骨髓间质细胞富血小板血浆修复肩袖损伤
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滨州医学院附属医院

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山东省医药卫生科技发展计划;滨州医学院徐荣祥再生医学发展项目计划;2020年产学合作协同育人项目(202002204024).


Repair of rotator cuff injury with platelet rich plasma from bone marrow stromal cells
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Binzhou Medical University Hospital

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    摘要:

    目的 评估骨髓间充质干细胞(bone marrow-derived mesenchymal stem cells, BMSCs)与富血小板血浆(platelet-rich plasma,PRP)对肩袖损伤术后愈合的影响。方法 2019年9月~ 2021年10月,两组匹配的160例患者进行关节镜下肩袖修复术。试验组80名患者予以肩关节镜手术和骨髓间充质干细胞与富血小板血浆辅助治疗,对照组80名患者只予以肩关节镜手术治疗。所有病人术后采用相同康复方案并随访1年,通过MRI扫描确认肌腱修复后的愈合情况,采用视觉模拟量表(VAS)、肩关节活动范围(ROM)以及美国加州洛杉矶大学(UCLA)功能评分标准对疼痛和肩关节功能进行评估。结果 两组患者术后平均VAS评分均显著改善,然而在最后随访中,两组之间没有显著差异(P=0.747)。与术前测量结果相比,两组患者在最后一次随访中的前屈、外展和体侧外旋均显著改善(均P<0.05)。但在最后随访中两组患者均未观察到显著差异(P=0.898、0.524、0.057)。术后两组UCLA评分均显著提升(均P<0.05),但在最终随访时各组间无显著差异(P=0.829)。通过磁共振成像检测,1年随访中,实验组80例患者中有66例(80%)发现了完整的肩袖,而对照组80例患者中只有48例(60%)发现完整肩袖(P<0.05),且试验组磁共振评分优于对照组(P<0.05)。结论 本实验可以观察到,MRI显示与单纯手术治疗相比,增加骨髓间充质干细胞与富血小板血浆进行辅助治疗显著改善了肩袖损伤修复术后愈合结果,减少再撕裂率。使用标准的结果测量方法显示术后临床差异不明显。

    Abstract:

    Objective Evaluation of the effects of bone marrow mesenchymal stem cells (BMSCs) versus platelet-rich plasma (PRP) on healing after rotator cuff injury . Methods From September 2019 to October 2021, 160 patients in the two groups underwent arthroscopic rotator cuff repair. 80 patients in the experimental group were treated with shoulder arthroscopy and adjuvant treatment of bone marrow mesenchymal stem cells and platelet rich plasma, while 80 patients in the control group were only treated with shoulder arthroscopy.All patients were treated with the same rehabilitation program and followed up for 1 year. The healing of tendon repair was confirmed by MRI scan. The pain and shoulder function were evaluated by visual analogue scale (VAS), shoulder range of motion (ROM) and UCLA functional scoring standard. Results The mean VAS score of the two groups improved significantly, but there was no significant difference between the two groups in the final follow-up (P = 0.747). Compared with the preoperative measurement results, the flexion, abduction and lateral external rotation of the two groups were significantly improved in the last follow-up (all P < 0.05). However, no significant difference was observed between the two groups in the final follow-up (P = 0.898, 0.524, 0.057). The UCLA scores of the two groups were significantly improved after operation (all P < 0.05), but there was no significant difference between the two groups at the final follow-up (P = 0.829).Through magnetic resonance imaging, during one-year follow-up, 66 (80%) of 80 patients in the experimental group found complete rotator cuff, while only 48 (60%) of 80 patients in the control group found complete rotator cuff (P < 0.05), and the magnetic resonance score of the experimental group was better than that of the control group (P < 0.05). Conclusions This experiment can be observed that MRI shows that compared with simple surgical treatment, increasing bone marrow mesenchymal stem cells and platelet rich plasma for adjuvant treatment significantly improves the healing results after rotator cuff injury repair and reduces the rate of re tear. The standard outcome measurement method showed that the postoperative clinical difference was not significant.

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  • 收稿日期:2022-06-29
  • 最后修改日期:2022-09-20
  • 录用日期:2022-12-08
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