富血小板血浆在急性跟腱断裂治疗中的应用

目的探讨富血小板血浆(PRP)在急性跟腱断裂治疗中的应用。方法回顾性研究苏州大学附属第一医院自2018年1月至2019年1月治疗的21例跟腱断裂患者资料。根据患者是否注射PRP将21例患者分为PRP组(改良Kessler缝合法联合PRP注射治疗,15例)和对照组(单纯使用改良Kessler缝合法治疗,6例)。比较两组患者术后3、6、9个月的踝关节跖屈和背伸角度、疼痛视觉模拟评分(VAS)、Victorian运动学会评分(VISA)及美国足踝外科协会(AOFAS)的踝-后足评分。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获9~12个月(平均11.3个月)随访。PRP组术后3、6、9个月跖屈角度(33.5°±1.8°、38.1°±1.2°、41.6°±1.6°)和背伸角度(10.3°、16.5°、21.5°)大于对照组[(26.9°±2.0°、31.5°±1.6°、35.6°±1.4°)和(5.3°、12.7°、18.2°)],PRP组术后3、6、9个月VISA评分[(41.2±6.5)、(78.7±10.4)、(91.0±4.1)分]和AOFAS的踝-后足评分[(75.5±5.4)、(88.6±5.2)、(95.2±3.5)分]高于对照组[(29.8±2.5)、(68.0±3.5)、(84.5±2.1)分和(66.8±4.8)、(82.8±3.6)、(90.7±1.1)分],PRP组术后3、6个月VAS评分[(1.7±0.9)、(1.3±0.4)分]低于对照组[(3.0±0.8)、(2.2±0.7)分],差异均有统计学意义(P<0.05)。结论PRP可以加速患者足及踝关节功能恢复,可以认为使用改良Kessler缝合法联合PRP是一种安全、实用、可靠的治疗方法。

Platelet-rich plasma and acute Achilles tendon rupture

Objective To study the clinical efficacy of platelet-rich plasma(PRP)in the treatment of acute Achilles tendon rupture.Methods A retrospective study was performed of the 21 patients who had been treated for acute Achilles tendon rupture at Department of Orthopaedics,The First Affiliated Hospital to Soochow University from January 2018 to January 2019.Of them,15 were treated by modified Kessler suture combined with PRP injection(PRP group)and 6 by simple modified Kessler suture(control group).The 2 groups were compared in terms of plantar flexion,dorsal expansion,visual analogue scale(VAS),Victorian Institute of Sport Assessment(VISA),and ankle-hindfoot score of American Orthopaedic Foot and Ankle Society(AOFAS)at 3,6,and 9 months postoperation.Results The 2 groups were comparable due to insignificant differences between them in the preoperative general data(P>0.05).All patients were followed up for 9 to 12 months(mean,11.3 months).At 3,6,and 9 months postoperation,the degrees of plantar flexion(33.5°±1.8°,38.1°±1.2°and 41.6°±1.6°)and dorsal expansion(10.3°,16.5°and 21.5°)in the PRP group were all significantly larger than those in the control group(26.9°±2.0°,31.5°±1.6°and 35.6°±1.4°;5.3°,12.7°±0.6°and 18.2°),and the VISA scores(41.2±6.5,78.7±10.4 and 91.0±4.1)and the AOFAS scores(75.5±5.4,88.6±5.2 and 95.2±3.5)in the PRP group were all significantly higher than those in the control group(29.8±2.5,68.0±3.5 and 84.5±2.1;66.8±4.8,82.8±3.6 and 90.7±1.1)(all P<0.05).At 3 and 6 months postoperation,the VAS scores in the PRP group(1.7±0.9 and 1.3±0.4)were significantly lower than those in the control group(3.0±0.8 and 2.2±0.7)(all P<0.05).Conclusion As PRP can release a high concentration of growth factors to promote recovery of Achilles tendon rupture and accelerate recovery of foot and ankle function,it can be considered a safe,practical and reliable treatment to use modified Kessler suture plus PRP injection.