Outcomes of prolotherapy for intra-tendinous Achilles tears: a case series.

Outcomes of prolotherapy for intra-tendinous Achilles tears: a case series.
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跟腱内撕裂增殖疗法的结果：病例系列。

DOI：
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发表时间：
2017
期刊：
Muscles Ligaments and Tendons Journal
影响因子：
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通讯作者：
D. Morrissey
D. Morrissey
中科院分区：
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文献类型：
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作者：
O. Chan;Ben Havard;S. Morton;M. Pritchard;N. Maffulli;T. Crisp;N. Padhiar;Jeremy David Perry;J. King;D. Morrissey

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背景 肌腱内撕裂是一种新的病理学，其定义为完全位于肌腱内的纤维不连续。增生疗法包括注射刺激物，如高渗葡萄糖，以刺激组织愈合反应，并最终减轻疼痛。 方法 纳入了43例诊断为肌腱内撕裂的连续患者（27例男性：16例女性，平均（SD）年龄41（11.3）岁）。患者注射50%葡萄糖和0.5%苦参碱以1：1的比例混合0.4ml-1.5ml（平均0.8ml）。4-6周的步行靴子固定期后进行渐进性康复（6-8周）。在基线、治疗后3个月和平均12.6（7.0）个月时使用VISA-A问卷评估结局。在治疗前和5.2（2.3）周后进行超声扫描，以评估超声变化。 结果 30名患者（70%）的VISA-A评分在3个月后增加了31（30.5）分（f=0.62，p<0.05），在12.60（7.0）个月后增加了40（29.3）分（f=0.87，p<0.05）。5.2（2.3）周后，回声显著降低（p<0.05），27%的撕裂不再可检测。在撕裂尺寸、肌腱厚度或新生血管形成方面，未观察到剩余撕裂的显著差异。 结论 治疗导致临床显著改善，需要进行对照试验。 证据等级 四.
BACKGROUND The intra-tendinous tear is a new pathology that is defined as a discontinuity of fibres situated entirely within the tendon. Prolotherapy involves injecting an irritant, such as hyperosmolar dextrose, to stimulate a tissue healing response and ultimately reduce pain. METHODS 43 consecutive patients diagnosed with an intra-tendinous tear were included (27 males: 16 females, mean (SD) age 41 (11.3). Patients were injected with 0.4ml-1.5ml (mean 0.8ml) of 50% dextrose and 0.5% marcaine mixed in a 1:1 ratio. A 4-6 week period of walking boot immobilisation was followed by progressive rehabilitation (6-8 weeks). Outcomes were assessed with a VISA-A questionnaire at baseline, 3 months and a mean 12.6 (7.0) months post-treatment. Ultrasound scans were conducted before treatment and 5.2 (2.3) weeks later to assess sonographic changes. RESULTS 30 patients (70%) responded with VISA-A scores increasing by 31 (30.5) points after 3 months (f=0.62, p<0.05) and by 40 (29.3) points after 12.60 (7.0) months (f=0.87, p<0.05). After 5.2 (2.3) weeks, echogenicity was significantly reduced (p<0.05) and 27% of tears were no longer detectable. No significant differences were observed in remaining tears with respect to tear size, tendon thickness or neovascularisation. CONCLUSION Treatment resulted in clinically significant improvements and controlled trials are warranted. LEVEL OF EVIDENCE IV.