肩袖损伤关节镜下修复是否使用富血小板血浆的比较

Arthroscopic repair of rotator cuff tears with or without platelet-rich plasma injection

摘要:

[目的] 探讨肩袖损伤关节镜下修复是否使用富血小板血浆（platelet-rich plasma, PRP）的疗效差异。[方法] 回顾性分析2022年4月—2024年5月118例肩袖损伤患者的资料。根据医患沟通结果，60例采用关节镜联合PRP治疗（PRP组），另外58例采用单纯关节镜治疗（无PRP组）。比较围术期、临床及影像结果。[结果] PRP组手术时间[min, (70.3±7.8) vs (65.9±7.3), P=0.002]和术中失血量[mL, (24.3±4.6) vs (13.8±2.9), P<0.001]显著高于无PRP组，两组住院时间、切口长度、切口愈合等级、关节主动活动时间差异无统计学意义（P>0.05）。PRP组恢复完全负重活动时间早于无PRP组[d, (60.4±7.4) vs (64.8±9.5), P=0.006]。随着时间推移，两组VAS评分逐渐降低，UCLA评分、Constant-Murley评分、ASES评分、前屈ROM、外展ROM均逐渐升高（P<0.05），且术后3个月、末次随访PRP组UCLA评分[分, (29.4±2.2) vs (28.2±2.0), P=0.003; (31.5±2.1) vs (30.2±2.0), P=0.001]、Constant-Murley评分[分, (69.4±4.9) vs (64.5±4.6), P<0.001; (31.5±2.1) vs (30.2±2.0), P<0.001]、ASES评分[分, (80.4±5.3) vs (76.5±4.9), P<0.001; (85.3±4.6) vs (81.0±4.5), P<0.001]、前屈上举ROM [°, (150.4±13.4) vs (145.8±10.4), P=0.040; (154.4±10.8) vs (150.6±9.6), P=0.046]、外展上举ROM [°, (132.8±9.6) vs (126.5±8.3), P<0.001; (138.5±8.7) vs (133.5±8.0), P=0.002]均显著优于无PRP组。影像方面，随着时间的推移，两组AHD均逐渐升高，肌腱完整性逐渐改善（P<0.05），但相应时间点两组间的差异均无统计学意义（P>0.05），两组再撕裂率差异无统计学意义（P>0.05）。[结论] 关节镜联合PRP治疗肩袖损伤虽然手术时间延长，出血量相对较高，但PRP可促进肩关节功能恢复。

Abstract:

[Objective] To explore the efficacy differences of arthroscopic repair of rotator cuff injury with or without platelet-rich plasma (PRP). [Methods] A retrospective research was conducted on 118 patients with rotator cuff injury from April 2022 to May 2024. According to the communication between doctors and patients, 60 patients were treated with arthroscopic repair combined with PRP (the PRP group), while the other 58 patients were treated with arthroscopic repair alone (the non-PRP group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] The PRP group was significantly greater than the non-PRP group in terms of operation time [min, (70.3±7.8) vs (65.9±7.3), P=0.002] and intraoperative blood loss [mL, (24.3±4.6) vs (13.8±2.9), P<0.001], however, there were no statistically significant differences in hospital stay, incision length, incision healing grade, and active joint movement time between the two groups (P>0.05). The PRP group resumed full weight-bearing activity earlier than the non-PRP group [d, (60.4±7.4) vs (64.8±9.5), P=0.006]. The VAS scores significantly decreased, while the UCLA, Constant-Murley and ASES scores, as well as forward flexion ROM, and abduction ROM significantly increased over time in both groups (P<0.05). The PRP group proved significantly superior to the non-PRP group in terms of UCLA [points, (29.4±2.2) vs (28.2±2.0), P=0.003; (31.5±2.1) vs (30.2±2.0), P=0.001], Constant-Murley [points, (69.4±4.9) vs (64.5±4.6), P<0.001; (31.5±2.1) vs (30.2±2.0), P<0.001], ASES [points, (80.4±5.3) vs (76.5±4.9), P<0.001; (85.3±4.6) vs (81.0±4.5), P<0.001], forward flexion ROM [°, (150.4±13.4) vs (145.8±10.4), P=0.040; (154.4±10.8) vs (150.6±9.6), P=0.046], and abduction ROM [°, (132.8±9.6) vs (126.5±8.3), P<0.001; (138.5±8.7) vs (133.5±8.0), P=0.002] 3 months postoperatively and at the last follow-up. As for imaging, the acromiohumeral distance (AHD) significantly increased, and the tendon integrity significantly improved over time in both groups (P<0.05), which were not statistically significant between the two groups at any time points accordingly (P>0.05), and there was no a statistically significant difference in the re-tear rate between the two groups (P>0.05). [Conclusion] Although arthroscopic repair of rotator cuff injury combined with PRP prolongs the operation time and increases the intraoperative blood loss, the PRP injection can promote the recovery of shoulder function.