急性肩袖损伤手术修复时机的初步组织学和生物力学研究  

Preliminary histological and biomechanical study about the timing of surgical repair for acute rotator cuff tears in rabbits

作　　者：卢耀甲[1] 鲁谊[1] 朱以明[1] 张蔷[1] 黎广平[2] 陶剑锋[2] 姜春岩[1] 

机构地区：[1]北京积水潭医院运动损伤科,100035 [2]北京市创伤骨科研究所

出　　处：《中华外科杂志》2012年第6期560-565,共6页Chinese Journal of Surgery

基　　金：首都医学发展科研基金资助项目（2009-2062）;北京市卫生系统高层次卫生技术人才培养计划资助项目（2009-3-16）

摘　　要：目的应用兔建立急性肩袖损伤模型，研究不同时间手术修复对冈上肌腱-骨愈合、腱-骨界面胶原纤维的生长分布以及生物力学特性的影响。方法取90只骨骼成熟的雄性新西兰大耳白兔，均行右侧冈上肌切断术，建立急性肩袖损伤模型。随机分为3组：早期修复组，术后1周行腱-骨缝合；晚期修复组，术后4周进行修复；不修复组，作为对照。分别于术后2、4、8周通过HE染色观察腱-骨愈合情况，通过苦味酸天狼星红染色计算Ⅰ型／Ⅲ型胶原面积比，代表胶原纤维生长分布情况；测量术侧和健侧冈上肌断裂的最大负荷，并计算二者的百分比。结果各组均未观察到明显的冈上肌脂肪浸润和萎缩变性。早期和晚期修复组在8周时形成了新的冈上肌止点。在早期修复组和晚期修复组，8周时Ⅰ型／Ⅲ型胶原比（2．02±0．77和2．06±0．58）显著大于2周时（1．10±0．24和1．14±0．50；t=3．082、3．655，P〈0．01）。各组冈上肌术侧／健侧最大负荷百分比在2、4及8周的情况：早期修复组（38％±11％、66％±7％、89％±4％）和晚期修复组（41％±16％、63％±7％、89％±9％）均显著高于不修复组（14％±6％、32％±4％、56％±12％），差异具有统计学意义（早期修复组：t=3．311、8．549、5．719；晚期修复组：t=3．713、8．063、6．044；t9〈0．01）；各组在8周时的冈上肌术侧／健侧最大负荷百分比显著高于4周（t=3．878—4．613，P〈0．01）和2周时（t=7．158—10．024，P〈0．01）。结论急性肩袖损伤在4周内修复可形成新止点，提高腱-骨界面Ⅰ型胶原的比例，恢复冈上肌的生物力学强度。Objectives To establish the animal model of acute rotator cuff tear in rabbits, and study the effect of timing of surgical repair on healing of tendon-bone interface, formation and distribution of collagens in the supraspinatus tendon insertion and biomechanical properties of supraspinatus. Methods Supraspinatus tenotomy was performed in the right shoulder of 90 skeletally matured male New Zealand white rabbits to establish the animal model of acute rotator cuff tear. The rabbits were randomly divided into 3 groups ： group of early repair, repaired at 1 week after tenotomy ; group of late repair, repaired at 4 weeks after tenotomy; and group without repair, used as control. At 2 weeks, 4 weeks and 8 weeks after repair, healing of tendon-bone interface was observed by HE staining. Collagens were observed by Sirius Red F 3B （SR） in saturated carbazotic acid staining. The areas of type Ⅰ and Ⅲ collagens were measured by using imaging analysis software and the ratio of type Ⅰ and Ⅲ collagens were calculated. Failure loads of supraspinatus on both sides were measured. The percentage of failure loads of the surgical side was calculated and contralateral supraspinatus were uninjured. Results There was no obvious fatty infiltration and muscle atrophy in supraspinatus in all groups. At 8 weeks, the formation of a new enthesis of supraspinatus in groups of early and late repair were observed. In groups of early and late repair, the ratio of areas of type Ⅰ and Ⅲ collagens at 8 weeks （2. 02± 0. 77 and 2. 06 ± 0. 58） was larger than that at 2 weeks （ 1.10 ± 0. 24 and 1.14 ± 0. 50, t = 3.082,3. 655, P 〈 0.01 ）. At 2, 4 and 8 weeks, the percentages of failure loads of the surgical side and uninjured contralateral supraspinatus in group of early repair（38% ± 11% ,66% ± 7% ,89% ± 4% ） and group of late repair（41%± 16% ,63% ±7%, 89% ± 9% ） were both higher than that in group without repair （ 14%± 6% ,32% ±4% ,56% ± 12% ） ; the differences were all statistically significant（ g

关 键 词：肩关节 肩 回旋套 创伤和损伤 修复外科手术 伤口愈合 功能恢复 

分 类 号：R687[医药卫生—骨科学] R-332[医药卫生—外科学]