使用肩峰下囊、浓缩骨髓抽吸物和富血小板血浆对关节镜下肩袖修复进行生物增强后的初步临床结果
Preliminary Clinical Outcomes Following Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Subacromial Bursa, Concentrated Bone Marrow Aspirate, and Platelet-Rich Plasma.
作者信息
Muench Lukas N, Kia Cameron, Berthold Daniel P, Uyeki Colin, Otto Alexander, Cote Mark P, McCarthy Mary Beth, Beitzel Knut, Arciero Robert A, Mazzocca Augustus D
机构信息
Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A.
Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
出版信息
Arthrosc Sports Med Rehabil. 2020 Oct 5;2(6):e803-e813. doi: 10.1016/j.asmr.2020.07.019. eCollection 2020 Dec.
PURPOSE
To evaluate the clinical outcomes of patients who underwent arthroscopic rotator cuff repair augmented using subacromial bursa, concentrated bone marrow aspirate (cBMA), and platelet-rich plasma.
METHODS
Sixteen patients were included in the study who underwent arthroscopic rotator cuff repair augmented using subacromial bursa, cBMA, and platelet-rich plasma from January 2018 to July 2018 and had a minimum 1-year follow-up. American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test, Constant-Murley, and Single Assessment Numerical Evaluation (SANE) scores were collected preoperatively and at terminal follow-up. To determine the clinical relevance of ASES scores, the minimal clinically important difference, substantial clinical benefit, and the patient acceptable symptomatic state thresholds were used. In vitro cellular proliferation of subacromial bursa (nucleated cells/gram) and cBMA (nucleated cells and colony-forming units/cc) samples was evaluated and correlated to clinical outcomes scores.
RESULTS
Mean follow-up was 12.6 ± 1.8 months (range 12-19 months). Patients achieved significant improvement in ASES (45.8±22.5 vs 88.5 ± 14.6 Δ44.7 ± 20.7; = .001), Simple Shoulder Test (4.3 ± 3.2 vs 10.4 ± 1.6, Δ5.7 ± 3.9, = .002), Constant-Murley (44.3 ± 18.2 vs 83.6 ± 17.5 Δ37.2 ± 21.8; = .001), SANE (13.3 ± 10.7 vs 86.3 ± 17.5 Δ71.9 ± 22.9; = .001), and pain scores (5.0±2.8 vs 1.1 ± 1.6 Δ3.5±2.5, = .001) at final follow-up. With regards to ASES score, 93.8% of patients achieved the minimal clinically important difference, 93.8% the substantial clinical benefit, and 62.5% reached or exceeded the patient acceptable symptomatic state criteria. There was a significant positive correlation of nucleated cell count of cBMA with postoperative SANE score (r = 0.707; = .015) and delta in ASES score (r = 0.727; = .011). All other correlations were found to be nonsignificant ( > .05, respectively).
CONCLUSIONS
Patients undergoing arthroscopic rotator cuff repair augmented using the Mega-Clot with bursa technique achieved significant improvement in functional outcomes at a minimum 1-year follow-up, with 93.8% of patients reaching substantial clinical benefit.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
评估接受关节镜下肩袖修补术并使用肩峰下滑囊、浓缩骨髓抽吸物（cBMA）和富血小板血浆进行增强治疗的患者的临床疗效。
方法
纳入16例于2018年1月至2018年7月接受关节镜下肩袖修补术并使用肩峰下滑囊、cBMA和富血小板血浆进行增强治疗且至少随访1年的患者。收集术前及末次随访时的美国肩肘外科医师学会（ASES）评分、简易肩关节测试评分、Constant-Murley评分和单项评估数值评定（SANE）评分。为确定ASES评分的临床相关性，采用最小临床重要差异、显著临床获益及患者可接受症状状态阈值。评估肩峰下滑囊样本（有核细胞数/克）和cBMA样本（有核细胞数和集落形成单位/立方厘米）的体外细胞增殖情况，并将其与临床疗效评分相关联。
结果
平均随访时间为12.6±1.8个月（范围12 - 19个月）。患者在末次随访时ASES评分（45.8±22.5对88.5±14.6，差值44.7±20.7；P = .001）、简易肩关节测试评分（4.3±3.2对10.4±1.6，差值5.7±3.9，P = .002）、Constant-Murley评分（44.3±18.2对83.6±17.5，差值37.2±21.8；P = .001）、SANE评分（13.3±10.7对86.3±17.5，差值71.9±22.9；P = .001）及疼痛评分（5.0±2.8对1.1±1.6，差值3.5±2.5，P = .001）均有显著改善。关于ASES评分，93.8%的患者达到最小临床重要差异，93.8%的患者获得显著临床获益，62.5%的患者达到或超过患者可接受症状状态标准。cBMA的有核细胞计数与术后SANE评分（r = 0.707；P = .015）及ASES评分差值（r = 0.727；P = .011）呈显著正相关。所有其他相关性均无统计学意义（分别P > .05）。
结论
采用带囊技术的Mega-Clot进行增强的关节镜下肩袖修补术患者在至少1年的随访中功能结局有显著改善，93.8%的患者获得显著临床获益。
证据级别
IV级，治疗性病例系列。
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