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生物诱导性胶原蛋白植入物治疗滑囊侧部分厚度肩袖撕裂的临床结果

The Clinical Outcomes of a Bioinductive Collagen Implant in Bursal-Sided Partial-Thickness Rotator Cuff Tears.

作者信息

Yoo Jaesung, Lee Daehee

机构信息

Department of Orthopaedic Surgery, WELIVE Hoispital, Asan 31465, Republic of Korea.

Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan 31116, Republic of Korea.

出版信息

Medicina (Kaunas). 2025 May 27;61(6):988. doi: 10.3390/medicina61060988.

Abstract

: Many middle-aged and older individuals experience shoulder pain, often due to partial-thickness rotator cuff tears (PTRCTs). If conservative treatment fails to relieve symptoms in a patient, surgical intervention may be necessary. In such cases, using a bioinductive collagen implant may offer a viable alternative to conventional rotator cuff repair. Most notably, it offers potential advantages, particularly in reducing postoperative pain and promoting faster recovery. Accordingly, this study aims to evaluate the clinical outcomes of treating bursal-sided partial-thickness rotator cuff tears using bioinductive collagen implants alone, without concurrent rotator cuff repair. : We followed 32 patients who had bursal-sided partial-thickness rotator cuff tears (Ellman grade I or II) and received conservative care for more than six months but continued to experience symptoms. These patients received surgery using bioinductive collagen implants without rotator cuff repair, and we followed up on their postoperative prognosis for at least one year after surgery. For a more accurate contrast, we performed clinical evaluation preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Western Ontario Rotator Cuff (WORC) score were used as assessment tools in this study. As for radiological outcomes, magnetic resonance imaging (MRI) and ultrasonography were helpful. This supported our assessment of graft integration and failure. : These 32 patients included 13 with Ellman grade I tear and 19 with grade II tear. In both cases, they underwent surgery only using bioinductive collagen implants, and any anchor-based cuff repair was completely excluded. As for VAS (3.8 ± 2.9), certain statistically significant improvements were found starting at 2 weeks postoperatively. On the other hand, the scores of ASES (58.6 ± 20.3), SANE (60.1 ± 23.2), and WORC (59.8 ± 22.4) began to indicate a significant improvement starting at 6 weeks postoperatively ( < 0.001), showing continuous progress. At each final step, we confirmed that there were no cases of graft failure by radiological evaluation and found successful healing indicators, such as much less pain in all patients. : The findings of this study provide the clinical evidence that a surgery using bioinductive collagen implant for bursal-sided partial-thickness rotator cuff tears is a highly effective treatment option in patients unresponsive to conservative therapy. Particularly, its practical clinical effectiveness includes facilitating rapid recovery without a significant risk of complications.

摘要

许多中老年人会经历肩部疼痛,这通常是由于肩袖部分厚度撕裂(PTRCTs)所致。如果保守治疗未能缓解患者的症状,则可能需要进行手术干预。在这种情况下,使用生物诱导性胶原蛋白植入物可能是传统肩袖修复的一种可行替代方案。最值得注意的是,它具有潜在优势,特别是在减轻术后疼痛和促进更快恢复方面。因此,本研究旨在评估单独使用生物诱导性胶原蛋白植入物治疗滑囊侧肩袖部分厚度撕裂的临床效果,而不同时进行肩袖修复。

我们对32例患有滑囊侧肩袖部分厚度撕裂(埃尔曼I级或II级)且接受了超过六个月保守治疗但仍有症状的患者进行了随访。这些患者接受了使用生物诱导性胶原蛋白植入物的手术,未进行肩袖修复,并且我们在术后至少随访了他们一年的预后情况。为了进行更准确的对比,我们在术前以及术后2周、6周、3个月、6个月和12个月进行了临床评估。本研究使用视觉模拟量表(VAS)、美国肩肘外科医师学会(ASES)评分、单项评估数字评定法(SANE)和西安大略肩袖(WORC)评分作为评估工具。至于影像学结果,磁共振成像(MRI)和超声检查很有帮助。这支持了我们对移植物整合和失败情况的评估。

这32例患者中,有13例为埃尔曼I级撕裂,19例为II级撕裂。在这两种情况下,他们仅接受了使用生物诱导性胶原蛋白植入物的手术,完全排除了任何基于锚钉的肩袖修复。至于VAS(3.8±2.9),术后2周开始发现有一定的统计学显著改善。另一方面,ASES(58.6±20.3)、SANE(60.1±23.2)和WORC(59.8±22.4)的评分从术后6周开始显示出显著改善(<0.001),且呈持续进展。在每个最终阶段,我们通过影像学评估确认没有移植物失败的病例,并发现了成功愈合的指标,比如所有患者的疼痛都大幅减轻。

本研究结果提供了临床证据,即对于对保守治疗无反应的患者,使用生物诱导性胶原蛋白植入物治疗滑囊侧肩袖部分厚度撕裂是一种非常有效的治疗选择。特别是,其实际临床效果包括促进快速恢复且无显著并发症风险。

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