (P<0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P>0.05). [Conclusion] PRP injection combined with LHBT transposition for MRCTs can accelerate the early pain relief and functional recovery after surgery with high safety.