臨床整形外科58巻10号

2023年10月発行

特集 腱板断裂の治療戦略

一次修復を促進させる治療

PGAシートを用いた腱板修復術—適応と限界

著者： 横矢晋¹

所属機関： ¹広島市立広島市民病院整形外科

ページ範囲：P.1205 - P.1210

文献概要

われわれは広範囲腱板断裂に対して術後再断裂率の低下を目的に，また修復可能なサイズの腱板断裂に対しては修復腱板の早期成熟を目的に，ポリグリコール酸(PGA)シートを補強する術式を行っている．PGAは細胞外基質産生に優れ，腱細胞の成長に有利に働くとされており，また生体親和性に優れている特徴がある人工生体材料である．PGAシートを修復した腱板の表層に補強することにより周囲の環境からの細胞や線維組織の導入がなされるだけでなく，PGAシートそのものがアンカーに付着する糸やテープからの応力集中を分散させる効果もある．

参考文献

1) Yokoya S, Nakamura, Harada Y, et al. Effectiveness of measuring tension during arthroscopic rotator cuff repair. J Exp Orthop 2021;8(1):21. doi:10.1186/s40634-021-00341-2.

2) Mihata T, Lee TQ, Watanabe C, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy 2013;29(3):459-70.

3) Yokoya S, Nakamura Y, Harada Y, et al. Outcomes of arthroscopic rotator cuff repair with muscle advancement for massive rotator cuff tears. J Shoulder Elbow Surg 2019;28(3):445-52.

4) Yokoya S, Mochizuki Y, Natsu K, et al. Rotator cuff regeneration using a bioabsorbable material with bone marrow-derived mesenchymal stem cells in a rabbit model. Am J Sports Med 2012;40(6):1259-68.

5) Dierckman BD, Ni JJ, Karzel RP, et al. Excellent healing rates and patient satisfaction after arthroscopic repair of medium to large rotator cuff tears with a single-row technique augmented with bone marrow vents. Knee Surg Sports Traumatol Arthrosc 2018;26(1):136-45.

6) Yokoya S, Harada Y, Negi H, et al. Arthroscopic rotator cuff repair with muscle advancement and artificial biodegradable sheet reinforcement for massive rotator cuff tears. Orthop J Sports Med 2020;8(10):2325967120960166. doi:10.1177/2325967120960166

7) Kokubu T, Mifune Y, Inui A, et al. Arthroscopic rotator cuff repair with graft augmentation of fascia lata for large and massive tears. Arthrosc Tech 2016;5(6):e1235-8. doi:10.1016/j.eats.2016.07.009.

8) Barth J, Olmos MI, Swan J, et al. Superior capsular reconstruction with the long head of the biceps autograft prevents infraspinatus retear in massive posterosuperior retracted rotator cuff tears. Am J Sports Med 2020;48(6):1430-8.

9) Choi S, Kim G, Lee Y, et al. Patch augmentation does not provide better clinical outcomes than arthroscopic rotator cuff repair for large to massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2022;30(11):3851-61.

10) Lädermann A, Denard PJ, Abrassart S, et al. Achilles tendon allograft for an irreparable massive rotator cuff tear with bony deficiency of the greater tuberosity. Knee Surg Sports Traumatol Arthrosc 2017;25(7):2147-50.

11) Avanzi P, Giudici LD, Capone A, et al. Prospective randomized controlled trial for patch augmentation in rotator cuff repair:24-month outcomes. J Shoulder Elbow Surg 2019;28(10):1918-27.

12) Washburn R, Anderson TM, Tokish JM. Arthroscopic rotator cuff augmentation:surgical technique using bovine collagen bioinductive implant. Arthrosc Tech 2017;6(2):e297-301. doi:10.1016/j.eats.2016.10.008.

13) Burkhard MD, Dietrich M, Andronic O, et al. Arthroscopic repair of posterosuperior rotator cuff tears with bioabsorbable patch augmentation:a magnetic resonance-controlled case series with 1-year follow-up. JSES Int 2020;4(4):860-8.

14) Lu L, Zhu X, Valenzuela RG, et al. Biodegradable polymer scaffolds for cartilage tissue engineering. Clin Orthop Relat Res 2001;(391 Suppl):S251-70. doi:10.1097/00003086-200110001-00024.

15) Landis WJ, Jacquet R, Hillyer J, et al. Design and assessment of a tissue-engineered model of human phalanges and a small joint. Orthod Craniofac Res 2005;8(4):303-12.

16) Yokoya S, Mochizuki Y, Nagata Y, et al. Tendon-bone insertion repair and regeneration using polyglycolic acid sheet in the rabbit rotator cuff injury model. Am J Sports Med 2008;36(7):1298-309.