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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2021, Vol. 09 ›› Issue (03) : 208 -211. doi: 10.3877/cma.j.issn.2095-5790.2021.03.004

论著

巨大肩袖撕裂同种异体脱细胞真皮补片修补的早中期疗效
王文1, 王敏1,†(), 秦胜男1, 梁绍华1, 陈亮1   
  1. 1. 510220　广州市红十字会医院骨科
  • 收稿日期:2021-01-15 出版日期:2021-09-13
  • 通信作者: 王敏
  • 基金资助:
    广州市科技创新委员会民生重大专项(201704020145); 广州市中医药和中西医结合项目(20202A011011); 广州市卫生健康委员会科技项目西医类一般引导(20211A011021)

Early- and medium-term curative effect of allogeneic acellular dermal patch repair for massive rotator cuff tears

Wen Wang1, Min Wang1,†(), Shengnan Qin1, Shaohua Liang1, Liang Chen1   

  1. 1. Department of Orthopaedics, Guangzhou Red Cross Hospital, Guangzhou 510220, China
  • Received:2021-01-15 Published:2021-09-13
  • Corresponding author: Min Wang
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引用本文：

王文, 王敏, 秦胜男, 梁绍华, 陈亮. 巨大肩袖撕裂同种异体脱细胞真皮补片修补的早中期疗效[J]. 中华肩肘外科电子杂志, 2021, 09(03): 208-211.

Wen Wang, Min Wang, Shengnan Qin, Shaohua Liang, Liang Chen. Early- and medium-term curative effect of allogeneic acellular dermal patch repair for massive rotator cuff tears[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2021, 09(03): 208-211.

目的

分析巨大肩袖撕裂同种异体脱细胞真皮补片修补的早中期疗效。

方法

回顾性分析我院2019年7月至2020年6月收治的12例巨大肩袖撕裂患者的临床资料，均接受同种异体脱细胞真皮补片修补且术后均随访3个月，对其早中期疗效进行分析。

结果

术后3个月12例患者肩关节活动度（肩前屈上举、肩外展上抬、外旋中、外旋外、肩后伸）、肩关节功能评分、生活质量评分（生理、心理、社会关系、环境）均较术前明显升高，疼痛评分均较术前明显降低，差异均有统计学意义（P<0.05）；随访3个月，无感染病例发生，并发症发生率0.00%。

结论

同种异体脱细胞真皮补片修补治疗巨大肩袖撕裂早中期疗效确切，安全性高，值得在今后治疗工作中推广使用。

关键词: 巨大肩袖撕裂, 同种异体脱细胞真皮补片修补, 早中期疗效
Background

Rotator cuff tear is a common type of injury in the current clinical practice. Over 90% of the patients are caused by chronic injuries. Massive rotator cuff tear is a type which exceeds 5 cm or is accompanied by the rupture of at least 2 tendons, and how to deal with this type of injury has become an intractable problem in clinical practice. These patients are generally accompanied by rotator cuff retraction, adhesion, tendon rupture, irregular stump, and poor blood supply, which impairs the tendon-bone healing. The biological environment and tendon blood supply factors make the clinical effect insufficient. Allogeneic acellular dermal patch repair is a patch repair technology which has emerged in recent years and achieved remarkable results in the treatment of giant umbilical bulge, but there are few clinical studies involving massive rotator cuff tear repair.

Objective

To analyze the early- and medium-term curative effect of allogeneic acellular dermal patch repair for massive rotator cuff tears.

Methods

From July 2019 to June 2020, 12 patients with massive rotator cuff tears received allogeneic acellular dermal patch repair in our hospital, and were followed up for 3 months. The clinical data were retrospectively analyzed.

Results

Three months after operation, the range of shoulder motion (forward lifting, abduction, external rotation and backward extension) , shoulder function score, and quality of life score (physiology , psychology, social relations and environment) of 12 patients were significantly higher than those before operation, and the VAS score was significantly lower than that before operation. There were statistical differences (P<0.05) . After 3 months follow-up, there was no infection cases occurred, and the complication rate was 0.00%.

Conclusion

Allogeneic acellular dermal patch repair has a definite early- and medium-term curative effect with high safety in the treatment of massive rotator cuff tears. It is worthy of promotion for future treatment.

Key words: Massive rotator cuff tear, Allogeneic acellular dermal patch repair, Early-and medium-term curative efficacy
图1 关节镜下肩袖撕裂
图2 于撕裂前侧及后侧分别置入带线锚钉
图3 同种异体脱细胞真皮补片修补
表1 手术前、后巨大肩袖撕裂患者肩关节活动度比较（°，±s）
时间 例数 肩前屈上举 肩外展上抬 外旋中 外旋外 肩后伸
术前 12 80.83±2.32 79.58±2.29 62.92±2.12 90.00±0.00 49.58±3.76
术后 12 145.85±4.33a 152.67±5.29a 161.44±5.56a 122.45±3.59a 82.38±4.32a
表2 手术前、后巨大肩袖撕裂患者肩关节功能评分、疼痛评分比较（分，±s）
时间 例数 肩关节功能评分 疼痛评分
术前 12 7.85±1.25 6.74±1.33
术后 12 24.02±1.59a 2.12±1.01a
表3 手术前、后巨大肩袖撕裂患者生活质量评分比较（分，±s）
时间 例数 生理 心理 社会关系 环境
术前 12 11.32±1.38 10.59±1.41 4.32±1.02 15.77±1.53
术后 12 24.89±1.51a 22.12±1.02a 10.20±1.00a 28.77±1.34a
图4 患者，男性，74岁，术前X线提示巨大肩袖撕裂，肌腱损伤3条，肌腱回缩粘连脂肪化严重（图A）；术后1周复查X线，提示撕裂处消失，修补效果良好（图B）；术后3个月复查X线，提示撕裂部位彻底愈合（图C）
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