Mishra Allan, Pavelko Terri
Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025, USA.
Am J Sports Med. 2006 Nov;34(11):1774-8. doi: 10.1177/0363546506288850. Epub 2006 May 30.
Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention.
Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem.
Cohort study; Level of evidence, 2.
One hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had significant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60-100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (active group, n = 15) or bupivacaine (control group, n = 5).
Eight weeks after the treatment, the platelet-rich plasma patients noted 60% improvement in their visual analog pain scores versus 16% improvement in control patients (P =.001). Sixty percent (3 of 5) of the control subjects withdrew or sought other treatments after the 8-week period, preventing further direct analysis. Therefore, only the patients treated with platelet-rich plasma were available for continued evaluation. At 6 months, the patients treated with platelet-rich plasma noted 81% improvement in their visual analog pain scores (P =.0001). At final follow-up (mean, 25.6 months; range, 12-38 months), the platelet-rich plasma patients reported 93% reduction in pain compared with before the treatment (P <.0001).
Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted. Finally, platelet-rich plasma should be considered before surgical intervention.
肘部肱骨外上髁肌腱病是一种常见问题，通常通过非手术治疗可得到缓解。然而，当这些措施失败时，患者会寻求手术干预之外的其他选择。
对于考虑手术治疗的慢性重度肘部肌腱病患者，使用缓冲富血小板血浆进行治疗将减轻疼痛并改善功能。
队列研究；证据等级，2级。
本研究评估了140例肘部肱骨外上髁疼痛患者。所有这些患者最初均接受了标准化的物理治疗方案及其他多种非手术治疗。尽管进行了这些干预措施，但其中20例患者仍持续存在明显疼痛，平均疼痛时间为15个月（视觉模拟疼痛量表评分平均为100分中的82分；范围为60 - 100分），所有患者均在考虑手术治疗。然后，将这组非手术治疗失败的患者分为两组，一组接受单次经皮注射富血小板血浆（治疗组，n = 15），另一组接受布比卡因注射（对照组，n = 5）。
治疗8周后，富血小板血浆治疗组患者的视觉模拟疼痛评分改善了60%，而对照组患者仅改善了16%（P = 0.001）。8周后，60%（3/5）的对照组受试者退出或寻求其他治疗，这使得无法进行进一步的直接分析。因此，仅对接受富血小板血浆治疗的患者进行了持续评估。6个月时，接受富血小板血浆治疗的患者视觉模拟疼痛评分改善了81%（P = 0.0001）。在最终随访时（平均25.6个月；范围12 - 38个月），富血小板血浆治疗组患者报告疼痛较治疗前减轻了93%（P < 0.0001）。
在这项初步研究中，使用缓冲富血小板血浆治疗慢性肘部肌腱病患者可显著减轻疼痛。有必要对这种新疗法进行进一步评估。最后，在进行手术干预之前应考虑使用富血小板血浆。
