不同界面处理方法对肩袖止点腱-骨愈合影响的研究  

EFFECT OF DIFFERENT SURGERY TECHNIQUES ON BONE-TENDON HEALING OF ROTATOR CUFF INSERTION

作　　者：陶旭[1] 唐康来[1] 陈磊[1] 周建波[1] 曹洪辉[1] 常廷杰[1] 李辉[1] 许建中[1] 

机构地区：[1]第三军医大学西南医院骨科全军矫形外科中心,重庆400038

出　　处：《中国修复重建外科杂志》2011年第4期385-388,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(30872620)~~

摘　　要：目的腱-骨愈合是肩袖损伤修复的关键因素,通过生物力学及组织学观察探讨不同界面处理方法对兔肩袖止点腱-骨愈合的影响。方法取42只成年日本短耳兔,雌雄不限,体重2.0～2.5kg,随机分为3组,分别为皮质骨层组(n=18)、松质骨层组(n=18)、空白对照组(n=6)。空白对照组不作任何处理,作为正常对照;皮质骨层组:全层切断冈上肌腱中1/2部分,将冈上肌腱直接缝合固定于肱骨大结节;松质骨层组:全层切断冈上肌腱中1/2部分,去除肱骨大结节骨皮质,将冈上肌腱缝合固定于肱骨大结节。术后4、8周处死实验动物,完整切取冈上肌腱与肱骨大结节及连接部,行大体观察、HE染色及生物力学测定。结果术后4周,皮质骨层组和松质骨层组标本的冈上肌均较空白对照组萎缩,腱-骨连接部界限不明显;术后8周,两组冈上肌与空白对照组比较已无明显差异。组织学观察示皮质骨层组术后4周,界面组织层与新生骨组织层移行尚可;术后8周,界面组织层与新生骨组织层逐渐移行,骨侧形态接近正常。松质骨层组术后4周,界面组织层与新生骨组织层连接不紧密,胶原纤维排列凌乱;术后8周,骨侧大量新生骨组织,界面组织层变薄,平行的胶原纤维长入。生物力学测试示术后4、8周,皮质骨层组最大负荷均较松质骨层组高,且每组术后8周的最大负荷均较术后4周高,差异均有统计学意义(P<0.05);除抗拉强度及术后4周两组间断裂强度外,其余结果比较差异均有统计学意义(P<0.05)。结论兔肩袖断裂模型中,界面处理至皮质骨层在愈合强度及程度方面均优于处理至松质骨层。Objective To analyze the effect of different surgery techniques on the tendon-bone healing of rotator cuff insertion.Methods Forty-two adult Japanese rabbits,weighing 2.0-2.5 kg and male or female,were selected.Thirtysix rabbits were given a sharply left-lateral tenotomy of the supraspinatus tendon with subsequent re-attachment of the tendon.According to the depth of re-attachment,36 rabbits were equally randomized into the cancellous-fixation group（a cancellous bed was prepared with a dental burr） and the cortical-fixation group（the same treatment was performed except the preparation of the bone bed）.Six rabbits served as the controls without treatment（control group）.At 4 and 8 weeks after operation,the general observation,HE staining,and the biomechanical test were performed.Results At 4 weeks after operation,the supraspinatushumerus specimens morphologically showed atrophy and vague between tendon and new bone in the cancellous-fixation group and the cortical-fixation group;at 8 weeks,no obvious difference was observed between 2 groups and the control group.The histological results of the cortical-fixation group at 4 weeks revealed the interface between tendon and new bone became smooth.The interface became transitional at 8 weeks,and the shape of bone tissue was nearly normal.The interface obtained from the cancellous-fixation group at 4 weeks became sclerotic,and collagen fibers formed in disorder.With ingrowth of new bone and reestablishment of collagen-fiber continuity at 8 weeks,thickness of interface became thin,and bone tissue was remodeling.The ultimate load were significantly higher in the cortical-fixation group than in the cancellous-fixation group at both 4 and 8 weeks,and the results gained at 8 weeks is significantly higher than that at 4 weeks in each group（P 0.05）.Except rupture strength at 4 weeks between 2 groups and all tensile strength（P 0.05）,there were significant differences in the results of others（P 0.05）.Conclusion In this model,the tendon-bone healing process

关 键 词：肩袖损伤 腱-骨愈合 松质骨 皮质骨 兔 

分 类 号：R687.3[医药卫生—骨科学]