肩袖修补术后延迟注射富血小板血浆的早期疗效对比

doi:10.3877/cma.j.issn.1674-134X.2025.03.014

目的

探讨肩袖修补术后关节腔内延迟注射富血小板血浆（PRP）治疗肩袖撕裂的早期临床疗效。

方法

选取盐城市第一人民医院2021年5月至2022年12月收治的90例肩袖撕裂患者，按照随机数字表法分为延迟注射单次组（单次组），延迟注射多次组（多次组）和对照组，每组各30例。所有患者均接受肩袖单排修补手术，肩袖撕裂大小为小至大型全层撕裂，术后3组患者采取相同的康复方案。单次组在关节镜下肩袖修补术后1个月时接受单次关节腔内注射PRP治疗；多次组在术后1个月时连续3周接受每周1次的关节腔内注射PRP治疗；对照组在关节镜手术结束即时接受单次关节腔内注射PRP治疗。记录患者术前、术后3、6、12个月时的视觉模拟疼痛评分（VAS）、Constant-Murley肩关节功能评分（CMS）、加州大学洛杉矶分校肩关节评分（UCLA），采用重复测量方差分析进行统计学分析。记录随访过程中的不良事件发生情况。术后12个月随访时复查肩关节MRI，评估肩袖再撕裂情况。

结果

所有患者均获得随访。术前3组患者的VAS、CMS、UCLA评分比较差异均无统计学意义（F=0.077、0.185、1.269，均为P>0.05）。术后3组患者VAS评分均低于术前，CMS、UCLA评分均高于术前，且多次组术后3、6、12个月的VAS评分均低于对照组（I-J=-0.933、-0.700、-0.833，均为P<0.05），CMS、UCLA评分均高于对照组（I-J=5.100、4.367、3.600，均为P<0.05；I-J=4.367、1.600、3.300，均为P<0.05）；多次组术后6、12个月的CMS评分以及术后3、12个月的UCLA评分高于单次组（I-J=2.533、2.267，均为P<0.05；I-J=2.933、1.600，均为P<0.05）。3组均未出现伤口红肿、渗液、血管及神经损伤等不良事件情况，3组患者肩袖再撕裂率差异无明显统计学意义（P>0.05）。

结论

肩袖修补术后延迟多次注射PRP治疗肩袖撕裂安全性良好，可起到减轻术后疼痛，加快肩关节功能恢复的作用，临床疗效较为满意。

关键词: 关节镜, 回旋套损伤, 富血小板血浆

Objective

To investigate the early clinical effect of delayed intraarticular injection of platelet-rich plasma (PRP) for the treatment of rotator cuff tears after repair.

Methods

Ninety patients with rotator cuff tears were selected from May 2021 to December 2022 in Yancheng NO.1 People’s Hospital. According to random number table, the patients were divided into three groups: the delayed single-injection group (single-injection group), the delayed multiple-injection group (multiple-injection group) and the control group, 30 cases in each group. All the patients underwent single-row rotator cuff repair with small to large full-thickness rotator cuff tears. All three groups of patients took the same rehabilitation program after surgery. The single-injection group received a single dose intra-articular injection of PRP one month after arthroscopic surgery. The multiple-injection group received intra-articular injection of PRP once a week for three consecutive weeks at one month postoperatively, while the control group received a single dose intraarticular injection of PRP at the end of arthroscopic surgery. Visual analogue scale (VAS), Constant-Murley score (CMS) and University of California Los Angeles shoulder score (UCLA) were recorded before and three, six,12 months after arthroscopic surgery. The results were statistically analyzed by repeated measurement variance analysis. Any adverse event during follow-up was record. The rotator cuff retear rates were evaluated 12 months after surgery by MRI.

Results

All the patients were followed up. There were no statistically significant differences in VAS, CMS or UCLA scores among the three groups before surgery (F=0.077, 0.185, 1.269, all P>0.05). The VAS scores of the three groups after surgery were lower than those before surgery, and the CMS and UCLA scores after surgery were higher than those before surgery; VAS scores at three, six and 12 months after surgery in the multiple-injection group were significantly lower than those in the control group (I-J=-0.933, -0.700, -0.833, all P<0.05); the CMS and UCLA scores at three, six and 12 months after surgery in the multiple-injection group were significantly higher than those in the control group (I-J=5.100, 4.367, 3.600, all P<0.05; I-J=4.367, 1.600, 3.300, all P<0.05). The CMS scores at six and 12 months and the UCLA scores at six and 12 months after surgery in the multiple-injection group were significantly higher than those in the single-injection group (I-J=2.533, 2.267, both P<0.05; I-J=2.933, 1.600, both P<0.05). No wound swelling, exudation, blood vessel and nerve injury occurred in the three groups. There was no statistically significant difference in the rate of rotator cuff retear among the three groups (P>0.05).

Conclusion

Delayed injection of PRP after rotator cuff repair is a safe and effective method in treatment of rotator cuff tears, which could relieve the postoperative pain and improve shoulder function.

Key words: Arthroscope, Rotator cuff injuries, Platelet rich plasma

表1 三组基本资料比较

Table 1 Comparison of baseline data among the three groups

组别Groups	例数Case number	性别（例） Gender		年龄[岁，（±s）]Age（year）	患侧（例） Side
组别Groups	例数Case number	男Male	女Female	年龄[岁，（±s）]Age（year）	左Left	右Right
单次组Single-injection group	30	7	23	56.1±8.4	12	18
多次组Multiple-injection group	30	9	21	56.3±7.1	12	18
对照组Control group	30	6	24	55.1±9.1	10	20
统计值Statistical values		χ²=0.842		F=0.187	χ²=0.378
P值		>0.05		>0.05	>0.05
组别Groups	例数Case number	病程[月，（±s）]Duration（month）	身体质量指数[kg/m²，（±s）]Body mass index	撕裂大小（例） Tear size
组别Groups	例数Case number	病程[月，（±s）]Duration（month）	身体质量指数[kg/m²，（±s）]Body mass index	小Small	中Medium	大Large
单次组Single-injection group	30	16.1±5.8	25.7±4.0	12	10	8
多次组Multiple-injection group	30	14.2±5.2	24.8±2.6	13	11	6
对照组Control group	30	15.2±5.5	25.9±3.5	10	11	9
统计值Statistical values		F=0.412	F=0.681	χ²=1.071
P值		>0.05	>0.05	>0.05

表1 三组基本资料比较

Table 1 Comparison of baseline data among the three groups

组别Groups	例数Case number	性别（例） Gender		年龄[岁，（±s）]Age（year）	患侧（例） Side
组别Groups	例数Case number	男Male	女Female	年龄[岁，（±s）]Age（year）	左Left	右Right
单次组Single-injection group	30	7	23	56.1±8.4	12	18
多次组Multiple-injection group	30	9	21	56.3±7.1	12	18
对照组Control group	30	6	24	55.1±9.1	10	20
统计值Statistical values		χ²=0.842		F=0.187	χ²=0.378
P值		>0.05		>0.05	>0.05
组别Groups	例数Case number	病程[月，（±s）]Duration（month）	身体质量指数[kg/m²，（±s）]Body mass index	撕裂大小（例） Tear size
组别Groups	例数Case number	病程[月，（±s）]Duration（month）	身体质量指数[kg/m²，（±s）]Body mass index	小Small	中Medium	大Large
单次组Single-injection group	30	16.1±5.8	25.7±4.0	12	10	8
多次组Multiple-injection group	30	14.2±5.2	24.8±2.6	13	11	6
对照组Control group	30	15.2±5.5	25.9±3.5	10	11	9
统计值Statistical values		F=0.412	F=0.681	χ²=1.071
P值		>0.05	>0.05	>0.05

表2 三组各时间点VAS、CMS、UCLA评分比较（

±s）

Table 2 Comparison of VAS, CMS and UCLA scores at different time points among the three groups

组别Groups	例数Case number	时间Time point	VAS	CMS	UCLA
单次组Single-injection group	30	术前Before surgery	6.4±1.7	55.7±5.4	13.3±2.6
		术后3个月Three months after surgery	3.7±1.0^c	77.1±4.2^ac	20.9±2.2^ac
		术后6个月Six months after surgery	2.6±1.0^c	83.9±4.3^c	28.3±1.7^ac
		术后12个月12 months after surgery	1.7±0.9^ac	89.3±3.2^c	31.3±1.9^c
多次组Multiple-injection group	30	术前Before surgery	6.6±1.3	55.9±4.9	12.7±2.6
		术后3个月Three months after surgery	3.1±1.0^ac	78.8±4.69^ac	23.8±2.2^abc
		术后6个月Six months after surgery	2.4±0.9^ac	86.5±5.1^abc	29.2±2.0^ac
		术后12个月12 months after surgery	1.5±0.8^ac	91.6±3.5^abc	32.5±1.7^abc
对照组Control group	30	术前Before surgery	6.6±1.5	55.1±5.4	13.8±2.3
		术后3个月Three months after surgery	4.0±1.45^c	73.7±4.0^c	19.4±2.2^c
		术后6个月Six months after surgery	3.1±0.9c	82.1±4.1^c	25.1±1.9^c
		术后12个月12 months after surgery	2.4±1.1^c	88.0±3.1^c	30.9±1.3^c
组间比较Comparison among groups	F值		4.490	19.702	29.210
组间比较Comparison among groups	P值		0.014	<0.001	<0.001
组内比较Comparison in group	F值		389.532	1031.387	1300.501
组内比较Comparison in group	P值		<0.001	<0.001	<0.001
交互作用Interaction	F值		1.646	1.576	9.264
交互作用Interaction	P值		>0.05	>0.05	<0.001

表2 三组各时间点VAS、CMS、UCLA评分比较（

±s）

Table 2 Comparison of VAS, CMS and UCLA scores at different time points among the three groups

组别Groups	例数Case number	时间Time point	VAS	CMS	UCLA
单次组Single-injection group	30	术前Before surgery	6.4±1.7	55.7±5.4	13.3±2.6
		术后3个月Three months after surgery	3.7±1.0^c	77.1±4.2^ac	20.9±2.2^ac
		术后6个月Six months after surgery	2.6±1.0^c	83.9±4.3^c	28.3±1.7^ac
		术后12个月12 months after surgery	1.7±0.9^ac	89.3±3.2^c	31.3±1.9^c
多次组Multiple-injection group	30	术前Before surgery	6.6±1.3	55.9±4.9	12.7±2.6
		术后3个月Three months after surgery	3.1±1.0^ac	78.8±4.69^ac	23.8±2.2^abc
		术后6个月Six months after surgery	2.4±0.9^ac	86.5±5.1^abc	29.2±2.0^ac
		术后12个月12 months after surgery	1.5±0.8^ac	91.6±3.5^abc	32.5±1.7^abc
对照组Control group	30	术前Before surgery	6.6±1.5	55.1±5.4	13.8±2.3
		术后3个月Three months after surgery	4.0±1.45^c	73.7±4.0^c	19.4±2.2^c
		术后6个月Six months after surgery	3.1±0.9c	82.1±4.1^c	25.1±1.9^c
		术后12个月12 months after surgery	2.4±1.1^c	88.0±3.1^c	30.9±1.3^c
组间比较Comparison among groups	F值		4.490	19.702	29.210
组间比较Comparison among groups	P值		0.014	<0.001	<0.001
组内比较Comparison in group	F值		389.532	1031.387	1300.501
组内比较Comparison in group	P值		<0.001	<0.001	<0.001
交互作用Interaction	F值		1.646	1.576	9.264
交互作用Interaction	P值		>0.05	>0.05	<0.001

图1 典型案例1右肩袖撕裂修补及PRP（富血小板血浆）治疗前后情况。图A为关节镜下显示右肩袖全层撕裂；图B为右肩袖单排锚钉修补术后的镜下图像；图C为术前右肩MRI显示肩袖撕裂；图D为术后右肩MRI显示肩袖修补良好，锚钉在位；图E为制备的5 ml PRP

Figure 1 Repair of right rotator cuff tear and PRP (platelet-rich plasma) treatment of typical case one. A is arthroscopic view of full-thickness right rotator cuff tear; B is arthroscopic view after single-row repair of right rotator cuff; C is preoperative MRI of right shoulder, showing rotator cuff tear; D is postoperative MRI of right shoulder, showing that the rotator cuff was well-repaired and the suture anchor was in place; E is preparation of five milliliters PRP

图2 典型案例2左侧肩袖修补术后再撕裂MRI图像。图A为术后3 d复查左肩MRI，示肩袖连续性完整、厚度正常；图B为术后12个月左肩MRI其中一个冠状位层面，示肩袖连续性完整，厚度不足正常的一半，为SugayaⅢ型；图C为术后12个月左肩MRI另一个冠状位层面，示肩袖不连续，提示小的全层撕裂，为SugayaⅣ型，记录为再撕裂

Figure 2 MRI images of re-tear after rotator cuff repair of left shoulder in typical case two. A is MRI image of left shoulder at three days after operation, showing that the rotator cuff was continuous and complete, and the thickness was normal; B is one coronal plane view of MRI image of left shoulder at 12 months after operation, showing that the rotator cuff was continuous and complete, and the thickness was less than half of normal, corresponding to Sugaya type Ⅲ; C is another coronal plane view of left shoulder MRI image at 12 months after operation, showing that the rotator cuff was discontinuity, suggesting a small full-thickness tear, corresponding to Sugaya type Ⅳ and recorded as re-tear

[1]	Akimoto K, Ochiai N, Hashimoto E, et al. Influence of a nerve injury proximal to the suprascapular nerve on healing of repaired rotator cuff tear[J]. J Orthop Sci, 2020, 25（1）: 96-103.
[2]	李方奇, 杨睿, 侯景义, 等. 富血小板血浆治疗腱病概况[J/OL]. 中华关节外科杂志（电子版）, 2019, 13（3）: 335-341.
[3]	孙程, 桑伟林, 马金忠. 富血小板血浆对关节镜下肩袖修补安全性和有效性影响的Meta分析与系统评价[J/OL]. 中华关节外科杂志（电子版）, 2016, 10（6）: 645-653.
[4]	Snow M, Hussain F, Pagkalos J, et al. The effect of delayed injection of leukocyte-rich platelet-rich plasma following rotator cuff repair on patient function: a randomized double-blind controlled trial[J]. Arthroscopy, 2020, 36（3）: 648-657.
[5]	DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair[J]. J Bone Joint Surg Am, 1984, 66（4）: 563-567.
[6]	Zou G, Zheng M, Chen W, et al. Autologous platelet-rich plasma therapy for refractory pain after low-grade medial collateral ligament injury[J/OL]. J Int Med Res, 2020, 48（2）: 300060520903636. DOI:10.1177/0300060520903636.
[7]	Sugaya H, Maeda K, Matsuki K, et al. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study[J]. J Bone Joint Surg Am, 2007, 89 （5）: 953-960.
[8]	Charousset C, Bellaïche L, Kalra K, et al. Arthroscopic repair of full-thickness rotator cuff tears: is there tendon healing in patients aged 65 years or older?[J]. Arthrosc J Arthrosc Relat Surg, 2010, 26（3）: 302-309.
[9]	Marques LF, Stessuk T, Camargo IC, et al. Platelet-rich plasma （PRP）: methodological aspects and clinical applications[J]. Platelets, 2015, 26（2）: 101-113.
[10]	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.
[11]	Malavolta EA, Gracitelli MEC, Assunção JH, et al. Clinical and structural evaluations of rotator cuff repair with and without added platelet-rich plasma at 5-year follow-up: a prospective randomized study[J]. Am J Sports Med, 2018, 46（13）: 3134-3141.
[12]	Pandey V, Bandi A, Madi S, et al. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial[J]. J Shoulder Elb Surg, 2016, 25（8）: 1312-1322.
[13]	Zhang Z, Wang Y, Sun J. The effect of platelet-rich plasma on arthroscopic double-row rotator cuff repair: a clinical study with 12-month follow-up[J]. Acta Orthop Traumatol Turc, 2016, 50（2）: 191-197.
[14]	Gwinner C, Gerhardt C, Haneveld H, et al. Two-staged application of PRP in arthroscopic rotator cuff repair: a matched-pair analysis[J]. Arch Orthop Trauma Surg, 2016, 136（8）: 1165-1171.
[15]	Ebert JR, Wang A, Smith A, et al. A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: a randomized controlled trial[J]. Am J Sports Med, 2017, 45（13）: 2965-2974.

[1]	管本科, 胡力轩, 刘宇. 关节镜下治疗胫骨平台骨折的应用现状及进展[J/OL]. 中华关节外科杂志(电子版), 2025, 19(02): 243-248.
[2]	肖志满, 张泽锋, 庄锡其, 肖青福. 关节镜术后下肢深静脉血栓早期及远期发生的对比[J/OL]. 中华关节外科杂志(电子版), 2025, 19(02): 253-256.
[3]	李政, 李雳, 欧传双, 杨琼, 李长树. 对比分析单束不同方式保残重建治疗前交叉韧带断裂[J/OL]. 中华关节外科杂志(电子版), 2025, 19(02): 162-171.
[4]	胡海涛, 王虎虎, 贺加明, 刘鹏波, 高山松, 李宏伟, 胡杰. 经三后内侧入路关节镜治疗后交叉韧带胫骨止点撕脱骨折[J/OL]. 中华关节外科杂志(电子版), 2025, 19(02): 172-177.
[5]	王春久, 田向东, 谭冶彤, 薛志鹏, 张伟, 刘昂. 单平面胫骨高位截骨联合关节镜治疗内翻型膝骨关节炎[J/OL]. 中华关节外科杂志(电子版), 2025, 19(02): 185-192.
[6]	刘彬, 汪奕, 叶明, 康永松, 陈建明. “Chinese way”单排修复巨大肩袖损伤临床疗效研究[J/OL]. 中华关节外科杂志(电子版), 2025, 19(01): 1-6.
[7]	王友良, 杜基朋措, 杨忠, 陈凯. 膝关节镜辅助与常规手术治疗胫骨平台骨折的疗效对比[J/OL]. 中华关节外科杂志(电子版), 2025, 19(01): 39-45.
[8]	罗鸣, 袁志, 樊俊俊, 廖炳辉, 党海峰, 郑天雷, 白灵心. 关节镜辅助经皮微创钢板内固定治疗胫骨平台骨折[J/OL]. 中华关节外科杂志(电子版), 2025, 19(01): 46-54.
[9]	马栋, 曾俊杰, 苑博, 田明, 张绍龙. 三种术式治疗老年肩袖损伤合并冻结肩疗效分析[J/OL]. 中华关节外科杂志(电子版), 2025, 19(01): 94-101.
[10]	王晶晶, 王辉, 李阿漫, 曾峥. 对肩峰下撞击综合征患者肩关节镜术后居家康复锻炼方案的应用效果与依从性分析[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(03): 227-232.
[11]	刘衍松, 曹天勇, 张文汉, 汪洋, 任恒, 冯光. 富血小板血浆凝胶治疗系统性红斑狼疮伴体表溃疡的效果观察[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(02): 112-116.
[12]	李亚龙, 王星童, 申传安. 异体富血小板血浆在创面修复中的临床应用进展[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 541-545.
[13]	王振宇, 张洪美, 荆琳, 何名江, 闫奇. 膝骨关节炎相关炎症因子与血浆代谢物间的因果关系及中介效应[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 467-473.
[14]	王帅, 陶海涛, 王素平. 肩袖损伤的生物修复治疗研究进展[J/OL]. 中华老年骨科与康复电子杂志, 2025, 11(01): 52-57.
[15]	黄皓, 梁群, 赵阳. 不同方法制备的富血小板血浆对烧伤感染创面常见致病菌的体外抑菌实验[J/OL]. 中华临床实验室管理电子杂志, 2025, 13(02): 84-90.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Comparison on early clinical effect of delayed injection of platelet-rich plasma following arthroscopic repair of rotator cuff

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Comparison on early clinical effect of delayed injection of platelet-rich plasma following arthroscopic repair of rotator cuff