肩袖损伤修复中的生物治疗

Biological therapy in rotator cuff injury

背景:富血小板血浆总体上对功能改善和修复完整性没有显著影响,但在小到中等撕裂的肩袖损伤中可能更有益处。进一步的研究应集中在富含白细胞的富血小板血浆与贫白细胞的富血小板血浆的应用对比以及富血小板血浆在修复失败高风险患者中的应用。目的:总结目前生物治疗在肩袖损伤修复中的相关基础研究和临床应用研究现状及进展,并回顾最近的科学研究发现。方法:以"biological therapy,biotherapy,RCT,rotator cuff tear"为关键词,检索了2008年至2018年PubM ed、MedL ine、Springerlink数据库中相关文献。初检得到文章168篇,筛选后对其中32篇文章进行分析。结果与结论:生物制品和合成贴片或增强件为大型且范围较广的肩袖撕裂提供了机械稳定性,并降低了再撕裂率。间充质干细胞表现出在不影响结果的前提下改善了愈合率。细胞因子和生长因子在动物模型实验中是很有希望的,但需要人体试验来进一步评估。在大面积的肩袖损伤或再次修复的肩袖损伤中,应考虑同种异体移植物或增强合成贴片。富含血小板的血浆可能对较小的肩袖撕裂有益处。需要进一步的研究来评估间充质干细胞和各种细胞学化学信号之间的价值。

BACKGROUND: Platelet-rich plasma has no significant impact on functional outcomes and repair integrity, but may be advantageous in small and medium tears of rotator cuff. Further studies should focus on leukocyte-rich versus poor preparations and the use of platelet-rich plasma in patients that are high risk for repair failure.OBJECTIVE: To summarize the current status and progress of basic research and clinical trials on biologic adjuvants in the repair of rotator cuff, and to review the latest scientific findings.METHODS: A computer-based search of PubMed, MedLine, and Springerlink databases was performed for relevant articles published from2008 to 2018 with the keywords of 'biological therapy, biotherapy, RCT, rotator cuff tear'. Initially, 168 articles were retrieved, and finally 32 eligible articles were included for result analysis.RESULTS AND CONCLUSION: Biologic and synthetic patches or augments provide mechanical stability for large and massive rotator cuff tears and decrease re-tear rate. Mesenchymal stem cells can improve healing rate without an impact on outcomes. Cytokines and growth factors are promising in animal experiments, but need to be verified by clinical trials. In massive or revision repairs, allograft or synthetic patch augmentation should be considered. Platelet-rich plasma may be available for small tears. Further investigations are needed to evaluate the value of mesenchymal stem cells and various chemical signals.