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Objective To study the clinical efficacy of platelet-rich plasma (PRP) in the treatment of acute Achilles tendon rupture.Methods A retrospective study was performed of the 21 patients who had been treated for acute Achilles tendon rupture at Department of Orthopaedics,The First Affiliated Hospital to Soochow University from January 2018 to January 2019.Of them,15 were treated by modified Kessler suture combined with PRP injection (PRP group) and 6 by simple modified Kessler suture (control group).The 2 groups were compared in terms of plantar flexion,dorsal expansion,visual analogue scale (VAS),Victorian Institute of Sport Assessment (VISA),and ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) at 3,6,and 9 months postoperation.Results The 2 groups were comparable due to insignificant differences between them in the preoperative general data (P ＞ 0.05).All patients were followed up for 9 to 12 months (mean,11.3 months).At 3,6,and 9 months postoperation,the degrees of plantar flexion (33.5°±1.8°,38.1°±1.2°and41.6°±1.6°) and dorsal expansion (10.3°,16.5°and 21.5°) in the PRP group were all significantly larger than those in the control group (26.9°± 2.0°,31.5°±1.6°and35.6°±1.4°;5.3°,12.7°±0.6°and 18.2°),and the VISA scores (41.2±6.5,78.7±10.4 and 91.0 ± 4.1) and the AOFAS scores (75.5 ± 5.4,88.6 ± 5.2 and 95.2 ± 3.5) in the PRP group were all significantly higher than those in the control group (29.8 ±2.5,68.0 ±3.5 and 84.5 ±2.1;66.8 ±4.8,82.8 ±3.6 and 90.7 ± 1.1) (all P ＜ 0.05).At 3 and 6 months postoperation,the VAS scores in the PRP group (1.7 ± 0.9 and 1.3 ±0.4) were significantly lower than those in the control group (3.0±0.8 and 2.2 ± 0.7) (all P ＜ 0.05).Conclusion As PRP can release a high concentration of growth factors to promote recovery of Achilles tendon rupture and accelerate recovery of foot and ankle function,it can be considered a safe,practical and reliable treatment to use modified Kessler suture plus PRP injection.
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Objective To investigate the effects of continuous stellate ganglion block (SGB) on serum thyroid hormone and cortisol levels in patients with severe brain injury.Methods Eighty ASA Ⅱ or Ⅲ patients with severe brain injury aged 22-61 yr undergoing emergency craniotomy were randomly divided into 2 groups ( n = 40 each): control group (group C) received routine treatment only and continuous SGB group (group SGB) received continuous SGB with 0.2% ropivacaine besides routine treatment. SGB was performed on the operated side after induction of general anesthesia and tracheal intubation. An epidural catheter was placed. A bolus of 0.2% ropivacaine 7 ml was followed by continuous infusion of 0.2% ropivacaine at a rate of 2 ml/h. Continuous SGB was maintained for 48 h. Successful SGB was confirmed by increase in skin temperature by ≥1.5℃ behind earlobe on the operated side.Venous blood samples were obtained at 30 min before and 3 and 7 day after operation for determination of serum thyroid stimulating hormone (TSH), triiodothyronine (T3) ,thyroxine (T4) , reverse triiodothyronine(rT3) and cortisol concentrations. Glasgow prognosis score was used to evaluate the clinical results at 3 months after operation. Results Serum T4 , rT3 , TSH and cortisol concentrations were significantly lower while the serum T3 concentration was higher in the SGB group than in group C at 3 and 7 d after operation. The clinical results were significant better in SGB group than in group C according to Glasgow prognosis scores at 3 months after operation. Conclusion Continuous SGB can inhibit the stress response, and improve hypothalamus-pituitary-thyroid gland axis function and is helpful to patient's recovery from injury.