Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures A Randomized Single-Blind Study
Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures A Randomized Single-Blind Study
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DOI：
10.1177/0363546510383515
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发表时间：
2011-01-01
影响因子：
4.8
通讯作者：
Aspenberg, Per
中科院分区：
文献类型：
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作者：
Schepull, Thorsten;Kvist, Joanna;Aspenberg, Per
动物研究表明，局部应用富血小板血浆（PRP）可刺激肌腱修复。回顾性病例系列的初步结果显示，恢复运动的速度更快。假设：自体PRP刺激急性跟腱断裂愈合。研究设计：随机对照试验；证据等级2。方法：连续招募30例患者。在手术中，钽珠被植入断裂的跟腱近端和远端。在皮肤缝合前进行随机分组，16例患者注射10 mL PRP（血小板浓度比外周血高10倍），14例未注射。通过三维x线片（伦线立体摄影测量分析；RSA），在患者承受不同踝关节背屈力矩的第7、19和52周时测量珠子之间的距离，从而估计每次负荷的肌腱应变。弹性模量的估计是通过计算机断层扫描得出的骨痂尺寸来计算的。1年时，对功能结果进行评估，包括足跟抬高指数和跟腱总断裂评分。主要影响变量为7周时的弹性模量和1年后的跟高指数。结果：力学变量在患者之间表现出很大程度的差异，不能用测量误差来解释。各组间弹性模量无显著差异。两组足跟抬高指数无显著差异。PRP组跟腱总断裂评分较低，提示有不良影响。7周和19周时的弹性模量与52周时的跟高指数存在相关性。结论：PRP对跟腱断裂的治疗效果不理想。弹性模量的变化提供了生物学相关信息，尽管尚不清楚早期生物力学如何与晚期临床结果相关联。
Background: Animal studies have shown that local application of platelet-rich plasma (PRP) stimulates tendon repair. Preliminary results from a retrospective case series have shown faster return to sports.Hypothesis: Autologous PRP stimulates healing of acute Achilles tendon ruptures.Study Design: Randomized controlled trial; Level of evidence, 2.Methods: Thirty patients were recruited consecutively. During surgery, tantalum beads were implanted in the Achilles tendon proximal and distal to the rupture. Before skin suture, randomization was performed, and 16 patients were injected with 10 mL PRP (10 times higher platelet concentration than peripheral blood) whereas 14 were not. With 3-dimensional radiographs (roentgen stereophotogrammetric analysis; RSA), the distance between the beads was measured at 7, 19, and 52 weeks while the patient resisted different dorsal flexion moments over the ankle joint, thereby estimating tendon strain per load. An estimate of elasticity modulus was calculated using callus dimensions from computed tomography. At 1 year, functional outcome was evaluated, including the heel raise index and Achilles Tendon Total Rupture Score. The primary effect variables were elasticity modulus at 7 weeks and heel raise index at 1 year.Results: The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error. No significant group differences in elasticity modulus could be shown. There was no significant difference in heel raise index. The Achilles Tendon Total Rupture Score was lower in the PRP group, suggesting a detrimental effect. There was a correlation between the elasticity modulus at 7 and 19 weeks and the heel raise index at 52 weeks.Conclusion: The results suggest that PRP is not useful for treatment of Achilles tendon ruptures. The variation in elasticity modulus provides biologically relevant information, although it is unclear how early biomechanics is connected to late clinical results.