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中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 335 -341. doi: 10.3877/cma.j.issn.1674-134X.2019.03.013

所属专题: 文献

综述

富血小板血浆治疗腱病概况
李方奇1, 杨睿1,(), 侯景义1, 汤毅勇1, 邓海权1, 宋斌1, 张正政1, 李卫平1   
  1. 1. 510000 广州,中山大学附属第二医院(孙逸仙纪念医院)骨科
  • 收稿日期:2018-07-12 出版日期:2019-06-01
  • 通信作者: 杨睿
  • 基金资助:
    广东省自然科学基金(2018A030313780); 广州市科技计划项目(201704020132)

Platelet-rich plasma in treatment of tendinopathy

Fangqi Li1, Rui Yang1,(), Jingyi Hou1, Yiyong Tang1, Haiquan Deng1, Bing Song1, Zhengzheng Zhang1, Weiping Li1   

  1. 1. Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510000, China
  • Received:2018-07-12 Published:2019-06-01
  • Corresponding author: Rui Yang
  • About author:
    Corresponding author: Yang Rui, Email:
引用本文:

李方奇, 杨睿, 侯景义, 汤毅勇, 邓海权, 宋斌, 张正政, 李卫平. 富血小板血浆治疗腱病概况[J]. 中华关节外科杂志(电子版), 2019, 13(03): 335-341.

Fangqi Li, Rui Yang, Jingyi Hou, Yiyong Tang, Haiquan Deng, Bing Song, Zhengzheng Zhang, Weiping Li. Platelet-rich plasma in treatment of tendinopathy[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(03): 335-341.

腱病是临床常见的疾病,给社会造成巨大的经济负担。注射富血小板血浆(PRP)作为对抗腱病发生发展的手段之一,有望为腱病的治疗带来新的选择。但是腱病是一大类疾病的统称,其具体分型间存在明显异质性。与此同时市售PRP本身也具有许多种类,因此本文对PRP在腱病中应用的文章进行了文献综述,以期科学评判PRP对腱病的治疗效果。对于传统保守治疗无效的慢性腱病患者而言,使用多个浓缩步骤制备的多次超声引导的PRP注射仍然具有治疗潜力,其中疗效最为明确的是膑腱炎以及肱骨外上髁炎。

Tendinopathy is a common clinical disease, which causes great economic burden to the society. Platelet-rich plasma(PRP)injection is one of the methods to combat the development of tendinopathy, which may bring new options for the treatment of tendinopathy. However, tendinopathy is a general category of diseases, and there is obvious heterogeneity among its specific types. At the same time, there are many kinds of PRP in the market. Therefore, this article reviewed the literature on the application of PRP in tendinopathy in order to scientifically evaluate the therapeutic effect of PRP on tendinopathy. For chronic tendinitis patients who fail to respond to conventional conservative treatment, multiple ultrasounds-guided PRP injection prepared by multiple enrichment procedures still has therapeutic potential, among which patella tendinitis and external humeral epicondylitis are the most obvious ones.

表1 市售PRP制备设备分类
图1 PRP(富血小板血浆)"PAW(血小板-活化-白细胞)"分类系统(翻译自Jeffrey[7])
表2 前人临床研究PRP的分类及治疗效果
疾病 作者 证据 等级 研究 类型 患者数量 PRP产品 PAW分型 是否B超引导 注射方法 临床结局
肱骨外上髁炎 Hechtman等[34] 病例报告 PRP治疗组(n=31) Cascade MTF NA-x-B β NA 单次注射,深部组织浸润 (+)疼痛及功能评分得到改善
Thanasas等[35] RCT PRP治疗组(n=14)VS自体全血(n=14) Biomet Ⅲ GPS P4-A α 单次注射,深部组织浸润 (+)疼痛及功能评分得到改善
Peerbooms等[17] RCT PRP治疗组(n=51)VS激素注射(n=49) Biomet NA-A α NA 单次注射,深部组织浸润 (+)疼痛减轻,功能改善
Gosens等[36] RCT PRP治疗组(n=51)VS激素注射(n=49) Biomet NA-A α NA 单次注射,深部组织浸润 (+)疼痛减轻,功能改善
Mishra等[16] 前瞻队列 PRP治疗组(n=15)VS布比卡因注射(n=5) Biomet P4-NA-A α NA 单次注射,深部组织浸润 (+)在症状严重的患者中有良好的治疗效果
Giovanni等[37] RCT PRP治疗组(n=51)VS关节镜松解(n=50) BiomedDevice, Modena ,Italy NA-A α 共注射2次,每次间歇2周 (+)中短期PRP与手术组在疼痛及功能评分的效果近似
(-)PRP治疗组长期效果(2y)差,同时肌力恢复不如手术组
de Vos等[22] RCT PRP治疗组(n=27)VS生理盐水注射(n=27) Biomet NA-A α 3个注射位点,第1次在低回声区域注射,另外两次分别在第一次注部位的近端和远端注射。如果没有低回声区,就在最痛的部位注射 (-)PRP与安慰剂相比并未带来功能和疼痛的更明显的改善
跟腱腱病 de Jonge等[39] RCT PRP治疗组(n=27)VS生理盐水注射(n=27) Biomet NA-A α 3个注射位点 (-)PRP与安慰剂相比并未带来功能和疼痛的更明显的改善
Schepull等[25] RCT PRP治疗组(n=16)VS生理盐水注射(n=14) NA P4-NA 术中植入 (-)PRP对跟腱断裂的患者未见明显改善,同时下肢功能评分甚至更差
Filardo等[40] 病例报告 PRP治疗组(n=1) NA P4-X-NA NA 共注射3次,每次间歇7 d (+)组织修复加快,较快恢复功能
Sánchez等[24] 病例报告 PRGF治疗组(n=6) BTI/PRGF NA-x-B β 术中植入 (+)活动度更良好,较快恢复功能
Jian Zou等[41] RCT 手术+PRP组 (n=16)VS单纯 手术(n=19) WEGO Ltd., Shandong,China NA 术中植入 (+)PRP改善中长期功能,2年后关节活动度仍有优势
跳跃者膝 Filardo等[42] 前瞻队列 PRP三次注射治疗组(n=15)VS NA P4-X-NA NA 共注射3次,每次间歇15 d (+)PRP有助于传统治疗方式失败的反复发作的腱病治疗
单纯康复训练(n=16)
Kon et al[26] 病例报告 PRP治疗组,6 m评估(n=20) NA P4-X-NA 单次注射,单或双点皮肤注射,4~6次肌腱渗透 (+)PRP有助于损伤肌腱组织的再生
肩袖疾病 Jo等[43] 前瞻队列 PRP治疗组(n=19)VS对照组(n=23) COBE spectra LRS Turbo P3-X-NA 术中植入 (-)PRP并未加速组织的修复
Randelli等[31] RCT PRP治疗组(n=26)VS对照组(n=27) Biomet NA-x-A α 术中植入 (+)PRP改善术后第一个月的疼痛,同时在术后1~2年促进肌腱修复。
Castricini等[32] RCT PRP治疗组(n=43)VS对照组(n=45) Cascade MTF NA-x-B β 术中植入 (-)PRP与对照组相比,不存在明显优势。
Randelli等[44] 病例报告 PRP治疗组(n=26) Biomet GPS Ⅱ NA-x-A α 术中植入 (±)PRP与对照组相比,不存在明显优势。
Barber等[45] 病例对照 PRP治疗组(n=20)VS对照组(n=20) Cascade MTF NA-x-B β 手术中植入 (+)PRP降低了肩袖修补术后的再撕裂率。
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