探讨不同浓度自体富血小板血浆(APRP)对慢性跟腱损伤的疗效。

选取2019年9月至2022年2月内江市第一人民医院收治的85例跟腱损伤的患者。所有患者均经超声、MRI、X线等影像学检查提示跟腱损伤，关节疼痛症状明显且伴活动受限，且均接受保守APRP治疗；排除精神或认知障碍、凝血功能异常等患者。采用随机数字表法将患者分为对照组、低浓度、中浓度、中高浓度和高浓度组，每组17例。各组均口服依托考昔片1片，1次/d，并持续1周作为基础治疗。对照组继续常规治疗，APRP治疗各组在常规治疗的基础上予注射2 ml的APRP，低浓度组APRP浓度为(0.9~1.2)×10¹²/L，中浓度组APRP浓度为(1.2~1.5)×10¹²/L，中高浓度组APRP浓度为(1.5~1.8)×10¹²/L，高浓度组APRP浓度为(1.8~2.1)×10¹²/L。比较5组治疗后肢体活动度、疼痛程度、炎症因子水平及不良反应情况。不良反应情况等计数资料行卡方检验；各项评分指标等计量资料呈正态分布时多组间差异比较行单因素方差分析，组间两两差异比较行LSD检验，组内比较行配对t检验。

5组治疗后2周及4周的AOFAS评分比较，差异有统计学意义(F＝3.213、3.195，均为P<0.05)，其中APRP治疗各组在治疗后2周、4周的AOFAS评分较对照组均显著升高(均为P<0.05)，且中高浓度组的AOFAS评分明显高于低浓度组、中浓度组和高浓度组(均为P<0.05)。5组治疗后2周及4周的VAS评分比较，差异有统计学意义(F＝2.496、3.551，均为P<0.05)，其中APRP治疗各组在治疗后2周、4周的VAS评分较对照组均显著降低(均为P<0.05)，且中高浓度组的VAS评分明显低于低浓度组、中浓度组和高浓度组(均为P<0.05)。5组治疗前后血清ΔCCL7、ΔPGE2 、ΔIL-1β及ΔTNF-α等炎性因子变化程度比较，差异有统计学意义(F＝2.501、3.056、5.000、4.762,均为P<0.05)；其中APRP治疗各组血清各炎性因子在治疗前后的浓度含量变化程度较对照组均显著降低(均为P<0.05)，且中高浓度组的各炎症因子水平变化程度明显低于低浓度组、中浓度组和高浓度组(均为P<0.05)。5组头晕恶心、局部肿胀、疼痛、活动受限等总不良反应情况差异无统计学意义(χ²＝6.839，P>0.05)。

不同浓度的APRP对治疗跟腱损伤有良好的效果，且最适宜的APRP浓度为(1.5~1.8)×10 ¹²/L。此浓度下治疗跟腱损伤可有效减轻患者的疼痛，改善患者的肢体活动度，抑制炎症反应，值得临床推广应用。

To investigate the effect of different concentrations of autologous platelet-rich plasma (APRP) on chronic Achilles tendon injury.

Eighty-five patients with Achilles tendon injury treated in Neijiang First People's Hospital from September 2019 to February 2022 were selected. All the patients were confirmed as Achilles tendon injury by ultrasound, MRI, X-ray imaging examinations, with obvious symptoms of joint pain accompanied by limited movement, and all received conservative APRP treatment. The patients with mental disorders and coagulation dysfunction were excluded. The patients were randomized into control group, low concentration group, medium concentration group, sub-high concentration group and high concentration group by random number table, 17 cases in each group. Each group took one etoposide tablet orally once a day for one week as basic treatment. The control group received the routine treatment, APRP treatment groups were injected with two millilter of APRP on the basis of routine treatment. The APRP concentrations were as follows: (0.9-1.2)×10¹²/L in the low concentration group; (1.2-1.5)×10¹²/L in the medium concentration group; (1.5-1.8)×10 ¹²/L in the sub-high concentration group; high concentration group- APRP(1.8-2.1)×10¹²/L. The mobility function and pain of the limb, serum inflammatory factors and adverse reactions of the five groups were compared after treatment. The adverse reactions rate was analyzed by Chi-square test. One-way ANOVA was used for data analyse among multiple groups, LSD t test was used for comparison between groups, and paired t test was used for comparison within groups.

The AOFAS scores of the five groups at two and four weeks after treatment showed statistically significant differences (F=3.213, 3.195, both P<0.05). AOFAS scores in the four APRP treatment groups at two and four weeks after treatment were higher than those of the control group (all P<0.05). The AOFAS score of sub-high concentration group was higher than those of low, medium and high concentration groups (all P<0.05). The VAS scores of the five groups at two and four weeks after treatment showed statistical significant differences (F=2.496, 3.551, both P<0.05). VAS scores of the four APRP treatment groups at two and four weeks after treatment were lower than those of the control group (all P<0.05). VAS score of sub-high concentration group was lower than low, medium and high concentration groups (all P<0.05). There were statistically significant differences in serum inflammatory factors such as ΔCCL7, ΔPGE2, ΔIL-1β and ΔTNF-α before and after treatment among the five groups (F=2.501, 3.056, 5.000, 4.762, all P<0.05). The changes of serum inflammatory factors in the four APRP treatment groups before and after treatment were lower than those in the control group (all P <0.05), and the changes of inflammatory factor levels in sub-high concentration group were significantly lower than those in low, medium and high concentration groups (all P <0.05). There was no statistically significant difference in the adverse reaction rate among the five groups (dizziness, nausea, local swelling, pain and movement limitation) (χ²=6.839, P>0.05).

The efficacy is good and in a dose-dependent model of different concentrations of APRP in the treatment of Achilles tendon injury, and the most suitable concentration of APRP is (1.5-1.8)×10¹²/L. The treatment of Achilles tendon injury at this concentration can effectively reduce the pain of patients, improve the limb motion of patients, inhibit the inflammatory reaction, which is worthy of clinical application.