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富血小板血浆注射与皮质类固醇注射治疗桡骨茎突狭窄性腱鞘炎的临床及功能预后比较

Comparison of Clinical and Functional Outcomes after Platelet-Rich Plasma Injection and Corticosteroid Injection for the Treatment of de Quervain's Tenosynovitis.

作者信息

Kumar Vivek, Talwar Jatin, Rustagi Ashish, Krishna Loveneesh G, Sharma Vinod Kumar

机构信息

Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

出版信息

J Wrist Surg. 2022 Dec 29;12(2):135-142. doi: 10.1055/s-0042-1760124. eCollection 2023 Apr.

Abstract

Platelet-rich plasma (PRP) has local anti-inflammatory actions, which is being used as a treatment in various tendinopathies.  The aim of the study is to compare the clinical results of PRP injection and corticosteroid injection in the management of de Quervain's tenosynovitis (DQTSV).  In this prospective study, 60 patients of DQTSV, fulfilling the predefined inclusion and exclusion criteria, were randomised into two groups. In group 1 (  = 30), patients received a single injection of autologous PRP and in group 2 (  = 30) they received a single injection of corticosteroid (methylprednisolone). All patients were followed up at 1 month, 3 months, 6 months, and 1 year for evaluation by Finkelstein test, visual analogue scale (VAS), DASH (Disabilities of the Arm, Shoulder and Hand) score, and Modified Mayo Wrist score (MMWS).  In both the groups improvement occurred in Finkelstein test, VAS score, DASH score, and MMWS which were found to be statistically significant at all points of follow-ups when compared to the pre-intervention values. Comparison of scores between the two groups did not show any statistical significance. No complications were reported in PRP group. Statistically significant complications ( -value = 0.026) like subcutaneous fat atrophy, depigmentation, and temporary increase in pain were seen in eight patients in the corticosteroid group with an overall complication rate of 26.67%.  Both the modalities are equally effective in the management of DQTSV remittance. PRP is equally effective as corticosteroid in reducing symptoms of first dorsal compartment stenosing tenosynovitis. PRP may have a lower complication profile, however, this benefit should be weighed against the slight increase in cost and time of PRP preparation and injection.  Level 2, prospective comparative study.

摘要

富含血小板血浆(PRP)具有局部抗炎作用,正被用于治疗各种肌腱病。本研究旨在比较PRP注射和皮质类固醇注射治疗桡骨茎突狭窄性腱鞘炎(DQTSV)的临床效果。在这项前瞻性研究中,60例符合预先设定的纳入和排除标准的DQTSV患者被随机分为两组。第1组(n = 30)患者接受单次自体PRP注射,第2组(n = 30)患者接受单次皮质类固醇(甲基泼尼松龙)注射。所有患者在1个月、3个月、6个月和1年时进行随访,通过芬克斯坦试验、视觉模拟量表(VAS)、上肢、肩部和手部功能障碍评分(DASH)以及改良梅奥腕关节评分(MMWS)进行评估。两组患者的芬克斯坦试验、VAS评分、DASH评分和MMWS均有改善,与干预前值相比,在所有随访点均具有统计学意义。两组评分比较无统计学意义。PRP组未报告并发症。皮质类固醇组有8例患者出现皮下脂肪萎缩、色素沉着和疼痛暂时加重等具有统计学意义的并发症(p值 = 0.026),总体并发症发生率为26.67%。两种治疗方式在DQTSV缓解治疗中同样有效。PRP在减轻第一背侧腱鞘狭窄性腱鞘炎症状方面与皮质类固醇同样有效。PRP可能具有较低的并发症发生率,然而,这种益处应与PRP制备和注射成本及时间的轻微增加相权衡。2级,前瞻性比较研究。

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