论文部分内容阅读
目的:比较富血小板血浆（PRP）注射及常规治疗部分肩袖损伤患者的疗效及可能作用机制。方法:采用前瞻性随机对照研究分析2019年1月至2020年12月首都医科大学附属北京同仁医院收治的100例部分肩袖损伤患者的临床资料。采用随机数字表法将患者分为观察组（50例）和对照组（50例）。两组均予以常规非手术治疗，同时观察组接受肩峰下PRP注射治疗，对照组接受肩峰下激素注射治疗。比较两组治疗前、治疗后3，6个月肩关节视觉模拟评分（VAS）、肩关节Constant-Murley评分（CMS）和血清炎症因子［白细胞介素-6（IL-6）、IL-1β、肿瘤坏死因子-α（TNF-α）］水平。对比观察组治疗前和治疗后6个月的MRI图像。结果:患者男55例，女45例；年龄40~75岁［（55.9±9.1）岁］n 。患者均获随访6.0~8.2个月［(6.2±2.9）个月］。治疗前两组VAS、CMS、IL-6、IL-1β、TNF-α差异无统计学意义（n P均>0.05）。治疗后3，6个月观察组VAS分别为（3.5±0.9）分、（1.4±0.4）分，显著低于对照组的（4.1±0.9）分、（1.8±0.5）分（n P均n <0.01）。治疗后3，6个月观察组CMS分别为（59.5±9.4）分、（86.5±7.9）分，显著高于对照组的（53.5±8.6）分、（78.5±8.4）分（n P均n <0.01）。治疗后3个月观察组血清IL-6、IL-1β、TNF-α水平分别为（0.69±0.21）μg/L、（2.06±0.55）μg/L、（2.12±0.49）μg/L，显著低于对照组的（0.92±0.26）μg/L、（2.67±0.48）μg/L、（2.87±0.51）μg/L（n P均n <0.01）；治疗后6个月观察组血清IL-6、IL-1β、TNF-α水平分别为（0.37±0.11）μg/L、（1.14±0.23）μg/L、（1.27±0.25）μg/L，显著低于对照组的（0.45±0.09）μg/L、（1.36±0.27）μg/L、（1.88±0.26）μg/L（n P均n <0.01）。组内比较显示，治疗后3，6个月两组VAS、CMS及血清炎症因子（IL-6、IL-1β、TNF-α）水平较治疗前显著改善（n P均n <0.05），且治疗后6个月各指标与治疗后3个月相比，差异有统计学意义（n P均n 0.05). The VAS was (3.5±0.9)points and (1.4±0.4)points] in observation group at 3, 6 months after treatment, significant lower than (4.1±0.9)points and (1.8±0.5)points in control group (alln P<0.01). The CMS was (59.5±9.4)points and (86.5±7.9)points in observation group at 3, 6 months after treatment, significant higher than (53.5±8.6)points and (78.5±8.4)points in control group (alln P<0.01). The serum levels of IL-6, IL-1β and TNF-α were (0.69±0.21)μg/L, (2.06±0.55)μg/L and (2.12±0.49)μg/L in observation group at 3 months after treatment, significant lower than (0.92±0.26)μg/L, (2.67±0.48)μg/L and (2.87±0.51)μg/L in control group (alln P<0.01). The serum levels of IL-6, IL-1β and TNF-α in observation group [(0.37±0.11)μg/L, (1.14±0.23)μg/L, (1.27±0.25)μg/L] were also significantly lower than those in control group [(0.45±0.09)μg/L, (1.36±0.27)μg/L, (1.88±0.26)μg/L] at 6 months after treatment (alln P<0.01). In both groups, the VAS, CMS and inflammatory cytokines (IL-6, IL-1β, TNF-α) showed significant improvement at 3, 6 months after treatment when compared to the pre-treatment levels (alln P<0.05). Simutaneously, each group showed significant differences in each indicator at 3, 6 months after treatment (n P<0.05). In observation group, MRI showed that the high signal on the superior surface of the supraspinatus disappeared whereas the high signal in the tendon decreased at 6 months after treatment.n Conclusion:For patients with partial rotator cuff tear, PRP injection can relive shoulder pain and improve shoulder function, which may be associated with the down-regulation of inflammatory responses.