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摘要：
目的 观察超声引导下富血小板血浆（platelet‑rich plasma, PRP）精准注射联合手法松解（manipulation release, MR）治疗冻结肩的临床效果及安全性。 方法 选取冻结肩患者63例，按随机数字表法分为两组：手法松解联合PRP注射组（MR‑PRP组，31例），臂丛麻醉行肩关节MR后，超声引导下肩关节周围及关节腔注射PRP；手法松解组（MR组，32例），臂丛麻醉行肩关节MR后，不进行肩关节药物注射治疗。记录治疗前和治疗后1周、1个月及3个月时的数字分级评分法（Numerical Rating Scale, NRS）评分、肩关节主动活动范围（active range of motion, AROM）和肩关节评分量表（Constant‐Murley Score, CMS）评分。记录治疗后各个时间点非甾体抗炎药使用量和恢复满意度，同时记录治疗相关的并发症和不良反应发生情况。 结果 两组患者一般资料和治疗前NRS评分、治疗前肩关节AROM及治疗前CMS评分比较，差异均无统计学意义（P>0.05）。与治疗前比较，两组患者治疗后各时间点NRS评分均降低（P<0.05），肩关节AROM及CMS评分均升高（P<0.05）。与MR组比较，MR‑PRP组患者治疗后1个月和3个月时NRS评分降低（P<0.05），肩关节AROM和CMS评分均升高（P<0.05）。MR‑PRP组患者治疗后1个月和3个月时非甾体抗炎药使用量低于MR组（P<0.05），恢复满意度高于MR组（P<0.05）；两组均无不良反应和并发症发生。 结论 超声引导PRP精准注射联合MR对于冻结肩的治疗效果优于单独MR治疗，且安全性较高。
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Abstract: Objective To observe the effectiveness and safety of ultrasound‐guided platelet‐rich plasma (PRP) precision injection combined with manipulation release (MR) for the treatment of patients with frozen shoulder. Methods A total of 63 patients who were diagnosed with frozen shoulder were selected. According to the random number table method, they were divided into two groups: a MR‑PRP group (n=31), where the patients underwent MR at the shoulder joint with brachial plexus block, followed by ultrasound‐guided injection of PRP around the shoulder joint and in the joint cavity; and a MR group (n=32), where the patients underwent MR at the shoulder joint with brachial plexus block, without injection treatment. The Numerical Rating Scale (NRS) scores, the active range of motion (AROM) of the shoulder joint, and the Constant‐Murley Score (CMS) were recorded before treatment, and at postoperative 1 week, 1 month, and 3 months. The consumption of nonsteroidal anti‑inflammatory drugs (NSAIDs) and post‑recovery satisfaction were recorded at each time points after treatment. Meanwhile, complications and adverse reactions were observed. Results There was no statistical difference in general information, NRS before treatment, AROM in the shoulder joint before treatment, and CMS before treatment (P>0.05). Compared with those before treatment, both groups presented decreases in NRS (P<0.05), and increases in AROM in the shoulder joint and CMS at each time points after treatment (P<0.05). Compared with the MR group, the MR‑PRP group showed decreases in NRS scores (P<0.05), and increases in AROM and CMS at postoperative 1 month and 3 months (P<0.05). At postoperative 1 month and 3 months, the MR‑PRP group showed lower dosages of NSAIDs (P<0.05), and higher post‑recovery satisfaction than the MR group (P<0.05). There were no serious adverse reaction and complications. Conclusions Ultrasound‐guided precision injection of PRP combined with MR has better effectiveness and safety than MR alone during the treatment of frozen shoulder.
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