使用脱细胞人真皮增强移植物治疗具有挑战性的肩袖撕裂的愈合率。
Healing rates for challenging rotator cuff tears utilizing an acellular human dermal reinforcement graft.
作者信息
Agrawal Vivek
机构信息
The Shoulder Center, 12188A North Meridian Street, Suite 310 Carmel, IN 46032, USA.
出版信息
Int J Shoulder Surg. 2012 Apr;6(2):36-44. doi: 10.4103/0973-6042.96992.
PURPOSE
This study presents a retrospective case series of the clinical and structural outcomes (1.5 T MRI) of arthroscopic rotator cuff repair with acellular human dermal graft reinforcement performed by a single surgeon in patients with large, massive, and previously repaired rotator cuff tears.
MATERIALS AND METHODS
Fourteen patients with mean anterior to posterior tear size 3.87 ± 0.99 cm (median 4 cm, range 2.5-6 cm) were enrolled in the study and were evaluated for structural integrity using a high-field (1.5 T) MRI at an average of 16.8 months after surgery. The Constant-Murley scores, the Flexilevel Scale of Shoulder Function (Flex SF), scapular plane abduction, and strength were analyzed.
RESULTS
MRI results showed that the rotator cuff repair was intact in 85.7% (12/14) of the patients studied. Two patients had a Sugaya Type IV recurrent tear (2 of 14; 14.3%), which were both less than 1 cm. The Constant score increased from a preoperative mean of 49.72 (range 13-74) to a postoperative mean of 81.07 (range 45-92) (P value = 0.009). Flexilevel Scale of Shoulder Function (Flex SF) Score normalized to a 100-point scale improved from a preoperative mean of 53.69 to a postoperative mean of 79.71 (P value = 0.003). The Pain Score improved from a preoperative mean of 7.73 to a postoperative mean of 13.57 (P value = 0.008). Scapular plane abduction improved from a preoperative mean of 113.64° to a postoperative mean of 166.43° (P value = 0.010). The strength subset score improved from a preoperative mean of 1.73 kg to a postoperative mean of 7.52 kg (P value = 0.006).
CONCLUSIONS
This study presents a safe and effective technique that may help improve the healing rates of large, massive, and revision rotator cuff tears with the use of an acellular human dermal allograft. This technique demonstrated favorable structural healing rates and statistically improved functional outcomes in the near term.
LEVEL OF EVIDENCE
- Retrospective case series.
目的
本研究呈现了一组回顾性病例系列，内容为一名外科医生对患有大型、巨大型以及既往已修复的肩袖撕裂患者进行的关节镜下肩袖修复并使用脱细胞人真皮移植物加强后的临床和结构结果（1.5T磁共振成像）。
材料与方法
14例患者纳入研究，其前后向撕裂平均大小为3.87±0.99厘米（中位数4厘米，范围2.5 - 6厘米），术后平均16.8个月使用高场强（1.5T）磁共振成像评估结构完整性。分析了Constant - Murley评分、肩部功能Flexilevel量表（Flex SF）、肩胛平面外展及力量情况。
结果
磁共振成像结果显示，在研究的患者中85.7%（12/14）肩袖修复完整。2例患者出现Sugaya IV型复发性撕裂（14例中的2例；14.3%），均小于1厘米。Constant评分从术前平均49.72（范围13 - 74）提高到术后平均81.07（范围45 - 92）（P值 = 0.009）。肩部功能Flexilevel量表（Flex SF）评分换算为100分制后从术前平均53.69提高到术后平均79.71（P值 = 0.003）。疼痛评分从术前平均7.73提高到术后平均13.57（P值 = 0.008）。肩胛平面外展从术前平均(113.64^{\circ})提高到术后平均(166.43^{\circ})（P值 = 0.010）。力量亚组评分从术前平均1.73千克提高到术后平均7.52千克（P值 = 0.006）。
结论
本研究展示了一种安全有效的技术，使用脱细胞人真皮同种异体移植物可能有助于提高大型、巨大型及翻修性肩袖撕裂的愈合率。该技术在短期内显示出良好的结构愈合率且功能结果有统计学意义的改善。
证据级别
4.回顾性病例系列。
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