不同界面處理方法對肩袖止點腱- 骨愈合影響的研究_《中國修復重建外科雜志》

作者：

陶旭 , 唐康來 , 陳磊 , 周建波 , 曹洪輝 , 常廷杰 , 李輝 , 許建中

第三軍醫大學西南醫院骨科全軍矯形外科中心（重慶，400038）;

關鍵詞：

肩袖損傷腱- 骨愈合松質骨皮質骨兔

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目的腱- 骨愈合是肩袖損傷修復的關鍵因素，通過生物力學及組織學觀察探討不同界面處理方法對兔肩袖止點腱- 骨愈合的影響。方法取42 只成年日本短耳兔，雌雄不限，體重2.0 ～ 2.5 kg，隨機分為3 組，分別為皮質骨層組（n=18）、松質骨層組（n=18）、空白對照組（n=6）。空白對照組不作任何處理，作為正常對照；皮質骨層組：全層切斷岡上肌腱中1/2 部分，將岡上肌腱直接縫合固定于肱骨大結節；松質骨層組：全層切斷岡上肌腱中1/2 部分，去除肱骨大結節骨皮質，將岡上肌腱縫合固定于肱骨大結節。術后4、8 周處死實驗動物，完整切取岡上肌腱與肱骨大結節及連接部，行大體觀察、HE 染色及生物力學測定。結果術后4 周，皮質骨層組和松質骨層組標本的岡上肌均較空白對照組萎縮，腱- 骨連接部界限不明顯；術后8 周，兩組岡上肌與空白對照組比較已無明顯差異。組織學觀察示皮質骨層組術后4 周，界面組織層與新生骨組織層移行尚可；術后8 周，界面組織層與新生骨組織層逐漸移行，骨側形態接近正常。松質骨層組術后4 周，界面組織層與新生骨組織層連接不緊密，膠原纖維排列凌亂；術后8 周，骨側大量新生骨組織，界面組織層變薄，平行的膠原纖維長入。生物力學測試示術后4、8 周，皮質骨層組最大負荷均較松質骨層組高，且每組術后8 周的最大負荷均較術后4 周高，差異均有統計學意義（P lt; 0.05）；除抗拉強度及術后4 周兩組間斷裂強度外，其余結果比較差異均有統計學意義（P lt; 0.05）。結論兔肩袖斷裂模型中，界面處理至皮質骨層在愈合強度及程度方面均優于處理至松質骨層。

引用本文： 陶旭,唐康來,陳磊,周建波,曹洪輝,常廷杰,李輝,許建中. 不同界面處理方法對肩袖止點腱- 骨愈合影響的研究. 中國修復重建外科雜志, 2011, 25(4): 385-388. doi: 復制

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7.	Gamradt SC, Gallo RA, Adler RS, et al. Vascularity of the supraspinatus tendon three months after repair: characterization using contrast-enhanced ultrasound. J Shoulder Elbow Surg, 2010, 19(1): 73-80.
8.	Lorbach O, Bachelier F, Vees J, et al. Cyclic loading of rotator cuff reconstructions: single-row repair with modified suture configurations versus double-row repair. Am J Sports Med, 2008, 36(8): 1504-1510.
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11.	Wong MW, Qin L, Lee KM, et al. Articular cartilage increases transition zone regeneration in bone-tendon junction healing. Clin Orthop Relat Res, 2009, 467(4): 1092-1100.
12.	Wong MW, Qin L, Lee KM, et al. Healing of bone-tendon junction in a bone trough: a goat partial patellectomy model. Clin Orthop Relat Res, 2003, (413): 291-302.
13.	Derwin KA, Baker AR, Iannotti JP, et al. Preclinical models for translating regenerative medicine therapies for rotator cuff repair. Tissue Eng Part B Rev, 2010, 16(1): 21-30.

1. Tang KL, Habermeryer P, Li QH, et al. Etiology, classification and clinical evaluation of partial-thickness tears of rotator cuff. Chin J Traumatol, 2003, 6(5): 309-317.
2. Meyer D, Fucentese S, Koller B, et al. Association of osteopenia of the humeral head with fullthickness rotator cuff tears. J Shoulder Elbow Surg, 2004, 13(3): 333-337.
3. Yamada M, Briot J, Pedrono A, et al. Age- and gender-related distribution of bone tissue of osteoporotic humeral head using computed tomography. J Shoulder Elbow Surg, 2007, 16(5): 596-602.
4. Barber FA, Herbert MA, Richards DP. Sutures and suture anchors: update 2003. Arthroscopy, 2003, 19(9): 985-990.
5. Barber FA, Herbert MA, Coons DA, et al. Sutures and suture anchors—update 2006. Arthroscopy, 2006, 22(10): 1063. e1-9.
6. Uhthoff HK, Seki M, Backman DS, et al. Tensile strength of the supraspinatus after reimplantation into a bony trough: an experimental study in rabbits. J Shoulder Elbow Surg, 2002, 11(5): 504-509.
7. Gamradt SC, Gallo RA, Adler RS, et al. Vascularity of the supraspinatus tendon three months after repair: characterization using contrast-enhanced ultrasound. J Shoulder Elbow Surg, 2010, 19(1): 73-80.
8. Lorbach O, Bachelier F, Vees J, et al. Cyclic loading of rotator cuff reconstructions: single-row repair with modified suture configurations versus double-row repair. Am J Sports Med, 2008, 36(8): 1504-1510.
9. Soda Y, Sumen Y, Murakami Y, et al. Attachment of autogenous tendon graft to cortical bone is better than to cancellous bone: a mechanical and histological study of MCL reconstruction in rabbits. Acta Orthop Scand, 2003, 74(3): 322-326.
10. St Pierre P, Olson E, Elliott J, et al. Tendon-healing to cortical bone compared with healing to a cancellous trough. A biomechanical and histological evaluation in goats. J Bone Joint Surg (Am), 1995, 77(12): 1858-1866.
11. Wong MW, Qin L, Lee KM, et al. Articular cartilage increases transition zone regeneration in bone-tendon junction healing. Clin Orthop Relat Res, 2009, 467(4): 1092-1100.
12. Wong MW, Qin L, Lee KM, et al. Healing of bone-tendon junction in a bone trough: a goat partial patellectomy model. Clin Orthop Relat Res, 2003, (413): 291-302.
13. Derwin KA, Baker AR, Iannotti JP, et al. Preclinical models for translating regenerative medicine therapies for rotator cuff repair. Tissue Eng Part B Rev, 2010, 16(1): 21-30.

《中國修復重建外科雜志》

不同界面處理方法對肩袖止點腱- 骨愈合影響的研究

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《中國修復重建外科雜志》

不同界面處理方法對肩袖止點腱- 骨愈合影響的研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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