Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN, USA.
PM R. 2011 Oct;3(10):900-11. doi: 10.1016/j.pmrj.2011.05.015. Epub 2011 Aug 26.
To determine whether ultrasound (US)-guided percutaneous needle tenotomy followed by a platelet-rich plasma (PRP) injection would result in pain reduction, functional improvement, or structural alterations in patients with chronic, recalcitrant tendinopathy.
Part A was a retrospective observational study. Part B was a prospective observational study.
Outpatient academic sports medicine center.
Patients were required to have chronic (>3 months), recalcitrant tendinopathy treated with US-guided percutaneous tenotomy and PRP injection between January 2007 and October 2009. Fifty-one subjects met the inclusion criteria. Forty-one (80%) participated in part A of the study, whereas 34 subjects (67%) participated in part B.
In part A, subjects completed a survey obtaining anthropomorphic, demographic, pain, and functional data. Subjects' platelet, hemoglobin, and white blood cell concentrations from their whole-blood and PRP samples were also obtained. In part B, subjects returned to the clinic after US-guided percutaneous needle tenotomy and PRP injection for a diagnostic US, which was compared with their preprocedure diagnostic US.
The main outcome measures included changes in pain, function, and tendon characteristics.
The tendinopathy location was in the upper extremity in 10 subjects (24.4%), was in the lower extremity in 31 subjects (75.6%), and had been present for a mean of 40 months. The mean postprocedure follow-up was 14 months, and the maximum benefits occurred 4 months postprocedure. There were mean functional and worst-pain improvements of 68% and 58%, respectively. Eighty-three percent of subjects were satisfied with their outcomes and would recommend the procedure to a friend. Although no tendons demonstrated a normal sonographic appearance after the procedure, 84% of subjects had an improvement in echotexture, 64% had a resolution of intratendinous calcifications, and 82% had a decrease in intratendinous neovascularity. None of the variables analyzed in this study demonstrated a significant correlation with pain or functional outcome measures.
In this case series, we found US-guided percutaneous needle tenotomy followed by PRP injection to be a safe and effective treatment for chronic, recalcitrant tendinopathy, and this treatment was associated with sonographically apparent improvements in tendon morphology. However, because of the intrinsic limitations of the study design and the heterogeneity of treated tendons, further research is required to corroborate our findings.
确定超声（US）引导下经皮针刀切开术联合富含血小板的血浆（PRP）注射是否会减轻慢性、难治性肌腱病患者的疼痛、改善功能或改变结构。
A 部分为回顾性观察性研究。B 部分为前瞻性观察性研究。
门诊学术运动医学中心。
要求患者患有慢性（>3 个月）、难治性肌腱病，接受 US 引导下经皮针刀切开术联合 PRP 注射治疗，时间为 2007 年 1 月至 2009 年 10 月。51 名患者符合纳入标准。41 名（80%）患者参加了研究 A，34 名（67%）患者参加了研究 B。
在 A 部分，患者完成了一份问卷调查，获得了人体测量、人口统计学、疼痛和功能数据。还获得了他们全血和 PRP 样本中的血小板、血红蛋白和白细胞浓度。在 B 部分，患者在 US 引导下经皮针刀切开术和 PRP 注射后返回诊所进行诊断性 US，与术前诊断性 US 进行比较。
主要观察指标包括疼痛、功能和肌腱特征的变化。
肌腱病位置在上肢 10 例（24.4%），下肢 31 例（75.6%），平均病程 40 个月。术后平均随访时间为 14 个月，最大获益发生在术后 4 个月。功能和最差疼痛分别有 68%和 58%的平均改善。83%的患者对治疗结果满意，并会向朋友推荐该治疗方法。尽管术后没有肌腱表现出正常的超声表现，但 84%的患者肌腱回声质地得到改善，64%的患者肌腱内钙化得到解决，82%的患者肌腱内新生血管减少。本研究中分析的变量均与疼痛或功能结局测量无显著相关性。
在本病例系列研究中，我们发现 US 引导下经皮针刀切开术联合 PRP 注射治疗慢性、难治性肌腱病是一种安全有效的治疗方法，且这种治疗方法与肌腱形态学的超声明显改善相关。然而，由于研究设计的固有局限性和治疗肌腱的异质性，需要进一步的研究来证实我们的发现。
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