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首例新型注射用重组人胶原蛋白支架联合自体富血小板血浆治疗外侧肱骨上髁炎(网球肘)的临床经验。

First clinical experience with a new injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma for the treatment of lateral epicondylar tendinopathy (tennis elbow).

机构信息

Department of Orthopedic Surgery, Assuta-Ashdod University Hospital, Ashdod, Israel, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.

Department of Orthopedic Surgery, Assaf Haroffeh Medical Center, Zrifin, Israel.

出版信息

J Shoulder Elbow Surg. 2019 Mar;28(3):503-509. doi: 10.1016/j.jse.2018.09.007. Epub 2018 Nov 26.

Abstract

BACKGROUND

Lateral epicondylitis is a tendinopathy of the common extensor origin at the elbow. When traditional conservative treatment fails, more effective therapies are needed. Vergenix Soft Tissue Repair (STR) Matrix (CollPlant Ltd., Ness-Ziona, Israel) is an injectable gel composed of cross-linked bioengineered recombinant human type I collagen combined with autologous platelet-rich plasma (STR/PRP). The complex forms a collagen-fibrin matrix that promotes cell migration and tissue repair. Based on positive outcomes from preclinical trials, this study is the first clinical trial of STR/PRP on tendinopathy. We hypothesized that STR/PRP would be a safe and effective treatment for lateral epicondylar tendinopathy.

METHODS

Patients with chronic lateral epicondylitis underwent treatment with STR/PRP. Outcome assessment included grip strength, functional disability, and changes in sonographic tendon appearance for up to 6 months after treatment.

RESULTS

The study enrolled 40 patients. No systemic or local severe adverse events were reported. Clinical evaluation revealed an improvement in the mean Patient-Rated Tennis Elbow Evaluation score from 64.8 before treatment and showed a 59% reduction at 6 months. The 12-Item Short-Form Health Survey questionnaire showed improvement from a mean score of 30.7 to 37.7 at the final follow-up. Grip strength increased from 28.8 kg at baseline to 36.8 kg at 6 months. Improvements in sonographic tendon appearance were evident among 68% of patients.

CONCLUSION

STR/PRP is a safe treatment that effectively induces clinically significant improvements in elbow symptoms and general well-being as well as objective measures of strength and imaging of the common extensor tendon within 6 months of treatment of elbow tendinopathy recalcitrant to standard treatments.

摘要

背景

外侧肱骨上髁炎是肘部常见伸肌起点的腱病。当传统的保守治疗失败时,需要更有效的治疗方法。Vergenix 软组织修复(STR)基质(CollPlant Ltd.,以色列内斯-齐翁)是一种由交联的生物工程重组人 I 型胶原与自体富血小板血浆(STR/PRP)组成的可注射凝胶。该复合物形成胶原纤维基质,促进细胞迁移和组织修复。基于临床前试验的积极结果,本研究是 STR/PRP 治疗腱病的首次临床试验。我们假设 STR/PRP 将是治疗外侧肱骨上髁炎的一种安全有效的治疗方法。

方法

患有慢性外侧肱骨上髁炎的患者接受 STR/PRP 治疗。疗效评估包括握力、功能障碍以及治疗后长达 6 个月时超声肌腱外观的变化。

结果

该研究纳入了 40 名患者。未报告全身性或局部严重不良事件。临床评估显示,治疗前患者自评网球肘评估评分的平均值从 64.8 改善,6 个月时降低了 59%。12 项简短健康调查问卷显示,最终随访时平均评分从 30.7 提高到 37.7。握力从基线时的 28.8 公斤增加到 6 个月时的 36.8 公斤。68%的患者超声肌腱外观改善。

结论

STR/PRP 是一种安全的治疗方法,可有效诱导肘部症状和整体健康状况以及力量和常见伸肌肌腱影像学的客观指标在标准治疗难治性肘腱病的 6 个月内得到显著改善。

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