人工真皮与同种异体脱细胞真皮修补肩袖损伤的对比​

doi:10.3877/cma.j.issn.1674-134X.2026.02.003

目的

对比关节镜下应用人工真皮皮耐克与同种异体脱细胞真皮补片增强修补肩袖损伤的临床疗效，为临床补片选择提供循证依据。

方法

回顾性分析暨南大学附属广州红十字会医院骨科2021年6月至2025年5月诊治的39例肩袖损伤患者资料。所有患者均为肌腱回缩距离≥3 cm，术前肩袖肌肉脂肪浸润按Goutallier分级≥2级，无局部骨质病变者，补片修复耐受性好且具备良好的认知功能，术后依从性好患者。排除合并骨关节炎，肱骨头骨折或Bankart损伤，神经麻痹史，治疗期间擅自服用影响疗效的药物或接受其他治疗方案治疗，终末期恶性肿瘤等患者。根据补片类型分为人工真皮（Pelnac）组（人工真皮组）（n=20）与同种异体脱细胞真皮组（脱细胞真皮组）（n=19）。均采用“双排锚钉+补片覆盖”术式，采用t检验、卡方检验和Mann-Whitney U检验，对比两组肩关节活动度、视觉模拟评分法（VAS）、Constant-Murley肩关节功能评分量表及肌腱厚度差异。

结果

两组患者基线资料差异无统计学意义（均为P>0.05）。治疗前两组观察指标差异均无统计学意义（均为P>0.05），治疗后肩关节活动度、Constant-Murley肩关节功能评分均较治疗前显著提升（均为P<0.05），VAS评分显著降低（Z=-3.983、-3.879，均为P<0.001）。治疗后两组Constant-Murley肩关节功能评分人工真皮组为（77±6）分、脱细胞真皮组（76±4）分，两组VAS评分分别为1.0（1.0，2.0）分和1.0（1.0，2.0）分，肌腱厚度分别为（8.4±0.6）mm和（8.3±0.8）mm，差异均无统计学意义（均为P>0.05）；治疗后两组肩关节活动度差异无统计学意义（t=0.583、1.228、0.578、1.127，均为P>0.05）。

结论

人工真皮皮耐克与同种异体脱细胞真皮补片对于肩袖损伤增强修补疗效均值得肯定。

关键词: 肩袖损伤, 皮肤, 人工, 脱细胞真皮, 肩关节, 缝合技术

Objective

To compare the clinical efficacy of arthroscopic augmented repair of rotator cuff injuries using artificial dermis (Pelnac) versus acellular allogeneic dermis, and to provide evidence for graft selection in clinical practice.

Methods

Clinical data of 39 patients with rotator cuff injuries treated in the orthopaedics department of Guangzhou Red Cross Hospital affiliated to Jinan University, from June 2021 to May 2025 were retrospectively analyzed. Inclusion criteria: tendon retraction distance ≥three centimetres, the preoperative Goutallier grade (fatty infiltration of the rotator cuff muscles) ≥grade two; no local osseous lesions, tolerant of patch augmentation, good cognitive function, and good compliance. Exclusion criteria: osteoarthritis, humeral head fracture, Bankart lesion, nerve palsy history, unauthorized use of drugs affecting efficacy or receipt of other treatments during the treatment period, end-stage malignant tumors. According to patch type, the patients were divided into an artificial dermis (Pelnac) group ( artificial group) (n=20) and the acellular allogeneic dermis group (acellular dermis group) (n=19). All the patients underwent a double-row anchor suture plus patch-covering procedure. T test, chi square test, and Mann-Whitney U test were used to compare shoulder range of motion, visual analogue scale (VAS) score, Constant-Murley score, and tendon thickness between the two groups.

Results

There were no statistically significant differences in baseline data between the two groups (all P>0.05). Before treatment, no statistically significant differences were found in any observed indicators between the two groups (P>0.05). After treatment, shoulder range of motion and Constant-Murley score were significantly improved in both groups compared with those before treatment (all P<0.05), while VAS score was significantly decreased (Z=-3.983, -3.879, both P<0.05). After treatment, Constant-Murley scores were 77±6 in the artificial group and 76±4 in the acellular dermis group, VAS scores were 1.0 (1.0, 2.0) and 1.0 (1.0, 2.0) repectivley, as well as tendon thickness (8.4±0.6) mm and (8.3±0.8) mm repectivley. There was no statistically significant difference between the two groups in (all P>0.05). No statistically significant difference was found in postoperative shoulder range of motion between the two groups (all P>0.05).

Conclusion

Both artificial dermis (Pelnac) and acellular allogeneic dermis patches achieved favorable efficacy in augmented repair of rotator cuff injuries.

Key words: Rotator Cuff Injuries, Skin, Artificial, Acellular Dermis, Shoulder Joint, Suture Techniques

图1 肩袖损伤修复术前及术中影像。图A~B为术前右肩MRI斜冠状位T2WI片，示冈上肌腱连续性中断，断端回缩至关节盂水平（图中红色箭头）；图C~D为关节镜下可见右肩冈上肌腱巨大撕裂；图E为关节镜下双排缝合术中脱细胞真皮补片止点增强；图F为关节镜下双排缝合术中人工真皮补片止点增强

Figure 1 Images before and during repair surgery of rotator cuff injury. A and B are oblique coronal T2-weighted MRI images of the right shoulder before surgery, showing disruption of supraspinatus tendon continuity, with retraction of the torn end to the glenoid level (red arrow); C and D are views under arthroscope , showing a massive tear of the supraspinatus tendon in the right shoulder; E shows footprint augmentation with an acellular dermal patch during double-row repair; F shows footprint augmentation with an artificial dermis patch during double-row repair

表1 两组患者术前一般资料比较

Table 1 Ggeneral information of the two groups before operation

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age (year)	性别（男/女） Gender (male/female)	侧别（左/右） Side (left/right)
人工真皮组 Artificial dermis group	20	66.7±6.3	7/13	7/13
脱细胞真皮组 Acellular dermis group	19	63.3±8.8	6/13	8/11
统计值 Statistical values		t=1.429	χ²=0.051	χ²=0.208
P值		>0.05	>0.05	>0.05
组别 Groups	例数 Number of cases	外伤史（有/无） Trauma history (yes/no)	吸烟史（有/无）Smoking history (yes/no)	病程［月，M（P₂₅，P₇₅）］ Course of disease (month)
人工真皮组 Artificial dermis group	20	9/11	6/14	5.0（1.0，12.0）
脱细胞真皮组 Acellular dermis group	19	11/8	5/14	5.0（1.0，8.0）
统计值 Statistical values		χ²=0.648	χ²=0.065	Z=-0.043
P值		>0.05	>0.05	>0.05

表1 两组患者术前一般资料比较

Table 1 Ggeneral information of the two groups before operation

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age (year)	性别（男/女） Gender (male/female)	侧别（左/右） Side (left/right)
人工真皮组 Artificial dermis group	20	66.7±6.3	7/13	7/13
脱细胞真皮组 Acellular dermis group	19	63.3±8.8	6/13	8/11
统计值 Statistical values		t=1.429	χ²=0.051	χ²=0.208
P值		>0.05	>0.05	>0.05
组别 Groups	例数 Number of cases	外伤史（有/无） Trauma history (yes/no)	吸烟史（有/无）Smoking history (yes/no)	病程［月，M（P₂₅，P₇₅）］ Course of disease (month)
人工真皮组 Artificial dermis group	20	9/11	6/14	5.0（1.0，12.0）
脱细胞真皮组 Acellular dermis group	19	11/8	5/14	5.0（1.0，8.0）
统计值 Statistical values		χ²=0.648	χ²=0.065	Z=-0.043
P值		>0.05	>0.05	>0.05

表2 两组的肩关节活动度比较［°，（

x ¯

±s）］

Table 2 Comparison of shoulder joint range of motion between two groups

组别 Group	例数 Number of cases	前屈上举 Flexion and overhead lift		外展上举 Abduction and overhead lift
组别 Group	例数 Number of cases	治疗前 Before treatment	治疗后 After treatment	治疗前 Before treatment	治疗后 After treatment
人工真皮组 Artificial dermis group	20	49.1±7.9	158.6±7.0^*	37.0±8.0	87.3±6.0^*
脱细胞真皮组 Acellular dermis group	19	46.5±6.0	157.4±6.1^*	33.8±4.8	85.1±5.4^*
t值		1.187	0.583	1.515	1.228
P值		>0.05	>0.05	>0.05	>0.05
组别 Group	例数 Number of cases	外旋 External rotations		内旋 Internal rotations
组别 Group	例数 Number of cases	治疗前 Before treatment	治疗后 After treatment	治疗前 Before treatment	治疗后 After treatment
人工真皮组 Artificial dermis group	20	32.4±4.8	62.0±3.6^*	24.5±3.9	57.3±5.6^*
脱细胞真皮组 Acellular dermis group	19	30.3±3.0	61.1±4.6^*	25.3±2.6	55.5±4.4^*
t值		1.667	0.578	-0.721	1.127
P值		>0.05	>0.05	>0.05	>0.05

表2 两组的肩关节活动度比较［°，（

x ¯

±s）］

Table 2 Comparison of shoulder joint range of motion between two groups

组别 Group	例数 Number of cases	前屈上举 Flexion and overhead lift		外展上举 Abduction and overhead lift
组别 Group	例数 Number of cases	治疗前 Before treatment	治疗后 After treatment	治疗前 Before treatment	治疗后 After treatment
人工真皮组 Artificial dermis group	20	49.1±7.9	158.6±7.0^*	37.0±8.0	87.3±6.0^*
脱细胞真皮组 Acellular dermis group	19	46.5±6.0	157.4±6.1^*	33.8±4.8	85.1±5.4^*
t值		1.187	0.583	1.515	1.228
P值		>0.05	>0.05	>0.05	>0.05
组别 Group	例数 Number of cases	外旋 External rotations		内旋 Internal rotations
组别 Group	例数 Number of cases	治疗前 Before treatment	治疗后 After treatment	治疗前 Before treatment	治疗后 After treatment
人工真皮组 Artificial dermis group	20	32.4±4.8	62.0±3.6^*	24.5±3.9	57.3±5.6^*
脱细胞真皮组 Acellular dermis group	19	30.3±3.0	61.1±4.6^*	25.3±2.6	55.5±4.4^*
t值		1.667	0.578	-0.721	1.127
P值		>0.05	>0.05	>0.05	>0.05

表3 两组患者VAS评分［分，M（P₂₅，P₇₅）］

Table 3 VAS score of the two groups

组别 Groups	例数 Number of cases	术前 Before operation	术后3个月 Three months after the operation	Z值	P值
人工真皮组 Artificial dermis group	20	7.0（6.3，8.0）	1.0（1.0，2.0）	-3.983	<0.001
脱细胞真皮组 Acellular dermis group	19	7.0（6.0，7.0）	1.0（1.0，2.0）	-3.879	<0.001
Z值		-0.704	-0.763
P值		>0. 05	>0. 05

表3 两组患者VAS评分［分，M（P₂₅，P₇₅）］

Table 3 VAS score of the two groups

组别 Groups	例数 Number of cases	术前 Before operation	术后3个月 Three months after the operation	Z值	P值
人工真皮组 Artificial dermis group	20	7.0（6.3，8.0）	1.0（1.0，2.0）	-3.983	<0.001
脱细胞真皮组 Acellular dermis group	19	7.0（6.0，7.0）	1.0（1.0，2.0）	-3.879	<0.001
Z值		-0.704	-0.763
P值		>0. 05	>0. 05

表4 两组患者Constant-Murley肩关节功能评分比较［分，（

x ¯

±s）］

Table 4 Constant-Murley shoulder joint function scores of the two groups

组别 Groups	例数 Number of cases	术前 Before operation	术后3个月 Three months after the operation	t值	P值
人工真皮组 Artificial dermis group	20	40±7	77±6	-20.614	<0.05
脱细胞真皮组 Acellular dermis group	19	40±4	76±4	-32.961	<0.05
t值		0.063	0.511
P值		>0.05	>0.05

表4 两组患者Constant-Murley肩关节功能评分比较［分，（

x ¯

±s）］

Table 4 Constant-Murley shoulder joint function scores of the two groups

组别 Groups	例数 Number of cases	术前 Before operation	术后3个月 Three months after the operation	t值	P值
人工真皮组 Artificial dermis group	20	40±7	77±6	-20.614	<0.05
脱细胞真皮组 Acellular dermis group	19	40±4	76±4	-32.961	<0.05
t值		0.063	0.511
P值		>0.05	>0.05

表5 两组的冈上肌肌腱厚度比较［mm，（

x ¯

±s）］

Table 5 Comparison of the thickness of the supraspinatus tendon among the two groups

组别 Groups	例数 Number of cases	术前撕裂回缩距离 Tear range before operation	术后3个月厚度 Thickness three months after operation
人工真皮组 Artificial dermis group	20	33.2±6.1	8.4±0.6
脱细胞真皮组 Acellular dermis group	19	38.1±6.2	8.3±0.8
t值		0.050	0.808
P值		>0.05	>0.05

表5 两组的冈上肌肌腱厚度比较［mm，（

x ¯

±s）］

Table 5 Comparison of the thickness of the supraspinatus tendon among the two groups

组别 Groups	例数 Number of cases	术前撕裂回缩距离 Tear range before operation	术后3个月厚度 Thickness three months after operation
人工真皮组 Artificial dermis group	20	33.2±6.1	8.4±0.6
脱细胞真皮组 Acellular dermis group	19	38.1±6.2	8.3±0.8
t值		0.050	0.808
P值		>0.05	>0.05

图2 肩袖修复术后3个月右肩MRI斜冠状位T2WI片。图A示人工真皮补片与冈上肌腱残端缝合处愈合良好，肌腱止点连续性良好（红色箭头）；图B示脱细胞真皮补片与冈上肌腱残端缝合处愈合良好，肌腱止点连续性良好（红色箭头）

Figure 2 Oblique coronal T2-weighted MRI image of the right shoulder three months after surgery. A shows good healing at the suture site between the artificial dermis patch and the remnant supraspinatus tendon, with good continuity of the tendon footprint (red arrow); B shows good healing at the suture site between the acellular dermal patch and the remnant supraspinatus tendon, with good continuity of the tendon footprint(red arrow)

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Comparison of artificial dermis and acellular allogeneic dermis for rotator cuff repair

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Comparison of artificial dermis and acellular allogeneic dermis for rotator cuff repair