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富血小板血浆注射治疗慢性中段跟腱病变不能改善肌腱功能障碍
作者:小柯机器人 发布时间:2021/7/18 14:35:17

英国牛津大学Matthew L. Costa联合华威大学Rebecca S. Kearney团队研究了富血小板血浆注射与假注射对慢性跟腱中段病变患者肌腱功能障碍的影响。2021年7月13日出版的《美国医学会杂志》发表了这项成果。

富血小板血浆注射用于治疗慢性中段跟腱病变,但这种治疗的证据有限。

为了在患有中度跟腱病变的成人中,评估单次富血小板血浆注射与假注射对维多利亚运动评估研究所跟腱(VISA-A)评分(可综合衡量跟腱病严重程度的指标)结果的影响,研究组进行了一项参与者盲、多中心、随机临床试验,2016年4月至2020年2月,来自24个机构的240人被随机分配接受富血小板血浆注射或假注射。最后的随访是在2020年7月。

这些参与者的年龄均大于18岁,中段跟腱疼痛超过3个月,且经超声、磁共振成像或两者证实。121例患者接受单次肌腱内富血小板血浆注射,119例接受单次假注射,即不进入肌腱的皮下干针插入。主要结局为治疗分配6个月后的VISA-A评分。VISA-A评分包含8个问题,涉及疼痛、功能和活动的3个领域,范围从0(最严重症状)到100分(无症状)。主要分析校正了偏侧性、年龄、性别和基线VISA-A评分。

240名患者的平均年龄为52岁,其中138例(58%)为女性,221例(92%)完成了试验。在6个月的随访中,富血小板血浆注射组的平均VISA-A评分为54.4分,假注射组为53.4分,组间差异不显著。富血小板血浆组与假注射组最常见的不良事件包括注射部位不适(分别为97例和73例)、肿胀(56例和52例)和淤青(48例和49例)。

研究结果表明,在慢性跟腱中段病变患者中,与皮下注射干针相比,单次注射富含血小板的肌腱内血浆治疗在6个月时并没有减轻跟腱功能障碍。这些发现不支持该疗法治疗慢性跟腱中段病。

附:英文原文

Title: Effect of Platelet-Rich Plasma Injection vs Sham Injection on Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy: A Randomized Clinical Trial

Author: Rebecca S. Kearney, Chen Ji, Jane Warwick, Nicholas Parsons, Jaclyn Brown, Paul Harrison, Jonathan Young, Matthew L. Costa, ATM Trial Collaborators, Kishore Dasari, Anna Chapman, Michael Carmont, Fraser Harrold, Jitendra Mangwani, David Loveday, Chris Blundell, Carolyn Chadwick, David Townshend, Kiran Putchakayala, Jagan Velpula, Simon Barnes, Sankalp Tripani, Anne-Marie Hutchison, Mike Hennessy, Evangelos Maxlous, Gillian Jackson, Ashtin Goorgakant, Caroline Lever, Joseph Alsousou, Mark Bloomfield, Andrew Williams, Andrew Bing, Sanjeev Madan, Andrew Hannah, Zain Abiddin, Adrian Hughes, Andrew Kelly, Rod Hammett, James Williams, Miriam Day, Aureola Tong, Gafin Morgan, Gavin Clague, Callum Clark, Ngwe Phyo, Shelain Patel, Naveethan Sivanadarajah, Anil Prasanna, Jasdeep Giddie, Ravindran Ranjith, Gurbinder Nandhara, Vineet Trivedi, Rajiv Limaye, Paul Hodgson, Abhijit Guha, Manoj Sivan, Rajarshi Bhattacharya, Dimitri Amiras

Issue&Volume: 2021/07/13

Abstract:

Importance  Platelet-rich plasma injections are used as a treatment for chronic midportion Achilles tendinopathy, but evidence for this treatment is limited.

Objective  In adults with midportion Achilles tendinopathy, to assess the effects of a single platelet-rich plasma injection, compared with sham injection, on the outcome of the Victorian Institute of Sport Assessment-Achilles (VISA-A) score (a single composite measure of Achilles tendinopathy severity).

Design, Setting, and Participants  A participant-blinded, multicenter randomized clinical trial that included 240 people from 24 sites assigned to either a platelet-rich plasma injection or a sham injection between April 2016 and February 2020. Final follow-up was July 2020. Participants were older than 18 years with midportion Achilles tendon pain for more than 3 months as confirmed by ultrasound, magnetic resonance imaging, or both.

Interventions  A single intratendinous platelet-rich plasma injection (n=121) or a single sham injection (insertion of a subcutaneous dry needle not entering the tendon) (n=119).

Main Outcomes and Measures  The primary outcome was the VISA-A score, measured 6 months after treatment allocation. The VISA-A score contains 8 questions that cover 3 domains of pain, function, and activity, analyzed as a composite score (range, 0 [worst symptoms] to 100 [no symptoms]; minimal clinically important difference in score, 12 points). The primary analysis was adjusted for laterality, age, sex, and baseline VISA-A score.

Results  Among 240 patients assigned to a platelet-rich plasma or sham injection (mean age, 52 years; 138 [58%] women), 221 (92%) completed the trial. At 6-month follow-up, mean VISA-A score values in the plasma-rich plasma group vs the sham injection group were 54.4 vs 53.4 (adjusted mean difference, 2.7 [95% CI, 8.8 to 3.3]). The most common adverse events compared between patients in the platelet-rich plasma group vs the sham group were injection site discomfort (97 vs 73 patients), swelling (56 vs 52 patients) and bruising (48 vs 49 patients).

Conclusions and Relevance  Among patients with chronic midportion Achilles tendinopathy, treatment with a single injection of intratendinous platelet-rich plasma, compared with insertion of a subcutaneous dry needle, did not reduce Achilles tendon dysfunction at 6 months. These findings do not support the use of this treatment for chronic midportion Achilles tendinopathy.

DOI: 10.1001/jama.2021.6986

Source: https://jamanetwork.com/journals/jama/article-abstract/2781859

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex