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可吸收生物诱导性牛胶原蛋白植入物可安全治疗全层肩袖撕裂:一项前瞻性多中心注册研究的一年结果

Full-Thickness Rotator Cuff Tears Can Be Safely Treated With a Resorbable Bioinductive Bovine Collagen Implant: One-Year Results of a Prospective, Multicenter Registry.

作者信息

McIntyre Louis F, McMillan Sean, Trenhaile Scott W, Bishai Shariff K, Bushnell Brandon D

机构信息

Orthopedic Partners, Nashville, Tennessee, United States.

Virtua Medical Center, Burlington, New Jersey, United States.

出版信息

Arthrosc Sports Med Rehabil. 2021 Aug 20;3(5):e1473-e1479. doi: 10.1016/j.asmr.2021.07.009. eCollection 2021 Oct.

Abstract

PURPOSE

The purpose of this study was to prospectively collect safety and efficacy data in a large group of patients undergoing arthroscopic repair of full-thickness rotator cuff tears augmented with a resorbable bioinductive bovine collagen implant designed to promote healing.

METHODS

Seventeen centers across the United States enrolled patients in an institutional review board-approved registry to collect outcomes data on the implant. Patients undergoing surgical management of full-thickness rotator cuff tears augmented with the implant were enrolled. Inclusion criteria were age of ≥21 years, willingness to participate and the ability to read and speak English. Exclusion criteria included hypersensitivity to bovine-derived products. Patients were assessed before and after surgery at up to 1 year with outcomes including the single-assessment numeric evaluation (SANE), Veterans RAND 12-Item (VR-12) mental components and physical components (VR-12 PCS), American Shoulder and Elbow Surgeons (ASES), and Western Ontario Rotator Cuff (WORC) outcome measures. Ad hoc analyses were performed to compare these outcomes at all time points depending on tear size (small/medium vs large/massive). Serious complications were collected.

RESULTS

Of 210 patients enrolled, 192 had 1-year follow-up data available. The patients experienced statistically significant improvement between baseline and 1 year for mean SANE, VR-12 PCS, ASES, and WORC scores (40.0-82.0, 33.5-47.3, 46.2-87.8, and 36.2-81.0, respectively;  < .001 for all results). Ad-hoc analysis demonstrated that similar results were obtained at 1 year regardless of tear size. Twenty patients (10.4%) experienced serious complications (10.4%), including revision surgery (n = 18), proximal humerus fracture/partial subscapularis tear resulting from multiple falls (n = 1), and adhesive capsulitis (n = 1).

CONCLUSIONS

The safety and efficacy of a bioinductive implant in the surgical management of full-thickness rotator cuff tears at 1 year was shown in this study. Implant efficacy appears to be comparable regardless of the underlying tear size.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

本研究的目的是前瞻性收集一大组接受关节镜修复全层肩袖撕裂并使用旨在促进愈合的可吸收生物诱导牛胶原蛋白植入物的患者的安全性和有效性数据。

方法

美国17个中心将患者纳入机构审查委员会批准的登记处,以收集有关该植入物的结果数据。纳入接受使用该植入物增强全层肩袖撕裂手术治疗的患者。纳入标准为年龄≥21岁、愿意参与且具备英语读写和口语能力。排除标准包括对牛源性产品过敏。在术前和术后长达1年的时间里对患者进行评估,结果包括单评估数字评价(SANE)、退伍军人兰德12项(VR-12)心理成分和身体成分(VR-12 PCS)、美国肩肘外科医师学会(ASES)以及西安大略肩袖(WORC)结局指标。根据撕裂大小(小/中与大/巨大)在所有时间点进行临时分析以比较这些结果。收集严重并发症情况。

结果

在纳入的210例患者中,192例有1年的随访数据。患者在基线和1年时的平均SANE、VR-12 PCS、ASES和WORC评分有统计学意义的改善(分别为40.0 - 82.0、33.5 - 47.3、46.2 - 87.8和36.2 - 81.0;所有结果P <.001)。临时分析表明,无论撕裂大小,1年时均获得相似结果。20例患者(10.4%)出现严重并发症(10.4%),包括翻修手术(n = 18)、多次跌倒导致的肱骨近端骨折/肩胛下肌部分撕裂(n = 1)以及粘连性关节囊炎(n = 1)。

结论

本研究显示了生物诱导植入物在全层肩袖撕裂手术治疗中1年时的安全性和有效性。无论潜在的撕裂大小如何,植入物的有效性似乎相当。

证据级别

IV级,治疗性病例系列。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d727/8527318/737480ab9b75/gr1.jpg

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