Platelet-rich plasma in treatment of tendinopathy

doi:10.3877/cma.j.issn.1674-134X.2019.03.013

Abstract

Abstract:

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.

Key words: Platelet-rich plasma, Tendinopathy

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.

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Figures/Tables 3

References 45

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产品名称	离心时间 (min)	血液体积 (ml)	PRP体积 (ml)	血小板浓度 (倍)	WBC浓度	PAW分类
产品名称	离心时间 (min)	血液体积 (ml)	PRP体积 (ml)	血小板浓度 (倍)	WBC浓度	内源性	外源性
血浆提取	?	?	?	?	?	?	?
Arthrex(Naples，美国FL)	5	16	4～7	2～3	低	P2-B β	P2-X-B β
Cascade/MTF Fabrinet	6	9	4.5	1.3～1.7	低	P2-B β	P2-X-B β
BTI(Vitoria-Gasteiz，西班牙)	8	9	2～3	2～3	低	P2-B β	P2-X-B β
使用其他提取液	?	?	?	?	?	?	?
Biomet(Warsaw，美国IN)	12～15	30或60	3或6	2～8	高	P2/3/4-A α	P2/3/4-X-A α
Harvest(Plymouth，美国MA)	12～15	30或60	3或7～10	3～7	高	P2/3/4-A α	P2/3/4-X-A α
Arteriocyte Medtronic (Minneapolis，美国MN)	14～20	30或60	3～10	3～7	高	P2/3/4-A α	P2/3/4-X-A α
Emcyte(Fort Myers，美国FL)	12	30或60	3或10	7～10	高	P4-A α	P4-X-A α

产品名称	离心时间 (min)	血液体积 (ml)	PRP体积 (ml)	血小板浓度 (倍)	WBC浓度	PAW分类
产品名称	离心时间 (min)	血液体积 (ml)	PRP体积 (ml)	血小板浓度 (倍)	WBC浓度	内源性	外源性
血浆提取	?	?	?	?	?	?	?
Arthrex(Naples，美国FL)	5	16	4～7	2～3	低	P2-B β	P2-X-B β
Cascade/MTF Fabrinet	6	9	4.5	1.3～1.7	低	P2-B β	P2-X-B β
BTI(Vitoria-Gasteiz，西班牙)	8	9	2～3	2～3	低	P2-B β	P2-X-B β
使用其他提取液	?	?	?	?	?	?	?
Biomet(Warsaw，美国IN)	12～15	30或60	3或6	2～8	高	P2/3/4-A α	P2/3/4-X-A α
Harvest(Plymouth，美国MA)	12～15	30或60	3或7～10	3～7	高	P2/3/4-A α	P2/3/4-X-A α
Arteriocyte Medtronic (Minneapolis，美国MN)	14～20	30或60	3～10	3～7	高	P2/3/4-A α	P2/3/4-X-A α
Emcyte(Fort Myers，美国FL)	12	30或60	3或10	7～10	高	P4-A α	P4-X-A α

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]	Ⅳ	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]	Ⅰ	RCT	PRP治疗组(n＝14)VS自体全血(n＝14)	Biomet Ⅲ GPS	P4-A α	是	单次注射，深部组织浸润	(＋)疼痛及功能评分得到改善
	Peerbooms等^[17]	Ⅰ	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]	Ⅰ	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]	Ⅱ	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]	Ⅰ	RCT	PRP治疗组(n＝51)VS关节镜松解(n＝50)	BiomedDevice, Modena ,Italy	NA-A α	是	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
	Giovanni等^[37]	Ⅰ	RCT	PRP治疗组(n＝51)VS关节镜松解(n＝50)	BiomedDevice, Modena ,Italy	NA-A α	是	共注射2次，每次间歇2周	(－)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]	Ⅰ	RCT	PRP治疗组(n＝27)VS生理盐水注射(n＝27)	Biomet	NA-A α	是	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]	Ⅰ	RCT	PRP治疗组(n＝27)VS生理盐水注射(n＝27)	Biomet	NA-A α	是	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]	Ⅱ	RCT	PRP治疗组(n＝16)VS生理盐水注射(n＝14)	NA	P4-NA	否	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]	Ⅳ	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]	Ⅳ	病例报告	PRGF治疗组(n＝6)	BTI/PRGF	NA-x-B β	否	术中植入	(＋)活动度更良好，较快恢复功能
	Jian Zou等^[41]	Ⅱ	RCT	手术＋PRP组 (n＝16)VS单纯手术(n＝19)	WEGO Ltd., Shandong，China	NA	否	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]	Ⅱ	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
	Filardo等^[42]	Ⅱ	前瞻队列	单纯康复训练(n＝16)	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
	Kon et al^[26]	Ⅳ	病例报告	PRP治疗组，6 m评估(n＝20)	NA	P4-X-NA	否	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]	Ⅱ	前瞻队列	PRP治疗组(n＝19)VS对照组(n＝23)	COBE spectra LRS Turbo	P3-X-NA	否	术中植入	(－)PRP并未加速组织的修复
	Randelli等^[31]	Ⅰ	RCT	PRP治疗组(n＝26)VS对照组(n＝27)	Biomet	NA-x-A α	否	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]	Ⅰ	RCT	PRP治疗组(n＝43)VS对照组(n＝45)	Cascade MTF	NA-x-B β	否	术中植入	(－)PRP与对照组相比，不存在明显优势。
	Randelli等^[44]	Ⅳ	病例报告	PRP治疗组(n＝26)	Biomet GPS Ⅱ	NA-x-A α	否	术中植入	(±)PRP与对照组相比，不存在明显优势。
	Barber等^[45]	Ⅲ	病例对照	PRP治疗组(n＝20)VS对照组(n＝20)	Cascade MTF	NA-x-B β	否	手术中植入	(＋)PRP降低了肩袖修补术后的再撕裂率。

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]	Ⅳ	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]	Ⅰ	RCT	PRP治疗组(n＝14)VS自体全血(n＝14)	Biomet Ⅲ GPS	P4-A α	是	单次注射，深部组织浸润	(＋)疼痛及功能评分得到改善
	Peerbooms等^[17]	Ⅰ	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]	Ⅰ	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]	Ⅱ	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]	Ⅰ	RCT	PRP治疗组(n＝51)VS关节镜松解(n＝50)	BiomedDevice, Modena ,Italy	NA-A α	是	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
	Giovanni等^[37]	Ⅰ	RCT	PRP治疗组(n＝51)VS关节镜松解(n＝50)	BiomedDevice, Modena ,Italy	NA-A α	是	共注射2次，每次间歇2周	(－)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]	Ⅰ	RCT	PRP治疗组(n＝27)VS生理盐水注射(n＝27)	Biomet	NA-A α	是	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]	Ⅰ	RCT	PRP治疗组(n＝27)VS生理盐水注射(n＝27)	Biomet	NA-A α	是	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]	Ⅱ	RCT	PRP治疗组(n＝16)VS生理盐水注射(n＝14)	NA	P4-NA	否	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]	Ⅳ	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]	Ⅳ	病例报告	PRGF治疗组(n＝6)	BTI/PRGF	NA-x-B β	否	术中植入	(＋)活动度更良好，较快恢复功能
	Jian Zou等^[41]	Ⅱ	RCT	手术＋PRP组 (n＝16)VS单纯手术(n＝19)	WEGO Ltd., Shandong，China	NA	否	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]	Ⅱ	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
	Filardo等^[42]	Ⅱ	前瞻队列	单纯康复训练(n＝16)	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
	Kon et al^[26]	Ⅳ	病例报告	PRP治疗组，6 m评估(n＝20)	NA	P4-X-NA	否	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]	Ⅱ	前瞻队列	PRP治疗组(n＝19)VS对照组(n＝23)	COBE spectra LRS Turbo	P3-X-NA	否	术中植入	(－)PRP并未加速组织的修复
	Randelli等^[31]	Ⅰ	RCT	PRP治疗组(n＝26)VS对照组(n＝27)	Biomet	NA-x-A α	否	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]	Ⅰ	RCT	PRP治疗组(n＝43)VS对照组(n＝45)	Cascade MTF	NA-x-B β	否	术中植入	(－)PRP与对照组相比，不存在明显优势。
	Randelli等^[44]	Ⅳ	病例报告	PRP治疗组(n＝26)	Biomet GPS Ⅱ	NA-x-A α	否	术中植入	(±)PRP与对照组相比，不存在明显优势。
	Barber等^[45]	Ⅲ	病例对照	PRP治疗组(n＝20)VS对照组(n＝20)	Cascade MTF	NA-x-B β	否	手术中植入	(＋)PRP降低了肩袖修补术后的再撕裂率。

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