[1]徐 靖,于国胜.部分肩袖撕裂治疗现状[J].新乡医学院学报,2022,39(7):694-700.[doi:10.7683/xxyxyxb.2022.07.019]
 XU Jing,YU Guosheng.Current status of treatment for partial-thickness rotator cuff tear[J].Journal of Xinxiang Medical University,2022,39(7):694-700.[doi:10.7683/xxyxyxb.2022.07.019]
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部分肩袖撕裂治疗现状
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年7
页码:
694-700
栏目:
综述
出版日期:
2022-07-05

文章信息/Info

Title:
Current status of treatment for partial-thickness rotator cuff tear
作者:
徐 靖1于国胜12
(1.河北中医学院中医骨伤学教研室,河北 石家庄 050091; 2.河北中医学院附属沧州中西医结合医院运动医学科,河北 沧州 061000)
Author(s):
XU Jing1YU Guosheng12
(1.Department of Orthopaedics and Traumatology of Chinese Medicine,Hebei University of Chinese Medicine,Shijiazhuang 050091,Hebei Province,China;2.Department of Sports Medicine,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Hebei University of Chinese Medicine,Cangzhou 061000,Hebei Province,China)
关键词:
部分肩袖撕裂治疗现状关节镜下清理术肩峰成形术原位修复术
Keywords:
partial rotator cuff teartreatment statusarthroscopic debridementacromioplastyin-situ remediation technology
分类号:
R683.41
DOI:
10.7683/xxyxyxb.2022.07.019
文献标志码:
A
摘要:
部分肩袖撕裂(PTRCT)是肩部常见的疾病,随着生物医疗科技的不断进步,PTRCT的治疗方式也在不断进步,但是最佳的治疗方式尚未达成共识。保守治疗适用于所有PTRCT患者且具有良好的临床疗效,被提倡为PTRCT第一治疗方案。关节镜下清理术具有良好的临床效果,肩峰成形术需要依据肩峰形态而判断是否可行。全层修复术和原位修复术对PTRCT患者各具优缺点,但都取得了满意的临床效果。新颖的生物治疗技术如肩袖补片或支架、富血小板血浆、干细胞技术和各种生物因子近年不断被发掘,未来可能会辅助保守治疗和手术治疗取得更加良好的临床疗效。本文综述了PTRCT患者的保守治疗、手术治疗以及生物治疗方法,以期为临床治疗PTRCT提供参考。
Abstract:
Partial-thickness rotator cuff tear (PTRCT) are common diseases of the shoulder.With the continuous progress of biomedical technology,the treatment method of PTRCT is also improving,but the best treatment method has not yet reached a consensus.Conservative treatment is suitable for all PTRCT patients and has good clinical efficacy,and is advocated as the first treatment plan for PTRCT.Arthroscopic debridement has a good clinical effect,and acromioplasty is performed according to the shape of the acromion.Complete repair and in-situ remediation technology of PTRCT have their own advantages and disadvantages,but both have achieved satisfactory clinical effect.Novel biological treatment technologies such as rotator cuff patch or scaffold,platelet-rich plasma,stem cell technology and various biological factors have been continuously discovered in recent years.In the future,they may assist conservative treatment and surgical treatment to achieve better clinical effect.This article reviews the conservative treatment,surgical treatment and biological treatment methods of patients with PTRCT,in order to provide reference for clinical treatment of PTRCT.

参考文献/References:

[1] ARDELJAN A,PALMER J,DRAWBERT H,et al.Partial thickness rotator cuff tears:patient demographics and surgical trends within a large insurance database[J].J Orthop,2019,17(17):158-161.
[2] ELLMAN H.Diagnosis and treatment of incomplete rotator cuff tears[J].Clin Orthop Relat Res,1990,(254):64-74.
[3] TURNER A.Conservative treatment of a rotator cuff tear with accompanying scapular dyskinesis:a case report[J].Athl Ther Today,2019,24(2):54-63.
[4] YOON T H,CHOI C H,KIM S J,et al.Attrition of rotator cuff without progression to tears during 2-5 years of conservative treatment for impingement syndrome[J].Arch Orthop Trauma Surg,2019,139(3):377-382.
[5] RYS A,LAIMI K,RIMAA V,et al.Surgery or conservative treatment for rotator cuff tear:a meta-analysis[J].Disabil Rehabil,2017,39(14):1357-1363.
[6] KIM Y S,LEE H J,KIM J H,et al.When should we repair partial-thickness rotator cuff tears? Outcome comparison between immediate surgical repair versus delayed repair after 6-month period of nonsurgical treatment[J].Am J Sports Med,2018,46(5):1091-1096.
[7] BRAUN C,HANCHARD N C,HANDOLL H H,et al.Predicting the outcome of conservative treatment with physiotherapy in adults with shoulder pain associated with partial-thickness rotator cuff tears:a prognostic model development study[J].BMC Musculoskelet Disord,2018,19(1) :329.
[8] NAKHAEI AMROODI M,SALARIYEH M.Predictors of failure after conservative treatment of symptomatic partial-thickness rotator cuff tear[J].J Shoulder Elbow Surg,2019,29(1):113-120.
[9] LO I K,DENKERS M R,MORE K D,et al.Partial-thickness rotator cuff tears:clinical and imaging outcomes and prognostic factors of successful nonoperative treatment[J].Open Access J Sports Med,2018,9:191-197.
[10] DWYER T,RAZMJOU H,HENRY P,et al.Short-term outcomes of arthroscopic debridement and selected acromioplasty of bursalvs articular-sided partial-thickness rotator cuff tears of less than 50[J].Orthop J Sports Med,2018,6(8):2325967118792001.
[11] BUDOFF J E,RODIN D,OCHIAI D,et al.Arthroscopic rotator cuff debridement without decompression for the treatment of tendinosis[J].Arthroscopy,2005,21(9):1081-1089.
[12] 蒋仕林,袁锋,邱勇嘉,等.三种关节镜手术方式治疗EllmanⅡ级关节侧部分肩袖损伤的疗效比较[J].中华创伤杂志,2020,36(9):779-784.
JIANG S L,YUAN F,QIU Y J,et al.Efficacy comparison of three different arthroscopic techniques in treating Ellman Ⅱ partial articular surface tendon avulsions[J].Chin J Trauma,2020,36(9):779-784.
[13] NEER C S.Anterior acromioplasty for the chronic impingement syndrome in the shoulder:a preliminary report[J].J Bone Joint Surg Am,1972;54(1):41-50.
[14] CHAMBLER A F,PITSILLIDES A A,EMERY R J.Acromial spur formation in patients with rotator cuff tears[J].J Shoulder Elbow Surg,2003,12(4):314-321.
[15] RANALLETTA M,ROSSI L A,ATALA N A,et al.Arthroscopic in situ repair of partial bursal rotator cuff tears without acromioplasty[J].Arthroscopy,2017,33(7):1294-1298.
[16] CHENG C,CHEN B,XU H,et al.Efficacy of concomitant acromioplasty in the treatment of rotator cuff tears:a systematic review and meta-analysis[J].PLoS One,2018,13(11):e0207306.
[17] YAMAKADO K.Histopathology of residual tendon in high-grade articular-sided partial-thickness rotator cuff tears (PASTA lesions)[J].Arthroscopy,2012,28(4):474-480.
[18] YANG H,LEE H J,LEE Y G,et al.Integrity of the untorn articular-sided tendon in bursal-sided partial-thickness rotator cuff tear:a comparative study of apoptotic activity in torn and untorn layers[J].Am J Sports Med,2018,46(10):2478-2485.
[19] AYDIN N,KARAISMAILOGLU B.High-grade bursal-side partial rotator cuff tears:comparison of mid- and long-term results following arthroscopic repair after conversion to a full-thickness tear[J].J Orthop Surg Res,2017,12(1):118.
[20] KIM H J,KIM J Y,KEE Y M,et al.Bursal-sided rotator cuff tears:simple versus everted type[J].Am J Sports Med,2017,46(2):441-448.
[21] XIAO J,CUI G.Clinical and structural results of arthroscopic repair of bursal-side partial-thickness rotator cuff tears[J].J Shoulder Elbow Surg,2015,24(2):e41-e46.
[22] SALEM H,CARTER A,TJOUMAKARIS F,et al.Double-row repair technique for bursal-sided partial-thickness rotator cuff tears[J].Arthrosc Tech,2018,7(3):e199-e203.
[23] CHERNCHUJIT B,SHAHUL HAMID M A,AIMPRASITTICHAI S.Knotless suture bridge technique in high-grade bursal-sided rotator cuff tears.Is this the way forward[J].Arthrosc Tech,2017,6(6):e2259-e2263.
[24] SHIN S J,KOOK S H,RAO N,et al.Clinical outcomes of modified mason-allen single-row repair for bursal-sided partial-thickness rotator cuff tears:comparison with the double-row suture-bridge technique[J].Am J Sports Med,2015,43(8):1976-1982.
[25] MIHATA T,MCGARRY M H,ISHIHARA Y,et al.Biomechanical analysis of articular-sided partial-thickness rotator cuff tear and repair[J].Am J Sports Med,2015,43(2):439-446.
[26] OSTRANDER R V,KLAUSER J M,MENON S,et al.Ultrasound and functional assessment of transtendinous repairs of partial-thickness articular-sided rotator cuff tears[J].Orthop J Sports Med,2017,5(3):232596711769737.
[27] RANALLETTA M,ROSSI L A,BERTONA A B,et al.Arthroscopic transtendon repair of partial-thickness articular-side rotator cuff tears[J].Arthroscopy,2016,32(8):1523-1528.
[28] WOODS T C,CARROLL M J,NELSON A A,et al.Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure[J].Open Access J Sports Med,2014,5:151-157.
[29] JI J H,SHAFI M,JEONG J J,et al.Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation:technical note and preliminary results[J].Arch Orthop Trauma Surg,2012,132(3):335-342.
[30] ZAFRA M,UCEDA P,MU N~OZ-LUNA F,et al.Arthroscopic repair of partial-thickness articular surface rotator cuff tears:single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation:results from a prospective randomized study[J].Arch Orthop Trauma Surg,2020,140(8):1065-1071.
[31] DILISIO M F,MILLER L R,HIGGINS L D.Transtendon,double-row,transosseous-equivalent arthroscopic repair of partial-thickness,articular-surface rotator cuff tears[J].Arthrosc Tech,2014,3(5):e559-e563.
[32] SHIN S J,JEONG J H,JEON Y S,et al.Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears:a novel arthroscopic transtendon anatomic repair technique[J].Arch Orthop Trauma Surg,2016,136(12):1701-1708.
[33] CHEON S J,LEE H Y,JEON W K.Arthroscopic treatment for intratendinous rotator cuff tear results in satisfactory clinical outcomes and structural integrity[J].Knee Surg Sports Traumatol Arthrosc,2018,26(12):3797-3803.
[34] KIM K C,LEE W Y,SHIN H D,et al.Repair integrity and functional outcomes of arthroscopic repair for intratendinous partial-thickness rotator cuff tears[J].J Orthop Surg,2019,27(2):2309499019847227.
[35] PARK S E,PANCHAL K,JEONG J J,et al.Intratendinous rotator cuff tears:prevalence and clinical and radiological outcomes of arthroscopically confirmed intratendinous tears at midterm follow-up[J].Am J Sports Med,2015,43(2):415-422.
[36] GERELI A,KOCAOGLU B,ULKU T K,et al.Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears[J].Knee Surg Sports Traumatol Arthrosc,2018,26(8):2498-2504.
[37] PULATKAN A,ANWAR W,AYK O,et al.Tear completion versus in situ repair for 50% partial-thickness bursal-side rotator cuff tears:a biomechanical and histological study in an animal model[J].Am J Sports Med,2020,48(8):1818-1825.
[38] SUN L,ZHANG Q,GE H,et al.Which is the best repair of articular-sided rotator cuff tears:a meta-analysis[J].J Orthop Surg Res,2015,10:84.
[39] ONO Y,WOODMASS J M,BOIS A J,et al.Arthroscopic repair of articular surface partial-thickness rotator cuff tears:transtendon technique versus repair after completion of the tear:a meta-analysis[J].Adv Orthop,2016,2016:7468054.
[40] CHARLES M D,CHRISTIAN D R,COLE B J.The role of biologic therapy in rotator cuff tears and repairs[J].Curr Rev Musculoskelet Med,2018,11(1):150-161.
[41] SMITH M J,BOZYNSKI C C,KUROKI K,et al.Comparison of biologic scaffolds for augmentation of partial rotator cuff tears in a canine model[J]. Shoulder Elbow Surg,2020,29(8):1573-1583.
[42] YEA J H,BAE T S,KIM B J,et al.Regeneration of the rotator cuff tendon-to-bone interface using umbilical cord-derived mesenchymal stem cells and gradient extracellular matrix scaffolds from adipose tissue in a rat model[J].Acta Biomater,2020,114:104-116.
[43] KIM W,KIM G E,ATTIA ABDOU M,et al.Tendon-inspired nanotopographic scaffold for tissue regeneration in rotator cuff injuries[J].ACS Omega,2020,5(23):13913-13925.
[44] HUANG C,ZHANG X,LUO H,et al.Effect of kartogenin-loaded gelatin methacryloyl hydrogel scaffold with bone marrow stimulation for enthesis healing in rotator cuff repair[J].J Shoulder Elbow Surg,2021,30(3):544-553.
[45] BOKOR D J,SONNABEND D,DEADY L,et al.Preliminary investigation of a biological augmentation of rotator cuff repairs using a collagen implant:a 2-year MRI follow-up[J].Muscles Ligaments Tendons J,2015,5(3):144-150.
[46] BOKOR D J,SONNABEND D,DEADY L,et al.Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant:a 2-year MRI follow-up[J]. Muscles Ligaments Tendons J,2016,6(1):16-25.
[47] LI J,LIU Z P,XU C,et al.TGF-β1-containing exosomes derived from bone marrow mesenchymal stem cells promote proliferation,migration and fibrotic activity in rotator cuff tenocytes[J].Regen Ther,2020,15:70-76.
[48] 张素珊,李赟,于贞成,等.甲基丙烯酸酐化明胶水凝胶介导的骨髓间充质干细胞增强肩袖损伤后愈合的研究[J].组织工程与重建外科杂志,2020(4):270-276.
ZHANG S S,LI Y,YU Z C,et al.Bone marrow-derived mesenchymal stem cells encapsulated by gelatin methacrylate hydrogels for enhancement of rotator cuff healing[J].J Tissue Eng Recon Surg,2020(4):270-276.
[49] SAFI E,FICKLSCHERER A,BONDARAVA M,et al.Migration of mesenchymal stem cells of bursal tissue after rotator cuff repair in rats[J].Joints,2018,6(1):4-9.
[50] MORIKAWA D,JOHNSON J D,KIA C,et al.Examining the potency of subacromial bursal cells as a potential augmentation for rotator cuff healing:an in vitro study[J].Arthroscopy,2019,35(11):2978-2988.
[51] WARTH R J,MATRE P,KOZEMCHAK A,et al.The subacromial bursa is a viable source of autologous mesenchymal stem cells for rotator cuff repair[J].Orthop J Sports Med,2019,7(5):2325967119S0027.
[52] JO C H,CHAI J W,JEONG E C,et al.Intratendinous injection of autologous adipose tissue derived mesenchymal stem cells for the treatment of rotator cuff disease:a first-in-human trial[J].Stem Cells,2018,36(9):1441-1450.
[53] JO C H,YOON K S,CHAI J W,et al.Intratendinous injection of mesenchymal stem cells for the treatment of rotator cuff disease:a 2-year follow-up study[J].Arthroscopy,2020,36(4):971-980.
[54] HURD J L,FACILE T R,WEISS J,et al.Safety and efficacy of treating symptomatic,partial-thickness rotator cuff tears with fresh,uncultured,unmodified,autologous adipose-derived regenerative cells (UA-ADRCs) isolated at the point of care:a prospective,randomized,controlled first-in-human pilot study[J].J Orthop Surg Res,2020,15(1):122.
[55] 罗鸿斌,方善鸿,江昊,等.肩峰下注射富血小板血浆治疗部分肩袖损伤研究[J].中华实验外科杂志,2019,36(1):160-162.
LUO H B,FANG S H,JIANG H,et al.Impact of platelet-rich plasma on partial thickness rotator cuff injuries a prospective randomized study[J].Chin J Exp Surg,2019,36(1):160-162.
[56] GUSNOWSKI E M,KWONG C A,WOODMASS J M,et al.The effect of platelet rich plasma on partial thickness rotator cuff tears:a double-blind prospective randomized controlled trial[J].Arthroscopy,2019.35(12):e10.
[57] SHAMS A,EL-SAYED M,GAMAL O,et al.Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears[J].Eur J Orthop Surg Traumatol,2016,26(8):837-842.
[58] CAI Y,SUN Z,LIAO B,et al.Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears[J].Med Sci Sports Exerc,2019,51(2):227-233.
[59] HURLEY E T,HANNON C P,PAUZENBERGER L,et al.Nonoperative treatment of rotator cuff disease with platelet-rich plasma:a systematic review of randomized controlled trials[J].Arthroscopy,2019,35(5):1584-1591.
[60] CARR A J,MURPHY R,DAKIN S G,et al.Platelet-rich plasma injection with arthroscopic acromioplasty for chronic rotator cuff tendinopathy:a randomized controlled trial[J].Am J Sports Med,2015,43(12):2891-2897.
[61] 刘岩,张皓序,刘付龙,等.注射富血小板血浆促进部分肩袖损伤的修复:基础研究与临床试验[J].中国组织工程研究,2019,23(3):487-492.
LIU Y,ZHANG H X,LIU F L,et al.Platelet-rich plasma injection promotes repair of partial rotator cuff of tears:basic research and clinical trials[J].Chin J Tissue Eng,2019,23(3):487-492.
[62] TOKUNAGA T,KARASUGI T,ARIMURA H,et al.Enhancement of rotator cuff tendon-bone healing with fibroblast growth factor 2 impregnated in gelatin hydrogel sheets in a rabbit model[J]. J Shoulder Elbow Surg,2017,26(10):1708-1717.
[63] YONEMITSU R,TOKUNAGA T,SHUKUNAMI C,et al.Fibroblast growth factor 2 enhances tendon-to-bone healing in a rat rotator cuff repair of chronic tears[J].Am J Sports Med,2019,47(7):1701-1712.
[64] OH J H,CHUNG S W,OH K S,et al.Effect of recombinant human growth hormone on rotator cuff healing after arthroscopic repair:preliminary result of a multicenter,prospective,randomized,open-label blinded end point clinical exploratory trial[J].J Shoulder Elbow Surg,2018,27(5):777-785.
[65] KIM J H,KIM D J,LEE H J,et al.Atelocollagen injection improves tendon integrity in partial-thickness rotator cuff tears a prospective comparative study[J].Orthop J Sports Med,2020,8(2):2325967120904012.
[66] TSEKES D,KONSTANTOPOULOS G,KHAN W S,et al.Use of stem cells and growth factors in rotator cuff tendon repair[J].Eur J Orthop Surg Traumatol,2019,29(4):747-757.

更新日期/Last Update: 2022-07-05