Lim Wonbong, Park Sang H, Kim Bora, Kang Sin W, Lee Jung W, Moon Young L
Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.
Laboratory of Orthopedic Research, Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.
J Orthop Res. 2018 Mar;36(3):913-920. doi: 10.1002/jor.23714. Epub 2017 Sep 20.
Lateral epicondylitis (LE) is difficult to manage and can result in significant patient morbidity. Currently, the clinical use of platelet-rich plasma (PRP) for painful tendons has received attention, but its efficacy remains controversial. This study aimed to investigate the clinical effects of PRP and its biological components. A total of 156 patients with LE were randomly divided into group 1, treated with a single injection of 2-ml autologous PRP, and group 2, treated with a control received only physical therapy without injection. Both groups used a tennis elbow strap and performed stretching and strengthening exercises during 24 weeks' follow-up. Pain and functional improvements were assessed using the visual analog scale (VAS), Modified Mayo Clinic Performance Index for the elbow, and magnetic resonance imaging (MRI). White blood cell count, platelet count, and levels of platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, transforming growth factor-β (TGF-β), vascular endothelial growth factor, epithelial growth factor, and interleukin-1 β in PRP were measured and investigated for statistical correlation with the clinical score. At 24 weeks, all pain and functional variables, including VAS score, Mayo Clinic performance scores, and MRI grade, improved significantly in group 1 (p < 0.05). PDGF-AB, PDGF-BB, and TGF-β levels were more significantly increased in PRP than in whole blood. TGF-β level significantly correlated with Mayo Clinic performance score and MRI grade improvement. Thus, TGF-β level in PRP is considered to play a pivotal role in tendon healing. These results may contribute to identifying the best protocol for PRP application in tendinopathies. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:913-920, 2018.
外侧上髁炎（LE）难以治疗，可导致患者出现严重病变。目前，富血小板血浆（PRP）在治疗疼痛性肌腱方面的临床应用受到关注，但其疗效仍存在争议。本研究旨在探讨PRP及其生物成分的临床效果。156例LE患者被随机分为两组，第1组接受单次注射2 ml自体PRP治疗，第2组作为对照组，仅接受物理治疗而不进行注射。两组均使用网球肘固定带，并在24周的随访期内进行伸展和强化锻炼。采用视觉模拟评分法（VAS）、改良的梅奥诊所肘关节功能指数和磁共振成像（MRI）评估疼痛和功能改善情况。检测PRP中的白细胞计数、血小板计数以及血小板衍生生长因子AB（PDGF-AB）、PDGF-BB、转化生长因子-β（TGF-β）、血管内皮生长因子、上皮生长因子和白细胞介素-1β水平，并研究其与临床评分的统计学相关性。在24周时，第1组所有疼痛和功能变量，包括VAS评分、梅奥诊所功能评分和MRI分级，均有显著改善（p < 0.05）。PRP中PDGF-AB、PDGF-BB和TGF-β水平的升高幅度明显高于全血。TGF-β水平与梅奥诊所功能评分和MRI分级改善显著相关。因此，PRP中的TGF-β水平被认为在肌腱愈合中起关键作用。这些结果可能有助于确定PRP在肌腱病应用中的最佳方案。© 2017骨科研究协会。由Wiley Periodicals, Inc.出版。《矫形外科研究杂志》36:913 - 920, 2018年。
