目的:探讨高频超声精准定位下注射富血小板血浆治疗肩袖部分损伤的疗效分析。方法:选取我院2018年1月至2020年1月收治的肩袖部分损伤患者67例作为研究对象,按照治疗方案的不同分为对照组(n = 33)和观察组(n = 34),对照组给予肩峰下注射玻璃酸钠治疗,观察组给予高频超声精准定位下注射富血小板血浆治疗,比较两组患者治疗临床效果;并于治疗前及治疗后3个月采用肩关节评分系统(UCLA)、美国肩肘关节外科医师协会评分(ASES)评分、肩关节功能测试CMS功能评分、视觉模拟法(VAS)评分评价两组患者肩功能;并于治疗后6个月观察两组患者恢复情况,包括疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间。结果:观察组治疗有效率为93.94% (31/33)明显高于对照组73.53% (25/34),差异有统计学意义(P < 0.05);治疗后两组患者UCLA、ASES、CMS以及VAS评分均较治疗前明显升高,且观察组者UCLA、ASES、CMS以及VAS评分明显高于对照组(P < 0.05);观察组疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间均较对照组缩短(P < 0.05)。结论:高频超声精准定位下注射富血小板血浆治疗肩袖部分损伤可明显改善患者肩功能,缓解疼痛,促进恢复,疗效显著,具有明显的应用价值。 Objective: To investigate the effect of high frequency ultrasound precise positioning injection of platelet rich plasma in the treatment of rotator cuff injury. Methods: 67 patients with partial rotator cuff injury in our hospital from January 2018 to January 2020 were selected as the research objects, and they were divided into the control group (n = 33) and the observation group (n = 34) according to different treatment schemes. The control group was given subacromial injection of sodium hyaluronate, and the observation group was given injection of platelet rich plasma under precise positioning of high frequency ultrasound. The shoulder function of the two groups was evaluated by UCLA, ASES, CMS and VAS before and 3 months after treatment, and the recovery of the two groups was observed at 6 months after treatment, including pain disappearance time, postoperative calcification disappearance time and edema disappearance Time and activity recovery time. Result: The effective rate of the observation group was 93.94% (31/33), which was significantly higher than 73.53% (25/34) of the control group (P < 0.05); after treatment, the scores of UCLA, ASES, CMS and VAS in the two groups were significantly higher than those before treatment, and the scores of ASES, CMS and VAS in the observation group were significantly higher than those in the control group (P < 0.05); the pain disappeared time and postoperative calcification disappeared in the observation group. Compared with the control group, the time of edema disappearance and the recovery time of activity function were shorter (P < 0.05). Conclusion: The high frequency ultrasound precise positioning injection of platelet rich plasma in the treatment of rotator cuff injury can significantly improve the shoulder function, relieve pain and promote recovery, with significant curative effect and obvious application value.
目的:探讨高频超声精准定位下注射富血小板血浆治疗肩袖部分损伤的疗效分析。方法:选取我院2018年1月至2020年1月收治的肩袖部分损伤患者67例作为研究对象,按照治疗方案的不同分为对照组(n = 33)和观察组(n = 34),对照组给予肩峰下注射玻璃酸钠治疗,观察组给予高频超声精准定位下注射富血小板血浆治疗,比较两组患者治疗临床效果;并于治疗前及治疗后3个月采用肩关节评分系统(UCLA)、美国肩肘关节外科医师协会评分(ASES)评分、肩关节功能测试CMS功能评分、视觉模拟法(VAS)评分评价两组患者肩功能;并于治疗后6个月观察两组患者恢复情况,包括疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间。结果:观察组治疗有效率为93.94% (31/33)明显高于对照组73.53% (25/34),差异有统计学意义(P < 0.05);治疗后两组患者UCLA、ASES、CMS以及VAS评分均较治疗前明显升高,且观察组者UCLA、ASES、CMS以及VAS评分明显高于对照组(P < 0.05);观察组疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间均较对照组缩短(P < 0.05)。结论:高频超声精准定位下注射富血小板血浆治疗肩袖部分损伤可明显改善患者肩功能,缓解疼痛,促进恢复,疗效显著,具有明显的应用价值。
高频超声,富血小板血浆,肩袖部分损伤,疗效
Huagang Hu1, Qingfeng Yi2
1Department of Orthopedics, Wenrong Hospital of Hengdian, Jinhua Zhejiang
2Department of Ultrasound, Wenrong Hospital of Hengdian, Jinhua Zhejiang
Received: Nov. 30th, 2020; accepted: Dec. 24th, 2020; published: Dec. 31st, 2020
Objective: To investigate the effect of high frequency ultrasound precise positioning injection of platelet rich plasma in the treatment of rotator cuff injury. Methods: 67 patients with partial rotator cuff injury in our hospital from January 2018 to January 2020 were selected as the research objects, and they were divided into the control group (n = 33) and the observation group (n = 34) according to different treatment schemes. The control group was given subacromial injection of sodium hyaluronate, and the observation group was given injection of platelet rich plasma under precise positioning of high frequency ultrasound. The shoulder function of the two groups was evaluated by UCLA, ASES, CMS and VAS before and 3 months after treatment, and the recovery of the two groups was observed at 6 months after treatment, including pain disappearance time, postoperative calcification disappearance time and edema disappearance Time and activity recovery time. Result: The effective rate of the observation group was 93.94% (31/33), which was significantly higher than 73.53% (25/34) of the control group (P < 0.05); after treatment, the scores of UCLA, ASES, CMS and VAS in the two groups were significantly higher than those before treatment, and the scores of ASES, CMS and VAS in the observation group were significantly higher than those in the control group (P < 0.05); the pain disappeared time and postoperative calcification disappeared in the observation group. Compared with the control group, the time of edema disappearance and the recovery time of activity function were shorter (P < 0.05). Conclusion: The high frequency ultrasound precise positioning injection of platelet rich plasma in the treatment of rotator cuff injury can significantly improve the shoulder function, relieve pain and promote recovery, with significant curative effect and obvious application value.
Keywords:High Frequency Ultrasound, Platelet Rich Plasma, Partial Rotator Cuff Injury, Curative Effect
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肩关节是人体活动度最大、最不稳定的典型的球窝关节,而其中肩袖是维持肩关节动态稳定的重要部位,当肩袖发生损伤时将引起肩关节疼痛,使肩部主动活动受限 [
选取我院2018年1月至2020年1月收治的肩袖部分损伤患者67例作为研究对象,按照治疗方案的不同分为对照组(n = 33)和观察组(n = 34)。由专门统计人员根据患者的病例资料以及随访结果统计入组患者的年龄,性别等基准信息,并录入Excel表格中。两组患者年龄、性别、病程等基本资料上相比差异无统计学意义(P < 0.05),具有可比性。
1) 所有患者均经影像学检查确诊为肩袖部分损伤;
2) 表现患侧上肢活动受限、肩关节疼痛;
3) 或家属均同意并签署知情同意书。
1) 合并心、肝、肾等重大器官严重障碍者;
2) 肩关节内有内容物者,包括金属或非金属;
3) 肩部损伤部位皮肤破损者;
4) 合并感染或恶性肿瘤者;
5) 妊娠及哺乳期妇女;
6) 不配合研究者。
1) 对照组:给予肩峰下注射玻璃酸钠治疗,先对肩峰下间隙进行穿刺标记,采用含玻璃酸钠透明的质酸盐(厂家:生化学工业株式会社高,批准文号:H20140533,规格:每支2.5 mL)的注射器针头进行穿刺注射,每周注射1次,治疗疗程为5周。
2) 观察组:给予高频超声精准定位下注射富血小板血浆治疗:抽取患者肘静脉血40 ml,加枸橼酸钠5 ml抗凝,于3200 r/min,4 min行第1次离心,后缓慢转动红细胞腔悬锁帽,锁定血清腔白膜层,倒转装置3300 r/min,5 min进行第2次离心,离心后旋转PRP锁定锁定杆,混匀后将制备好的PRP抽取备用。取坐位,于局部麻醉下进行治疗,于患肩采用超声探头放置行肩袖部分损伤病灶的定位,标记最恰当的穿刺点位置。在高频超声引导下将制备出的4 ml PRP注入标记穿刺点。
1) 比较两组患者治疗临床效果;a) 治愈,疼痛反应得到显著改善及控制,肩功能恢复较佳;b) 好转,疼痛反应及肩功稍有改善,但效果并不显著;c) 无效,患者经过治疗后,疼痛反应并未得到任何改变。治疗有效率 = (治愈 + 好转)/总例数 × 100%。
2) 采用肩关节评分系统(UCLA) [
3) 患者恢复情况,包括疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间。
采用SPSS21.0统计软件处理数据,以均数±标准差表示定量资料,采用t检验;以百分比表示定性资料,采用X2检验,多组多分类资料用秩和检验z,以P < 0.05表示差异有统计学意义。
观察组治疗有效率为93.94% (31/33)明显高于对照组73.53% (25/34),差异有统计学意义(P < 0.05);如表1所示。
组别 | 治愈 | 好转 | 无效 | 治疗有效率 |
---|---|---|---|---|
观察组(n = 33) | 21 | 10 | 2 | 93.94% (31/33) |
对照组(n = 34) | 17 | 8 | 9 | 73.53% (25/34) |
x2 | 2.526 | |||
P | <0.05 |
表1. 两组患者临床治疗效果比较
结果显示,治疗后两组患者UCLA、ASES、CMS以及VAS评分均较治疗前明显升高,且观察组者UCLA、ASES、CMS以及VAS评分明显高于对照组(P < 0.05),如表2所示。
组别 | UCLA | ASES | CMS | VAS | ||||
---|---|---|---|---|---|---|---|---|
治疗前 | 治疗后 | 治疗前 | 治疗后 | 治疗前 | 治疗后 | 治疗前 | 治疗后 | |
观察组(n = 33) | 11.45 ± 2.44 | 32.09 ± 3.34 | 51.77 ± 5.34 | 92.67 ± 4.43 | 50.76 ± 4.25 | 88.56 ± 5.47 | 7.22 ± 2.01 | 1.25 ± 0.21 |
对照组(n = 34) | 11.14 ± 2.13 | 25.88 ± 3.57 | 51.66 ± 5.13 | 82.56 ± 5.33 | 50.34 ± 4.12 | 80.14 ± 5.22 | 6.34 ± 2.11 | 3.09 ± 0.23 |
t | 0.033 | 2.346 | 0.621 | 2.784 | 0.898 | 3.081 | 0.944 | 4.097 |
P | >0.05 | <0.05 | >0.05 | <0.05 | >0.05 | <0.05 | >0.05 | <0.05 |
表2. 两组患者治疗前后肩功能情况比较
结果显示,观察组疼痛消失时间、术后钙化灶消失时间、水肿消失时间以及活动功能恢复时间均较对照组缩短(P < 0.05),如表3所示。
组别 | 疼痛消失时间 | 术后钙化灶消失时间 | 水肿消失时间 | 活动功能恢复时间 |
---|---|---|---|---|
观察组(n = 33) | 115.23 ± 15.34 | 93.14 ± 12.56 | 81.09 ± 9.12 | 15.45 ± 10.09 |
对照组(n = 34) | 152.27 ± 16.24 | 137.02 ± 12.13 | 112.22 ± 11.14 | 142.77 ± 11.56 |
t | 2.972 | 3.225 | 2.325 | 3.383 |
p | <0.05 | <0.05 | <0.05 | <0.05 |
表3. 两组患者恢复情况比较
经典病例如图1所示,患者女性,给予高频超声精准定位下注射富血小板血浆治疗,效果满意。
图1. 经典病例:患者女性,48岁,左肩袖损伤,给予高频超声精准定位下注射富血小板血浆治疗。(a) 治疗前MR结果;(b) (c) 治疗后患者的活动度良好
有研究数据显示,肩袖部分损伤在肩关节疾病中发病率为15%~40%左右,具有一定的多发性,该类疾病主要是由于肱骨大结节在超常范围内急剧转动多次引起劳损而造成的 [
对于肩袖损伤的治疗,临床上多采用阶梯治疗,对于损伤较小的患者,可以采用药物保守治疗,比如塞来昔布胶囊等 [
综上所述,高频超声精准定位下注射富血小板血浆治疗肩袖部分损伤可明显改善患者肩功能,缓解疼痛,促进恢复,疗效显著,具有明显的应用价值。
浙江省金华市科学技术研究计划项目(2019-4-124)。
胡华刚,易庆丰. 高频超声精准定位下注射富血小板血浆治疗肩袖部分损伤的疗效分析Analysis of the Therapeutic Effect of High Frequency Ultrasound and Precise Location of Platelet Rich Plasma Injection on Partial Rotator Cuff Injury[J]. 医学诊断, 2020, 10(04): 295-300. https://doi.org/10.12677/MD.2020.104046