富血小板血浆注射治疗难治性跟腱病：4年随访结果
Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years.
作者信息
Filardo Giuseppe, Kon Elizaveta, Di Matteo Berardo, Di Martino Alessandro, Tesei Giulia, Pelotti Patrizia, Cenacchi Annarita, Marcacci Maurilio
机构信息
II Orthopaedic and Traumatology Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
出版信息
Blood Transfus. 2014 Oct;12(4):533-40. doi: 10.2450/2014.0289-13. Epub 2014 Jun 19.
BACKGROUND
Chronic Achilles tendinopathy is responsible for a severe reduction in physical performance and persistent pain. There is currently a number of therapeutic options and the local administration of growth factors is an emerging treatment strategy. In particular, platelet-rich plasma (PRP) is a widely used way to provide a local regenerative stimulus for tendon healing. The aim of this study was to document the mid-term results obtained after treating recalcitrant Achilles tendinopathy with injections of high concentrate, leucocyte-rich PRP.
MATERIALS AND METHODS
Twenty-seven patients (mean age: 44.6 years; 22 men and 5 women) affected by chronic mid-portion Achilles tendinopathy (7 bilateral, for a total of 34 tendons), refractory to previous treatments, were enrolled. Patients were treated with three ultrasound-guided intra-tendinous injections of PRP at 2-week intervals. Patients were prospectively evaluated at baseline, and then at 2, 6, and up to a mean of 54.1 months of follow-up (minimum 30 months), using the following tools: Blanzina, VISA-A, EQ-VAS for general health, and Tegner scores.
RESULTS
The VISA-A score showed a significant improvement: the baseline score of 49.9±18.1 increased to 62.9±19.8 at 2 months (p=0.002), with a further improvement at 6 months (84.3±17.1, p<0.0005), and stable results at 4.5 years (90.0±13.9). The EQ-VAS score also showed a similar positive trend. An evaluation of the activity level confirmed these findings, showing a significant improvement in the Tegner score over time (p=0.017 for the final evaluation). The longer duration of symptoms before treatment was associated with a slower return to sport (p=0.041).
DISCUSSION
PRP injections produced good overall results for the treatment of chronic recalcitrant Achilles tendinopathy with a stable outcome up to a medium-term follow-up. Longer symptom duration was related with a more difficult return to sporting activity.
背景
慢性跟腱病会导致身体机能严重下降和持续疼痛。目前有多种治疗选择，局部应用生长因子是一种新兴的治疗策略。特别是，富血小板血浆（PRP）是一种广泛使用的为肌腱愈合提供局部再生刺激的方法。本研究的目的是记录用高浓度、富含白细胞的PRP注射治疗顽固性跟腱病后的中期结果。
材料与方法
纳入27例慢性跟腱中段病患者（平均年龄：44.6岁；22例男性和5例女性），共34条肌腱（7例双侧），对先前治疗无效。患者接受3次超声引导下的肌腱内PRP注射，间隔2周。前瞻性地在基线时对患者进行评估，然后在2个月、6个月以及平均54.1个月的随访期（最短30个月）使用以下工具进行评估：布兰齐纳（Blanzina）、VISA - A、一般健康状况的EQ - VAS以及特格纳（Tegner）评分。
结果
VISA - A评分显示有显著改善：基线评分为49.9±18.1，在2个月时升至62.9±19.8（p = 0.002），在6个月时进一步改善（84.3±17.1，p < 0.0005），在4.5年时结果稳定（90.0±13.9）。EQ - VAS评分也显示出类似的积极趋势。对活动水平的评估证实了这些发现，显示特格纳评分随时间有显著改善（最终评估p = 0.017）。治疗前症状持续时间较长与恢复运动较慢相关（p = 0.041）。
讨论
PRP注射治疗慢性顽固性跟腱病总体效果良好，中期随访结果稳定。症状持续时间较长与恢复体育活动更困难有关。
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