De Carli Angelo, Lanzetti Riccardo Maria, Ciompi Alessandro, Lupariello Domenico, Vadalà Antonio, Argento Giuseppe, Ferretti Andrea, Vulpiani M C, Vetrano M
Orthopaedic Unit, "Kirk Kilgour" Sports Injury Center, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy.
Diagnostic Imaging Unit, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy.
Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2231-7. doi: 10.1007/s00167-015-3580-1. Epub 2015 Mar 22.
Our hypothesis was that the Achilles tendon healing process after surgical treatment would be promoted by PRP with a faster return to sports activities.
Thirty patients with Achilles tendon rupture and surgically treated with a combined mini-open and percutaneous technique were prospectively enroled in the study. Patients were alternately case-by-case assigned to Group A (control group; 15 patients) or Group B (study group; 15 patients). In Group B, PRP was locally infiltrated both during surgery and 14 days after surgery. Patients in both groups were followed up at 1, 3, 6 and 24 months post-operatively via physical examination, VAS, FAOS and VISA-A scales; ultrasonography (US) and MRI were also conducted at one and 6 months; at the 6-month follow-up, isokinetic and jumping capacity tests were also performed.
The VAS, FAOS and VISA-A scale showed no difference between the two groups at 1, 3, 6 and 24 months post-operatively. Isokinetic evaluation showed no differences at both angular speeds. Jumping evaluation showed no difference at 6 months. Also US evaluation showed no differences. MRI data analysis before administration of gadolinium did not reveal significant differences between the two groups. Moreover, after intravenous injection of gadolinium, patients in Group B showed signal enhancement in 30 % of patients compared to 80 % in Group A at 6 months, as indirect evidence of better tendon remodelling (P < 0.05).
A substantial equivalence in structural and functional results in Achilles tendon ruptures surgically treated with and without addition of PRP is shown by present study. Clinical results, morphological features and jumping capability were similar in both groups. The addition of PRP to the surgical treatment of Achilles tendon rupture does not appear to offer superior clinical and functional results.
IV.
我们的假设是,术后使用富血小板血浆(PRP)可促进跟腱愈合过程,并能更快恢复体育活动。
30例采用小切口联合经皮技术手术治疗的跟腱断裂患者被前瞻性纳入本研究。患者逐例交替分配至A组(对照组;15例患者)或B组(研究组;15例患者)。B组在手术期间及术后14天进行PRP局部浸润。两组患者在术后1、3、6和24个月通过体格检查、视觉模拟评分法(VAS)、踝关节功能评分(FAOS)和踝关节功能指数(VISA - A)量表进行随访;术后1个月和6个月还进行了超声检查(US)和磁共振成像(MRI);在6个月随访时,还进行了等速运动和跳跃能力测试。
术后1、3、6和24个月,VAS、FAOS和VISA - A量表在两组间无差异。等速运动评估在两个角速度下均无差异。跳跃评估在6个月时无差异。US评估也无差异。在注射钆对比剂之前的MRI数据分析显示两组间无显著差异。此外,静脉注射钆对比剂后,B组6个月时有30%的患者出现信号增强,而A组为80%,这是肌腱重塑更好的间接证据(P < 0.05)。
本研究表明,手术治疗跟腱断裂时添加或不添加PRP在结构和功能结果上具有实质等效性。两组的临床结果、形态学特征和跳跃能力相似。在跟腱断裂手术治疗中添加PRP似乎并不能提供更好的临床和功能结果。
IV级