Barber F Alan
Plano Orthopedic Sports Medicine and Spine Center, Plano, TX.
Sports Med Arthrosc Rev. 2013 Dec;21(4):199-205. doi: 10.1097/JSA.0b013e31828a7c6a.
Rotator cuff tears are a common cause of shoulder pain and disability. Because they combine both traumatic and degenerative elements, the surgical repair can be challenging. Even after surgical intervention, tendon residual defects or "retears" often develop. Risk factors for tendon "retears" include patient age, number of tendons involved, tear size, and smoking. Platelet-rich plasma (PRP) is a supraphysiological concentration of platelets, which may be able to positively augment rotator cuff tendon healing. Not all PRPs are the same and those containing higher leukocyte levels may be detrimental to tendon healing. Thrombin activation triggers an immediate release of growth factors from the PRP and may actually inhibit some parts of the healing response. As yet, the clinical data does not conclusively prove a benefit from PRP, but discernment is required in evaluating the published results. As different PRPs may act differently and the results may be dose dependent requiring more PRP to achieve a beneficial threshold. How success is measured (clinical outcomes vs. intact cuff tendons) and how long the patients are followed are also critical items. Currently, the PRP fibrin matrix version holds the greatest promise for improving clinical success after rotator cuff tendon repair.
肩袖撕裂是肩部疼痛和功能障碍的常见原因。由于其兼具创伤性和退行性因素，手术修复颇具挑战性。即便经过手术干预，肌腱残余缺损或“再撕裂”仍常常出现。肌腱“再撕裂”的风险因素包括患者年龄、受累肌腱数量、撕裂大小以及吸烟情况。富血小板血浆（PRP）是血小板的超生理浓度，或许能够积极促进肩袖肌腱愈合。并非所有的PRP都相同，那些白细胞水平较高的PRP可能对肌腱愈合有害。凝血酶激活会促使PRP立即释放生长因子，实际上可能会抑制愈合反应的某些环节。目前，临床数据尚未确凿证明PRP有益，但在评估已发表的结果时需要审慎判断。由于不同的PRP作用可能不同，且结果可能依赖剂量，需要更多的PRP才能达到有益阈值。衡量成功的标准（临床结果与完整的袖带肌腱）以及对患者的随访时长也是关键因素。目前，PRP纤维蛋白基质版本在改善肩袖肌腱修复后的临床成功率方面最具前景。
