Thepsoparn Marvin, Thanphraisan Phark, Tanpowpong Thanathep, Itthipanichpong Thun
Pain Management Research Unit, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Orthop J Sports Med. 2021 Sep 1;9(9):23259671211024937. doi: 10.1177/23259671211024937. eCollection 2021 Sep.
Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy.
To compare pain relief, functional improvement, and complications after an intratendinous PRP injection versus a subacromial corticosteroid injection for partial supraspinatus tears.
Randomized controlled trial; Level of evidence, 1.
A total of 32 patients with partial supraspinatus tears were randomly assigned to receive a leukocyte-poor PRP (LP-PRP) injection or a corticosteroid injection. One patient withdrew from the PRP group, leaving 15 patients in the PRP group and 16 patients in the corticosteroid group. The ultrasound-guided procedures were performed by a single experienced pain physician. Pain relief and functional improvement were evaluated using the visual analog scale (VAS) and the Oxford Shoulder Score (OSS), respectively. Treatment efficacy and complications were documented, and the 2 groups were compared at 1- and 6-month follow-up.
There were no differences in VAS and OSS scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group had on both the VAS and OSS at 6-month follow-up (VAS: 14.5 ± 15.4 vs 37.5 ± 24.9, respectively; OSS: 16.2 ± 3.9 vs 25.0 ± 10.2, respectively; < .01 for both). Both groups showed significant improvement in VAS and OSS scores from before treatment to 1-month follow-up (mean difference, 35.67 and 11.47 points, respectively, for the PRP group; mean difference, 29.69 and 11.13 points, respectively, for the corticosteroid group; < .01 for all). The VAS and OSS scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and OSS scores between 1- and 6-month follow-up (mean difference, 15.87 and 7.40 points, respectively; < .01 for both). There were no complications in either group.
An injection using either a corticosteroid or LP-PRP resulted in a similar reduction in pain and improvement in function at 1 month in patients with a partial supraspinatus tear. However, PRP showed superior benefits over the corticosteroid at 6-month follow-up.
部分冈上肌腱撕裂常采用肩峰下皮质类固醇注射或手术治疗。尽管缺乏富血小板血浆（PRP）注射疗效的确切证据，但它在临床上是该疾病的一种替代治疗方法。
比较肌腱内注射PRP与肩峰下皮质类固醇注射治疗部分冈上肌腱撕裂后的疼痛缓解情况、功能改善情况及并发症。
随机对照试验；证据等级为1级。
32例部分冈上肌腱撕裂患者被随机分为两组，分别接受贫白细胞PRP（LP-PRP）注射或皮质类固醇注射。PRP组有1例患者退出，最终PRP组15例患者，皮质类固醇组16例患者。超声引导操作由同一位经验丰富的疼痛科医生进行。分别采用视觉模拟评分法（VAS）和牛津肩评分（OSS）评估疼痛缓解和功能改善情况。记录治疗效果和并发症，并在1个月和6个月随访时对两组进行比较。
1个月随访时，PRP组和皮质类固醇组的VAS和OSS评分无差异。然而，在6个月随访时，PRP组在VAS和OSS评分上均优于皮质类固醇组（VAS评分分别为14.5±15.4和37.5±24.9；OSS评分分别为16.2±3.9和25.0±10.2；两者均P<0.01）。两组从治疗前到1个月随访时VAS和OSS评分均有显著改善（PRP组平均差异分别为35.67分和11.47分；皮质类固醇组平均差异分别为29.69分和11.13分；所有均P<0.01）。皮质类固醇组在6个月随访时VAS和OSS评分无显著变化；然而，PRP组在1个月至6个月随访期间VAS和OSS评分持续改善（平均差异分别为15.87分和7.40分；两者均P<0.01）。两组均无并发症发生。
对于部分冈上肌腱撕裂患者，皮质类固醇注射或LP-PRP注射在1个月时疼痛减轻和功能改善程度相似。然而，在6个月随访时，PRP比皮质类固醇显示出更优的疗效。
