目的 腱- 骨愈合是肩袖損傷修復(fù)的關(guān)鍵因素，通過生物力學(xué)及組織學(xué)觀察探討不同界面處理方法對兔肩袖止點(diǎn)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(jī)分為3 組，分別為皮質(zhì)骨層組（n=18）、松質(zhì)骨層組（n=18）、空白對照組（n=6）?？瞻讓φ战M不作任何處理，作為正常對照；皮質(zhì)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(jié)節(jié)；松質(zhì)骨層組：全層切斷岡上肌腱中1/2 部分，去除肱骨大結(jié)節(jié)骨皮質(zhì)，將岡上肌腱縫合固定于肱骨大結(jié)節(jié)。術(shù)后4、8 周處死實驗動物，完整切取岡上肌腱與肱骨大結(jié)節(jié)及連接部，行大體觀察、HE 染色及生物力學(xué)測定。 結(jié)果 術(shù)后4 周，皮質(zhì)骨層組和松質(zhì)骨層組標(biāo)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(shù)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(xué)觀察示皮質(zhì)骨層組術(shù)后4 周，界面組織層與新生骨組織層移行尚可；術(shù)后8 周，界面組織層與新生骨組織層逐漸移行，骨側(cè)形態(tài)接近正常。松質(zhì)骨層組術(shù)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(shù)后8 周，骨側(cè)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(xué)測試示術(shù)后4、8 周，皮質(zhì)骨層組最大負(fù)荷均較松質(zhì)骨層組高，且每組術(shù)后8 周的最大負(fù)荷均較術(shù)后4 周高，差異均有統(tǒng)計學(xué)意義（P lt; 0.05）；除抗拉強(qiáng)度及術(shù)后4 周兩組間斷裂強(qiáng)度外，其余結(jié)果比較差異均有統(tǒng)計學(xué)意義（P lt; 0.05）。 結(jié)論 兔肩袖斷裂模型中，界面處理至皮質(zhì)骨層在愈合強(qiáng)度及程度方面均優(yōu)于處理至松質(zhì)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(diǎn)腱- 骨愈合影響的研究. 中國修復(fù)重建外科雜志, 2011, 25(4): 385-388. doi: 復(fù)制
| 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. |
- 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.