切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 608 -613. doi: 10.3877/cma.j.issn.1674-134X.2018.05.003

所属专题： 文献；

临床论著

富血小板血浆局部注射治疗肱骨外上髁炎的疗效
董佩龙1, 唐晓波1,†(), 王健1, 朱振安2   
  1. 1. 224700　盐城，南通大学附属建湖医院骨科
    2. 200011　上海交通大学医学院附属第九人民医院骨科
  • 收稿日期:2016-12-15 出版日期:2018-10-01
  • 通信作者: 唐晓波
  • 基金资助:
    江苏省"科教强卫工程"专项经费资助(QNRC2016463)

Efficacy of local injection of autologous platelet rich plasma in treatment of lateral epicondylitis

Peilong Dong1, Xiaobo Tang1,†(), Jian Wang1, Zhen’an Zhu2   

  1. 1. Department of Orthopedics, Jianhu Hospital affiliated to Nantong University, Yancheng 224700, China
    2. Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to School of Medicine, Shanghai JiaoTong University, Shanghai 200011, China
  • Received:2016-12-15 Published:2018-10-01
  • Corresponding author: Xiaobo Tang
  • About author:
    Corresponding author: Tang Xiaobo, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

董佩龙, 唐晓波, 王健, 朱振安. 富血小板血浆局部注射治疗肱骨外上髁炎的疗效[J]. 中华关节外科杂志(电子版), 2018, 12(05): 608-613.

Peilong Dong, Xiaobo Tang, Jian Wang, Zhen’an Zhu. Efficacy of local injection of autologous platelet rich plasma in treatment of lateral epicondylitis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(05): 608-613.

目的

探讨自体富血小板血浆局部注射治疗肱骨外上髁炎的效果及可靠性，为临床治疗提供参考。

方法

2013年01月至2015年01月，将南通大学附属建湖医院骨科60例拟定行局部注射治疗的患者随机分为两组：富血小板血浆组(注射应用自体富血小板血浆)30例；糖皮质激素组(使用同等剂量的醋酸泼尼松龙注射液和利多卡因)30例。两组治疗后康复训练方案相同。术后1、3、12个月随访并临床评价，包括注射部位炎性反应程度、疼痛视觉模糊评分(VAS)、Mayo肘关节功能评分系统(MEPS)及臂、肩、手功能障碍(DASH)评分。组间比较采用独立样本t检验，等级资料采用秩和检验，VAS评分、DASH评分及MEPS评分的总体差异分析采用重复测量资料的方差分析，各时间点的组间差异采用独立样本t检验。

结果

治疗后第4天，富血小板血浆组注射部位炎性反应程度无28例，轻1例，中1例，糖皮质激素组为无27例，轻2例，中1例；富血小板血浆组VAS评分由治疗前的(75±9)分降为治疗后1个月时的(64±8)分、3个月时(42±9)分及12个月时的(21±9)分，DASH评分由治疗前的(138± 10)分将降为治疗后1个月时的(113±10)分、3个月时的(82± 10)分及12个月时的(52±10)分，MEPS评分由治疗前的(25±4)分提高为治疗后1个月时的(45±4)分、3个月时的(63±4)分及12个月时的(82± 4)分；糖皮质激素组VAS评分由治疗前的(74±9)分降为治疗后1个月时的(53±9)分、3个月时的(45±8)分及12个月时的(55±9)分，DASH评分由治疗前的(133±11)分将降为治疗后1个月时的(99±10)分、3个月时的(85±10)分及12个月时的(98±10)分，MEPS评分由治疗前的(27±4)分提高为治疗后1个月时的(54±4)分、3个月时的(62± 4)分及12个月时的(47±5)分。两组注射部位炎性反应程度比较差异无统计学意义(P >0.05)。两组VAS评分、DASH评分及MEPS评分的总体差异有统计学意义(组间VAS：F＝15.98，P <0.01；DASH：F＝15.00，P <0.01；MEPS：F＝68.98，P<0.01)，两组组间比较治疗后1个月、12个月VAS评分、DASH评分及MEPS评分比较差异有统计学意义(1个月VAS：t ＝5.0034，1个月DASH：t ＝5.4442，1个月MEPS：t ＝8.7142，P<0.05；12个月VAS：t ＝14，6313，12个月DASH：t ＝17.8157，12个月MEPS：t ＝29.9390，P<0.05)，而治疗后3个月VAS评分、DASH评分及MEPS评分比较差异无统计学意义(VAS：t ＝1.3646，DASH：t ＝1.1619，MEPS：t ＝0.9682，P>0.05)。

结论

自体富血小板血浆及糖皮质激素局部注射治疗肱骨外上髁炎均能缓解疼痛，恢复肘关节功能；但糖皮质激素早期起效快，后期治疗效果缓和，自体富血小板血浆治疗效果逐渐提高，同时不增加治疗后的并发症，从长远看值得推广。

关键词: 富血小板血浆, 网球肘, 糖皮质激素类, 疼痛
Objective

To investigate the effect of local injection of autologous platelet rich plasma in the treatment of lateral epicondylitis.

Methods

From January 2013 to January 2015, 60 patients with lateral epicondylitis undergent local injection therapy were randomly divided into two groups: PRP group (30 patients received autologous PRP)and glucocorticoid group(30 patients received prednisolone acetate and lidocaine). All the patients had the same accelerated rehabilitation protocol and were followed up in one, three, and 12 months. Evaluation consisted of inflammatory reaction, visual analogue scale(VAS), Mayo elbow performance score(MEPS)and disablities of the arm shoulder and hand(DASH)score. Independent samples t test was used to compared two groups, grade data used rank sum test. Overall differences in VAS , MEPS, DASH scores were analyzed by variance for repeated measurement data, differences at each time point were analyzed by independent samples t test.

Results

After the operation, no inflammatory reaction was in 28 cases of the PRP group and in 27 cases of the glucocorticoid group, mid inflammatory reaction in one case of PRP group and in two cases of glucocorticoid group, moderate inflammatory reaction in one case of PRP group and in one case of glucocorticoid group. In PRP group, the pretreatment, one month , three months and 12 months post-treatment VAS scores were (75±9), (64±8), (42±9), (21±9); DASH scores were (138±10), (113±10) , (82±10), (52±10) , MEPS scores were (25±4), (45±4), (63±4) , (82±4). In glucocorticoid group, the pretreatme, 1month, 3 months and 12 months post-treatment VAS scores were (74±9) , (53±9), (45±8), (55±9) , DASH scores were (133±11), (99±10), (85±10), (98±10), MEPS scores were (27±4), (54±4), (62±4), (47±5). Inflammatory reaction was not statistically significant different between the two groups (P>0.05). The total difference of VAS , DASH, MEPS score between the two groups were statistically significant(VAS F=15.98, P<0.01; DASH F=15.00, P<0.01 MEPS; F=68.98, P<0.01). One month and three months postoperative VAS, MEPS, DASH were statistically significant different in the PRP group and the glucocorticoid group(one month VAS t=5.0034, one month DASH t=5.4442, one month MEPS t=8.7142, P <0.05; 12 months VAS t=14.6313, 12 months DASH t=17.8157, 12 months MEPS t=29.9390, P<0.05), but three months postoperative VAS, DASH, MEPS differences were not statistically significant between the two groups (VAS t=1.3646, DASH t=1.1619, MEPS t=0.9682, P>0.05).

Conclusions

Antologous PRP and glucocorticoid local injection in the treatment of external humeral epicondylitis can alleviate pain, restore the function of elbow joint. Glucocorticoid may be better at the begining and then the effect will decline, whereas PRP can progressively improve effects without adverse effects, which is worthy of promotion in the clinic.

Key words: Platelet-rich plasma, Tennis elbow, Glucocorticoids, Pain
表1 PRP组和糖皮质激素组患者术前临床资料比较
组别 例数 男/女(例) 年龄[岁，(±s)] 侧别(左/右) VAS评分(±s) DASH评分(±s) MEPS评分(±s)
PRP组 30 13/17 42±7 9/21 75±9 138±10 25±4
糖皮质激素组 30 14/16 43±7 8/22 74±9 133±11 27±4
统计值 ? χ2＝0.0673 t＝0.5533 χ2＝0.0821 t＝0.4303 t＝1.8422 t＝1.9365
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表2 PRP组和糖皮质激素组患者术后随访组间各项指标比较
组别 例数 炎性反应程度(无/轻/中) 治疗后1个月(±s) 治疗后3个月(±s) 治疗后12个月(±s)
VAS评分 DASH评分 MEPS评分 VAS评分 DASH评分 MEPS评分 VAS评分 DASH评分 MEPS评分
PRP组 30 28/1/1 64±8 113±10 45±4 42±9 82±10 63±4 21±9 52±10 82±4
糖皮质激素组 30 27/2/1 53±9 99±10 54±4 45±8 85±10 62±4 55±9 98±10 47±5
统计值 － u＝0.4473 t＝5.0034 t＝5.4442 t＝8.7142 t＝1.3646 t＝1.1619 t＝0.9682 t＝14.6313 t＝17.8157 t＝29.9390
P值 － >0.05 <0.01 <0.01 <0.01 >0.05 >0.05 >0.05 <0.01 <0.01 <0.01
[1]
Krogh TP, Fredberg U, Stengaard-Pedersen K, et al. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial[J]. Am J Sports Med, 2013, 41(3):625-635.
[2]
Gosens T, Peerbooms JC, Van Laar W, et al. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis[J]. Am J Sports Med, 2011, 39(6):1200-1208.
[3]
Descatha A, Dale AM, Silverstein BA, et al. Lateral epicondylitis: New evidence for work relatedness[J]. Joint Bone Spine, 2015, 82(1):5-7.
[4]
Brummel J, Baker IC, Hopkins R, et al. Epicondylitis: lateral[J]. Sports Med Arthrosc, 2014, 22(3):E1-E6.
[5]
Peerbooms JC, Sluimer J, Bruijn DJ, et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a Double-Blind randomized controlled trial Platelet-Rich plasma versus corticosteroid injection with a 1-year follow-up[J]. Am J Sports Med, 2010, 38(2):255-262.
[6]
Dobreci DL, Dobrescu T. The effects of extracorporeal shockwave therapy(ESWT)in treating lateral epicondylitis in People between 40 and 50 years old[J]. Proc Soci Behav Sci, 2014, 137(1):32-36.
[7]
Krogh TP, Bartels EM, Ellingsen T, et al. Comparative effectiveness of injection therapies in lateral epicondylitis：a systematic review and network meta-analysis of randomized controlled trials[J]. Am J Sports Med, 2013, 41(6):1435-1446.
[8]
Everts PA, Knape JT, Weibrich G, et al. Platelet-rich plasma and platelet gel: a review[J]. J Extra Corpor Technol, 2006, 38(2):174-187.
[9]
Lacci KM, Dardik A. Platelet-rich plasma：support for its use in wound healing[J]. Yale J Biol Med, 2010, 83(1):1-9.
[10]
Wasterlain AS, Braun HJ, Harris AH, et al. The systemic effects of Platelet-Rich plasma injection[J]. Am J Sports Med, 2013, 41(1):186-193.
[11]
Chaudhury S, De La Lama M, Adler RS, et al. Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity (pilot study)[J]. Skeletal Radiol, 2013, 42(1):91-97.
[12]
Podesta L, Crow SA, Volkmer D, et al. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma[J]. Am J Sports Med, 2013, 41(7):1689-1694.
[13]
Morrey BF, Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow[J]. J Bone Joint Surg Am, 1922, 74(4):479-490.
[14]
Raven EE, Haverkamp D, Sierevelt IN, et al. Construct validity and reliability of the disability of arm, shoulder and hand questionnaire for upper extremity complaints in rheumatoid arthritis[J]. J Rheumatology, 2008, 35(12):2334-2338.
[15]
Kaux JF, Crielaard JM. Platelet-rich plasma application in the management of chronic tendinopathies[J]. Acta Orthop Belg, 2013, 79(1):10-15.
[16]
Bosch G, Moleman M, Barneveld A, et al. The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions[J]. Scand J Med Sci Sports, 2011, 21(4):554-561.
[17]
Jo CH, Kim JE, Yoon KS, et al. Platelet-rich plasma stimulates cell proliferation and enhances matrix gene expression and synthesis in tenocytes from human rotator cuff tendons with degenerative tears[J]. Am J Sports Med, 2012, 40(5):1035-1045.
[18]
Kesikburun S, Tan A, Yilmaz B, et al. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up[J]. Am J Sports Med, 2013, 42(11):2609-2616.
[19]
梁大伟，卫小春，魏垒．富血小板血浆在肌肉骨骼疾病中的应用[J/CD]．中华关节外科杂志(电子版)，2016，10(2):199-204.
[20]
Brass L. Understanding and evaluating platelet function[J]. Hematology Am Soc Hematol Educ Program, 2010(1):387-396.
[21]
Xie X, Wu H, Zhao S, et al. The effect of platelet-rich plasma on patterns of gene expression in a dog model of anterior cruciate ligament Reconstruction[J]. J Surg Res, 2013, 180(1):80-88.
[22]
Yoshida R, Murray MM. Peripheral blood mononuclear cells enhance the anabolic effects of platelet-rich plasma on anterior cruciate ligament fibroblasts[J]. J Orthop Res, 2013, 31(1):29-34.
[23]
Taylor DW, Petrera M, Hendry MA. A systematic review of the use of Platelet-Rich plasma in sports medicine as a new treatment for tendon and ligament injuries[J]. Clin J Sport Med, 2011, 21(4):344-352.
[1] 刘嘉嘉, 王承华, 陈绪娇, 刘瑗玲, 王善钰, 屈海花, 张莉. 经阴道子宫-输卵管实时三维超声造影中患者疼痛发生情况及其影响因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 959-965.
[2] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[3] 欧阳剑锋, 李炳权, 叶永恒, 胡少宇, 向阳. 关节镜联合富血小板血浆治疗粘连性肩周炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 765-772.
[4] 许正文, 李振, 侯振扬, 苏长征, 朱彪. 富血小板血浆联合植骨治疗早期非创伤性股骨头坏死[J]. 中华关节外科杂志(电子版), 2023, 17(06): 773-779.
[5] 董红华, 郭艮春, 江磊, 吴雪飞, 马飞翔, 李海凤. 骨科康复一体化模式在踝关节骨折快速康复中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(06): 802-807.
[6] 张中斌, 付琨朋, 朱凯, 张玉, 李华. 胫骨高位截骨术与富血小板血浆治疗膝骨关节炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(05): 633-641.
[7] 王泽勇, 覃健. 白细胞含量对富血小板血浆治疗运动系统损伤的影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 684-688.
[8] 杨皓媛, 龚杰, 邹青伟, 阮航. 哮喘孕妇的母婴不良妊娠结局研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 522-529.
[9] 韩李念, 王君. 放射性皮肤损伤治疗的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 533-537.
[10] 吴畏, 吴永哲, 李宗倍, 崔宏力, 李华志, 许臣. 轻质大网孔补片腹腔镜下疝修补术治疗老年腹股沟疝的疗效及炎症因子的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 70-73.
[11] 王可, 范彬, 李多富, 刘奎. 两种疝囊残端处理方法在经腹腹膜前腹股沟疝修补术中的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 692-696.
[12] 夏松, 姚嗣会, 汪勇刚. 经腹腹膜前与疝环充填式疝修补术治疗腹股沟疝的对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 702-705.
[13] 王敏, 蒋家斌, 李茂新. 预警宣教联合个性化疼痛管理对腹股沟疝手术患者的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 764-767.
[14] 马聪, 李雪靖, 郑晓佐, 张晓阳, 段坤峰, 刘国强, 郄素会. 关节腔内注射富血小板血浆与透明质酸钠治疗Ⅰ-Ⅲ期膝骨关节炎的对比研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 282-288.
[15] 付强, 秦丽媛, 李全波. 神经病理性疼痛患者血清miR-15a水平及意义分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 293-298.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号