불응성 주관절 외상과염에 대한 혈소판 풍부 혈장 주입 치료의 임상적 결과

국문 초록 (Abstract)

목적: 주관절 외상과염은 주관절 동통을 유발하는 대표적인 질환 중 하나로 이에 대한 치료 방법은 여러 문헌에서 보고 된 바 있다. 본원에서는 외상과염에 대한 혈소판 풍부 혈장 (Platelet-Rich-Plsma) 주입 치료를 시행한 후 그 임상적 결과를 평가해 보고자 하였다.
대상 및 방법: 2009년 1월부터 2009년 12월까지 본원에서 외상과염으로 진단받은 환자 15명 (남자 5명, 여자 10명)을 대상으로 하였으며, 평균 연령은 43.5세 였다. 모든 환자는 타 병원에서 1년 이상의 물리치료, 약물치료 등의 보존적 치료를 시행 받았으나, 증상호전을 보이지 않아 수술적 치료를 고려하는 환자였다. 대상 환자는 주관절 외상과에 경피적 혈소판 풍부 혈장 농축액 3cc를 1회 주입하였으며, 치료효과의 판정은 휴식 시와 작업 시의 visual analogue scale (VAS), The Patient-Rated Tennis Elbow Evaluation (PRTEE)를 시술 후 4, 12주 후 측정하고 치료 전후를 비교평가 하였다.
결과: 치료 4주, 12주 단기 추시에서 휴식시 통증의 VAS 평균 값은 치료 전 4.6에서 치료 4주째 2.5 12주째 1.8로 개선 되었고, 작업시 통증의 경우 치료 전 7.8에서 치료 4주째 6.2 치료 12주째 4.25로 개선 되었다. PRTEE score 평균 값은 치료 전 60.13에서 치료 4주째 46.12, 12주째 24.6으로 개선 되었다.
결론: 보존적 치료에 반응을 보이지 않는 불응성 주관절 외상과염의 치료에 있어 혈소판 풍부 혈장 주입을 이용한 치료는 효과적인 치료법이며, 수술적 치료를 시행 전 고려 되어야 한다고 사료된다.

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate clinical results of a single percutaneous injection of platelet-rich plasma in patients with refractory lateral epicondylitis.
Materials and Methods: Between Jan and Dec 2009, fifteen patients (5 male, 10 female) received a diagnosis of lateral epicondylitis of the elbow and were evaluated in this study. Their average age was 43.5 years. All patients were initially given a variety of non-surgical treatments for more than 1year. All patients were considering surgery. These patients were given a single percutaneous injection of 3cc of platelet-rich plasma. To assess pain, we used a visual analogue scale (VAS) at rest and during work & the Patient-Rated Tennis Elbow Evaluation (PRTEE) score. We compared the score before treatment with scores 4 and 12 weeks after treatment.
Results: Average VAS scores at rest improved from 4.6 before treatment to 2.5 at week 4, and 1.8 at week 12. The average VAS score while working also improved from 7.8 before treatment to 6.2 at week 4, and 4.25 at week 12. The average PRTEE score improved from 60.13 before treatment to 46.12 at week 4 and 24.6 at week 12.
Conclusion: Treatment using a single percutaneous injection of platelet-rich plasma in patients with refractory lateral epicondylitis appears to be an effective treatment modality. Platelet-rich plasma should be considered before surgical intervention.

목차 (Table of Contents)

• 서론
• 대상 및 연구방법
• 결과
• 고찰
• 결론
• REFERENCES
• 초록

참고문헌 (Reference)

1 Runge F, "Zur Genese und Behandlung des Schreibekrampfes: Ber Klin Wchnschr, 10: 245-248, 1873. Cited from Boyd HB, Mcleod AC Jr: Tennis elbow" 55 : 1183-1187, 1873

2 Fillon PL, "Treatment of lateral epicondylitis" 45 : 340-343, 1991

3 Mishra A, "Treatment of chronic elbow tendinosis with buffered platelet-rich plasma" 34 : 1774-1778, 2006

4 Nagy L, "The treatment of therapy-resistant lateral epicondylitis" 3 : 76-80, 1997

5 Gellman H, "Tennis elbow: Lateral epicondylitis" 23 : 75-82, 1992

6 Gunn CC, "Tennis elbow. The surgical treatment of lateral epicondylitis" 62 : 313-314, 1980

7 Rockwood CA, "Tennis elbow" 53 : 430-436, 1960

8 Nirschl RP, "Tennis elbow" 4 : 787-, 1973

9 Marx R, "Platelet-rich plasma: growth factor enhancement for bone grafts" 85 : 638-646, 1998

10 Kon E, "Platelet-rich plasma: New clinical application;Apilot study for treatment of jumper’ knee" 40 : 598-603, 2009

11 Randelli PS, "Maffulli N: Autologous platelet rich plasma fot arthroscopic rotator cuff repair; A pilot study" 30 : 1584-1589, 2008

12 Nirschl RP, "Lateral and medial epicondylitis. In : Master techniques in Orthopedic Surgery. The Elbow" Raven Press 129-148, 1994

13 Labelle H, "Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis" 74 : 646-651, 1992

14 Coonard RW, "It’ course, natural history, conservative and surgical management" 55 : 1177-1182, 1973

15 Slater M, "Involvement of platelets in stimulating osteogenic activity" 13 : 655-663, 1995

16 Barrett S, "Growth factors for chronic plantar fascitis" 17 : 37-42, 2004

17 Klein M, "Flexor tendon healing in vitro: effects of TGF-b on tendon cell collagen production" 27 : 615-620, 2002

18 Melikyan E, "Extracorporeal shockwave treatment for tennis elbow: a randomized double-blind study" 85 : 852-855, 2003

19 Smidt N, "Effectiveness of physiotherapy for lateral epicondylitis: a systematic review" 35 : 51-62, 2003

20 Orrego M, "Effect if platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel" 24 : 1373-1380, 2008

21 Geoffroy P, "Diagnosing and treating lateral epicondylitis" 40 : 73-78, 1994

22 Kraushaar BS, "Current concepts review, Tendinosis of the elbow" 81 : 256-278, 1999

23 Sanchez M, "Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices" 35 : 245-251, 2007

24 Jobe F, "Ciccotti M: Lateral and medial epicondylitis of the elbow" 2 : 1-8, 1994

25 Edwards S, "Autologous blood injections for refractory lateral epicondylitis" 28 : 272-278, 2003

26 Ferrari M, "A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery" 10 : 47-50, 1987

27 Kamien M, "A Rational management of tennis elbow" 9 : 173-191, 1990