Zavadil Douglas P, Satterlee C Craig, Costigan Jaime M, Holt David W, Shostrom Valerie K
Department of Surgery, Penn View Perfusion, Inc., North Kansas City Hospital, North Kansas City, Missouri 64116, USA.
J Extra Corpor Technol. 2007 Sep;39(3):177-82.
The recovery of patients undergoing total shoulder arthroplasty (TSA) can be adversely affected by a number of complications. Autologous platelet gel (APG), produced by activating platelet-rich plasma (PRP), has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures. Activated platelet-poor plasma (PPP) has also been used as a hemostatic agent. This study examines the effects of APG and PPP treatment on TSA patients postoperatively. After Institutional Review Board (IRB) approval, 40 patients undergoing TSA at our institution were prospectively enrolled in our study. They were randomized into either a control (n = 20) or study (n = 20) group, with the study group receiving APG and PPP treatment. Preoperative demographic data, pre- and postoperative laboratory data, pain scores, pain medication, complications, pre- and postoperative range of motion measurements, and postoperative lengths of stay were recorded for each group. The preoperative internal rotation index was significantly higher in the control group compared with treatment patients (4.64 +/- 4.46 vs. 1.88 +/- 2.44, p < .05). The percent hemoglobin retained postoperatively was higher in the treatment group at 24 (84.54 +/- 5.32 vs. 79.87 +/- 8.73) and 72 hours (87.46 +/- 16.03 vs. 76.70 vs. 5.96), but neither difference reached statistical significance. The treatment group had significantly lower pain scores (p = .007) and total fentanyl requirements (p < .05) compared with control patients. The internal rotation index improvement factor (postoperative internal rotation index/preoperative internal rotation index) was significantly higher in the treatment group vs. the control group (p < .05). Although it did not reach statistical significance, the treatment group was discharged almost 9 hours earlier than the control group (64.44 +/- 15.23 vs. 73.39 +/- 15.37). APG and PPP treatment decreased pain and provided a greater increase in internal rotation measurements postoperatively.
全肩关节置换术（TSA）患者的康复可能会受到多种并发症的不利影响。通过激活富血小板血浆（PRP）产生的自体血小板凝胶（APG）已被证明在一些外科手术中可改善止血和伤口愈合并减少感染。激活的贫血小板血浆（PPP）也被用作止血剂。本研究探讨了APG和PPP治疗对TSA患者术后的影响。经机构审查委员会（IRB）批准，我们机构中40例行TSA的患者被前瞻性纳入本研究。他们被随机分为对照组（n = 20）或研究组（n = 20），研究组接受APG和PPP治疗。记录每组患者的术前人口统计学数据、术前和术后实验室数据、疼痛评分、止痛药物使用情况、并发症、术前和术后活动度测量以及术后住院时间。与治疗组患者相比，对照组术前内旋指数显著更高（4.64±4.46对1.88±2.44，p<.05）。治疗组术后24小时（84.54±5.32对79.87±8.73）和72小时（87.46±16.03对76.70±5.96）血红蛋白保留百分比更高，但两者差异均未达到统计学意义。与对照组患者相比，治疗组疼痛评分显著更低（p = .007）且芬太尼总需求量更低（p<.05）。治疗组内旋指数改善因子（术后内旋指数/术前内旋指数）显著高于对照组（p<.05）。尽管未达到统计学意义，但治疗组比对照组提前近9小时出院（64.44±15.23对73.39±15.37）。APG和PPP治疗可减轻疼痛并使术后内旋测量值有更大增加。
