富血小板血浆和葡萄糖注射治疗慢性外侧上髁炎后神经肌肉功能的变化：一项随机对照研究
Variations in Neuromuscular Functions After Platelet-Rich Plasma and Dextrose Injections in Chronic Lateral Epicondylitis: A Randomized Controlled Study.
作者信息
Chen Yueh, Hong Chih-Kai, Hsu Kai-Lan, Kuan Fa-Chuan, Su Wei-Ren, Chen Yi-Ching, Hwang Ing-Shiou
机构信息
Institute of Allied Health Sciences, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
Department of Orthopedics, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan.
出版信息
Sports Health. 2025 Jan 31:19417381251314056. doi: 10.1177/19417381251314056.
BACKGROUND
Lateral epicondylitis is caused by overuse and manifests as pain, weakness, and difficulty with object manipulation. Platelet-rich plasma (PRP) and dextrose injections have shown promise in reducing pain and improving function.
HYPOTHESIS
PRP is more effective for force precision control of the extensor carpi radialis brevis (ECRB) muscle than dextrose injection for patients with chronic lateral epicondylitis (CLE).
STUDY DESIGN
Randomized, double-blinded clinical trial.
LEVEL OF EVIDENCE
Level 1.
METHODS
A total of 62 participants (25 healthy subjects and 37 CLE patients) were assigned randomly to either PRP (19) or dextrose (18) groups. Assessments included maximal voluntary contraction (MVC), wrist extension force, questionnaires, sonography, and electromyography assessments.
RESULTS
PRP and dextrose had similar effects on clinical questionnaire scores. Compared with pre-test values, only PRP demonstrated a significant increase in MVC (PRP, 75.3 ± 107.7%; < 0.01; dextrose, 34.0 ± 66.1%; = 0.08), and greater reduction in force fluctuations (PRP, -27.4 ± 13.3%; < 0.01; dextrose, -5.4 ± 33.2%; = 0.22) during post-test wrist extension. After treatment, the PRP group experienced a roughly 41.7% increase in motor units (MUs) with recruitment thresholds (Rec_TH) (pre-test, 3.67 ± 6.15% MVC; post-test, 5.20 ± 8.02% MVC; < 0.01). The dextrose group showed no significant change (-3.74%) in MU Rec_THs (pre-test, 3.48 ± 6.80% MVC; post-test, 3.35 ± 6.62% MVC; = 0.75). PRP increased the MU discharge rate with Rec_THs at <30% MVC, whereas dextrose administration elevated MU discharge rate with Rec_THs >20% MVC.
CONCLUSION
PRP may be more effective than dextrose in improving neuromuscular control of the ECRB muscle, particularly for enhancing the scaling of force during wrist extension, attributed to distinct MU activation strategies.
CLINICAL RELEVANCE
Detailed comparison and head-to-head analysis of PRP and dextrose injections offers more options for patients considering injections.
背景
外侧上髁炎由过度使用引起，表现为疼痛、无力以及进行物体操作困难。富血小板血浆（PRP）注射和葡萄糖注射已显示出减轻疼痛和改善功能的前景。
假设
对于慢性外侧上髁炎（CLE）患者，PRP在改善桡侧腕短伸肌（ECRB）肌力精确控制方面比葡萄糖注射更有效。
研究设计
随机双盲临床试验。
证据水平
1级。
方法
总共62名参与者（25名健康受试者和37名CLE患者）被随机分配到PRP组（19人）或葡萄糖组（18人）。评估包括最大自主收缩（MVC）、腕关节伸展力、问卷调查、超声检查和肌电图评估。
结果
PRP和葡萄糖对临床问卷评分有相似的效果。与测试前值相比，只有PRP组的MVC有显著增加（PRP组，75.3±107.7%；P<0.01；葡萄糖组，34.0±66.1%；P=0.08），并且在测试后腕关节伸展时力的波动减少幅度更大（PRP组，-27.4±13.3%；P<0.01；葡萄糖组，-5.4±33.2%；P=0.22）。治疗后，PRP组募集阈值（Rec_TH）的运动单位（MU）数量增加了约41.7%（测试前，3.67±6.15%MVC；测试后，5.20±8.02%MVC；P<0.01）。葡萄糖组的MU Rec_TH没有显著变化（-3.74%）（测试前，3.48±6.80%MVC；测试后，3.35±6.62%MVC；P=0.75）。PRP增加了Rec_TH<30%MVC时的MU放电率，而葡萄糖注射增加了Rec_TH>20%MVC时的MU放电率。
结论
PRP在改善ECRB肌肉的神经肌肉控制方面可能比葡萄糖更有效，特别是在增强腕关节伸展过程中的力调节方面，这归因于不同的MU激活策略。
临床意义
对PRP注射和葡萄糖注射进行详细比较和直接对比分析，为考虑注射治疗的患者提供了更多选择。
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