超声引导下富血小板血浆注射治疗肌腱训练伤的应用研究

doi:10.3877/cma.j.issn.1672-6448.2020.04.010

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (04) : 347 -352. doi: 10.3877/cma.j.issn.1672-6448.2020.04.010

所属专题：文献；

肌肉骨骼超声影像学

超声引导下富血小板血浆注射治疗肌腱训练伤的应用研究

林海丹¹, 吕发勤²^,^†(

), 黄钰清¹, 吴盛正², 黄雅³, 王海宝³, 陈祥慧², 张冰琦², 单雪霞², 林星禧², 武杜杜²

^1. 100853　北京，中国人民解放军总医院第一医学中心超声科
^2. 572013　三亚，中国人民解放军总医院海南医院超声科
^3. 572013　三亚，中国人民解放军总医院海南医院输血科

收稿日期:2019-10-15 出版日期:2020-04-01
通信作者: 吕发勤
基金资助:
解放军总医院军事医学创新研究项目(CX19025); 科技部"十三五"国家重点研发计划(2016YFC0105006)

Ultrasound-guided platelet-rich plasma therapy for tendinopathy caused by military training

Haidan Lin¹, Faqin Lyv²^,^†(), Yuqing Huang¹, Shengzheng Wu², Ya Huang³, Haibao Wang³, Xianghui Chen², Bingqi Zhang², Xuexia Shan², Xingxi Lin², Dudu Wu²

^1. Department of Ultrasound, the First Medical Center of PLA General Hospital, Beijing 100853, China
^2. Department of Ultrasound, Hainan Hospital of PLA General Hospital, Sanya 572013, China
^3. Department of Blood Transfusion, Hainan Hospital of PLA General Hospital, Sanya 572013, China

Received:2019-10-15 Published:2020-04-01
Corresponding author: Faqin Lyv
About author:
Corresponding author: Lyv Faqin, Email: lvjin8912@163.com

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

林海丹, 吕发勤, 黄钰清, 吴盛正, 黄雅, 王海宝, 陈祥慧, 张冰琦, 单雪霞, 林星禧, 武杜杜. 超声引导下富血小板血浆注射治疗肌腱训练伤的应用研究[J]. 中华医学超声杂志（电子版）, 2020, 17(04): 347-352.

Haidan Lin, Faqin Lyv, Yuqing Huang, Shengzheng Wu, Ya Huang, Haibao Wang, Xianghui Chen, Bingqi Zhang, Xuexia Shan, Xingxi Lin, Dudu Wu. Ultrasound-guided platelet-rich plasma therapy for tendinopathy caused by military training[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(04): 347-352.

目的

探讨超声引导下自体血提取富血小板血浆（PRP）注射治疗军事训练肌腱伤的效果。

方法

选取2018年3月至2019年6月于解放军总医院海南医院就诊的军事训练所致肌腱损伤患者共41例。常规超声检查并评估病变肌腱后，在超声引导下经皮穿刺对肌腱损伤灶多点注射自体PRP。观察并比较治疗前与治疗后2周、1个月的常规超声表现、肢体活动度和疼痛评分。

结果

41例患者注射PRP剂量为（2.85±0.49）ml。治疗后超声表现为肌腱厚度变小、形态结构改善、周围血管增生减少。患者自觉疼痛症状减轻，治疗后2周、1个月的疼痛评分（4.66±2.43、2.71±1.39）与治疗前（6.53±2.78）相比明显降低，差异有统计学意义（治疗后2周vs治疗前：P=0.008，治疗后1个月vs治疗前：P=0.006）。治疗后患肢的活动幅度增大，治疗后2周、1个月的关节功能评分（72.33±3.34、79.70±5.09）与治疗前（61.84±9.98）相比明显增加，差异有统计学意义（治疗后2周vs治疗前：P=0.006，治疗后1个月vs治疗前：P=0.004）。

结论

超声引导自体PRP治疗军事训练所致的肌腱伤安全、有效，值得临床推广应用。

关键词: 富血小板血浆, 超声检查，介入性, 肌腱病, 军事训练

Objective

To assess the clinical efficacy of ultrasound-guided autologous platelet-rich plasma (PRP) injection into injured tendons caused by military training.

Methods

Between March 2018 and June 2019, 41 patients with tendinopathy caused by military training were enrolled at Hainan Hospital of PLA General Hospital. Conventional ultrasound was used to evaluate the injuried tendons. Under the guidance of ultrasound, the 21G PTC needle was used to percutaneously puncture into the injury site, and autologous PRP was then injected into the lesions in amulti-point manner. Conventional ultrasound, limb mobility score, and pain score were used to evaluate the clinical efficacy. The results were compared between pre-treatment and 2 weeks or 1 month after treatment.

Results

The injection dose of PRP was (2.85±0.49) ml in the 41 patients. After treatment, ultrasound showed that the tendon became thinning, the morphological structure was improved, and the proliferation of peripheral blood vessels was lessened. The pain was alleviated gradually, and the movement range of all affected limbs was expanded. Pain score was significantly decreased at 1 month (2.71±1.39) and 2 weeks (4.66±2.43) after treatment compared with pre-treatment score (6.53±2.78) (P=0.006 and P=0.008, respectively). Limb mobility score was significantly increased at 1 month (79.70±5.09) and 2 weeks (72.33±3.34) after treatment compared with pre-treatment score (61.84±9.98) (P=0.004 and P=0.006, respectively).

Conclusion

Ultrasound-guided autologous PRP therapy is safe and effective in the treatment of tendinopathy caused by military training.

Key words: Platelet-rich plasma, Ultrasonography, interventional, Tendinopathy, Military training

图1 超声引导下注射富血小板血浆（PRP）治疗冈上肌腱部分撕裂。图a为训练伤所致冈上肌腱肿胀伴部分撕裂，图中游标测量其厚度；图b为超声引导下对冈上肌腱多点刺伤；图c为超声引导下冈上肌腱内多点注射PRP

图2 超声引导下注射富血小板血浆（PRP）治疗伸肌总腱肌腱炎治疗前、后对比图像。图a~f示伸肌总腱肌腱厚度逐渐变小，肌腱内血管增生逐渐减少。图a、d为注射PRP前常规超声和彩色多普勒声像图表现，肌腱厚度约8.0 mm；图b、e为注射治疗后2周常规超声和彩色多普勒声像图表现，肌腱厚度约7.4 mm；图c、f为注射治疗后1个月常规超声和彩色多普勒声像图表现，肌腱厚度约6.4 mm

表1 41例肌腱损伤患者注射PRP前后的VAS评分与关节功能评分比较（分，±s）

时间		例数	VAS评分	关节功能评分
治疗前		41	6.53±2.78	61.84±9.98
治疗后2周		41	4.66±2.43^a	72.33±3.34^a
治疗后1个月		41	2.71±1.39^bc	79.70±5.09^bc
	F值		30.54	141.26
	P值		<0.05	<0.05

表1 41例肌腱损伤患者注射PRP前后的VAS评分与关节功能评分比较（分，±s）

时间		例数	VAS评分	关节功能评分
治疗前		41	6.53±2.78	61.84±9.98
治疗后2周		41	4.66±2.43^a	72.33±3.34^a
治疗后1个月		41	2.71±1.39^bc	79.70±5.09^bc
	F值		30.54	141.26
	P值		<0.05	<0.05

1	岳欣, 戴冬梅, 张美玲. 2007-2017年我国军事训练伤文献计量分析 [J]. 解放军医院管理杂志, 2018, 25(6): 597-600.
2	邵壮超, 解宏伟, 贺祯, 等. 结构方程模型在军事训练伤致因分析中的运用 [J]. 军事医学, 2013, 37(10): 762-764, 796.
3	Wu F, Nerlich M, Docheva D. Tendoninjuries:basic science and new repair proposals [J]. EFORT Open Rev, 2017, 2(7): 332-342.
4	Ben-Nafa W, Munro W. The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: a systematic review [J]. SICOT J, 2018, 4: 11.
5	Wasterlain AS, Braun HJ, Harris AH, et al. The systemic effects of Platelet-Rich plasma injection [J] . Am J Sports Med, 2013, 41(1): 186-193.
6	Chen L, Dong SW, Tao X, et al. Autologous platelet-rich clot releasate stimulates proliferation and inhibits differentiation of adult rat tendon stem cells towards nontenocyte lineages [J]. J Int Med Res, 2012, 40(4): 1399-1409.
7	Wang X, Qiu Y, Triffitt J, et al. Proliferation and differentiation of human tenocytes in response to platelet rich plasma: an in vitro and in vivo study [J]. J Orthop Res, 2012, 30(6): 982-990.
8	Anitua E, Andai I, Sanchez M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture [J]. J Orthop Res, 2005, 23(2): 281-286.
9	Wang JH, Guo Q, Li B. Tendon biomechanics and mechanobiology: a minireview of basic concepts and recent advancements [J]. J Hand Ther, 2012, 25(2): 133-141.
10	Krogh TP, Bartels EM, Ellingsen T, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials [J]. Am J Sports Med, 2013, 41(6): 1435-1446.
11	Foster TE, Puskas BL, Mandelbaum BR, et al. Platelet-rich plasma from basic science to clinical applications [J]. Am J Sports Med, 2009, 37(11): 2259-2272.
12	Shiple BJ. How effective are injection treatments for lateral epicondylitis? [J]. Clin J Sport Med, 2013, 23: 502-503.
13	Malanga GL, Nakamura R. The role of regenerative medicine in the treatment of spores injuries [J]. Phys Med Rehabil Clin N Am, 2014, 25(4): 881-895.
14	de Almeida AM, Demange MK, Sobrado MF, et al. Patellar tendon healing with platelet-rich plasma: a prospective randomized controllde trial [J]. Am J Sports Med, 2012, 40(6): 1282-1288.
15	Zhou Z, Akinbiyi T, Xu L, et al. Tendin-derived stem/progenitor cell aging: defective self-renewal and altered fate [J]. Aging Cell, 2010, 9(50): 911-915.
16	Hilber F, Loibl M, Lang S, et al. Leukocyte-reduced platelet-rich plasma increases proliferation of tenocytes treated with prednisolone: a cell cycle analysis [J]. Arch Orthop Trauma Surg, 2017, 137(10): 1417-1422.
17	Xu K, Al-Ani MK, Sun Y, et al. Platelet-rich plasma activates tendon-derived stem cells to promote regeneration of achills tendon rupture in rats [J]. J Tissue Eng Regen Med, 2017, 11(4): 1173-1184.
18	Giusti I, D′ascenzo S, Mancò A, et al. Platelet concentration in platelet-rich plasma affects tenocyte behavior in vitro [J/OL]. Biomed Res Int, 2014, 2014: 630870.
19	Hutchinson ID, Rodeo SA, Perrone GS, et al. Can platelet-rich plasma enhance anterior cruciate ligament and meniscal repair? [J]. J Knee Surg, 2015, 28(1): 19-28.
20	Zhou Y, Wang JH. PRP treatment efficacy for tendinopathy:a review of basic science studies [J]. Biomed Res Int, 2016, 2016(1): 9103792.
21	Carvalho Ade M, Badial PR, Lvarez LE, et al. Equine tendonitis therapy using mesenchymal stem cells and platelet concentrates: a randomized controlled trial [J/OL]. Stem Cell Res Ther, 2013, 4: 85.
22	Zargar Baboldashti N, Poulsen RC, Franklin SL, et al. Platelet-rich plasma protects tenocytes from adverse side effects of dexamethasone and ciprofloxacin [J]. Am J Sports Med, 2011, 39(9): 1929-1935.
23	Lyras DN, Kazakos K, Georgiadis G, et al. Does a single application of PRP alter the expression of IGF-I in the early phase of tendon healing? [J]. J Foot Ankle Surg, 2011, 50 (3): 276-282.
24	Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients [J]. Am J Sports Med, 2014, 42(2): 463-471.
25	Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leukocyte-and platelet-rich fibrin (L-PRF) [J]. Trends Biotechnol, 2009, 27: 158-167.

[1]	许正文, 李振, 侯振扬, 苏长征, 朱彪. 富血小板血浆联合植骨治疗早期非创伤性股骨头坏死[J]. 中华关节外科杂志(电子版), 2023, 17(06): 773-779.
[2]	欧阳剑锋, 李炳权, 叶永恒, 胡少宇, 向阳. 关节镜联合富血小板血浆治疗粘连性肩周炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 765-772.
[3]	夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[4]	王泽勇, 覃健. 白细胞含量对富血小板血浆治疗运动系统损伤的影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 684-688.
[5]	张中斌, 付琨朋, 朱凯, 张玉, 李华. 胫骨高位截骨术与富血小板血浆治疗膝骨关节炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(05): 633-641.
[6]	詹钦文, 靳科, 袁家钦. 不同浓度自体富血小板血浆对慢性跟腱损伤的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(04): 500-507.
[7]	邬春虎, 马玉海, 陈长松, 尹华东, 朱晓峰, 何剑星, 刘彧. 冲击波联合富血小板血浆对骨关节炎软骨损伤的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(03): 334-339.
[8]	韩李念, 王君. 放射性皮肤损伤治疗的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 533-537.
[9]	祁焕康, 包俊杰, 张婧, 田琰, 卓么加, 祁万乐. 富血小板血浆联合微粒皮移植在高原地区老年慢性小创面中的临床研究[J]. 中华损伤与修复杂志(电子版), 2023, 18(01): 32-38.
[10]	廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
[11]	曾庆劲, 赵里汶, 吴宇轩, 贺需旗, 张兰霞, 余萱, 何娜, 郑荣琴, 李凯. 超声引导经皮热消融治疗邻近心脏的肝脏恶性肿瘤疗效分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 49-54.
[12]	胡国政, 刘飞, 徐丛, 吕剑, 王巍. 肩袖修补术联合足印区注射富血小板血浆的疗效分析[J]. 中华肩肘外科电子杂志, 2023, 11(02): 111-116.
[13]	马聪, 李雪靖, 郑晓佐, 张晓阳, 段坤峰, 刘国强, 郄素会. 关节腔内注射富血小板血浆与透明质酸钠治疗Ⅰ-Ⅲ期膝骨关节炎的对比研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 282-288.
[14]	苗壮, 刘培来. 富血小板血浆治疗膝骨关节炎的现状与展望[J]. 中华临床医师杂志(电子版), 2023, 17(01): 1-6.
[15]	熊鑫, 邓勇志. 基于血管内超声的机器学习在冠状动脉病变中的研究进展[J]. 中华诊断学电子杂志, 2023, 11(03): 153-157.

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

Ultrasound-guided platelet-rich plasma therapy for tendinopathy caused by military training

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

Ultrasound-guided platelet-rich plasma therapy for tendinopathy caused by military training