巨大肩袖损伤手术修复时机的实验与临床研究  

作　　者：吴关[1] 鲁谊[1] 张蔷[1] 李奉龙[1] 朱以明[1] 姜春岩[1] 

机构地区：[1]北京积水潭医院运动损伤科,100035

出　　处：《中华创伤骨科杂志》2013年第3期240-246,共7页Chinese Journal of Orthopaedic Trauma

基　　金：北京市科技新疆计划（2008818）

摘　　要：目的 探讨无明显脂肪浸润和萎缩变性的巨大肩袖损伤手术时机对修复效果的影响。方法选取60只新西兰大耳白兔，建立肩袖损伤模型。随机分为2组（n=30）：早期修复绀（损伤后1周后手术修复）和晚期修复组（4周后修复）。术后2、4、8周HE染色观察腱-骨愈合情况．苦味酸灭狼堪红染包计算I型胶原与Ⅲ型胶原面积比；测量并比较术侧与健侧冈上肌的最大负荷百分比。临床上随访2008午1月至2011年1月手术治疗的无明显脂肪浸润和萎缩变性的巨大肩袖损伤患者51例，按手术修复时间的不同分为急性组18例（6周内手术）、亚急性组17例（6周至3个川内手术和慢性组16例（超过3个月手术）。关节镜下双排承建修复损伤肩袖。记录并比较各组肩关节活动范围（ROM）、疼痛评分（VAS）、Constant—Murley评分、加州大学洛杉矶分校（UCLA）评分、肩关节简单（SST）评分。结果动物实验表明，修复术后2、4、8周时，早期修复组0晚期修复组间组织学用生物力学数据差异均无统计学意义（P〉0．05）。早期修复组的结果2周与4、8周之间以及晚期修复纰2、4周与8周之间差异均有统计学意义（P〈0．05）。51例患行术后获12～36个门（平均18个月）随访，均顺利愈合，无发生并发症。术后ROM、VAs评分、Constant—Murley评分、UCI-A评分、SST评分与术前比较明硅改善，差异有统计学意义（P〈0．05）；3组间在术后末次随访时ROM、功能评分以及疼痛等方州差异均尤统计学意义（P〉0．05）。结论巨大肩袖损伤发生脂肪浸润和萎缩变性之前，不同时点修复住动物实验的组织学、力学及临床治疗效果方面均无明显差异。Objective To study the effect of operative timing on repairing massive rotator cuff tears (RCT) before fatty infiltration and atrophic degeneration in animal models and clinic as well.Methods Sixty New Zealand rabbits were used to set up models of massive RCT without fatty infiltration and atrophic degeneration and randomly divided into 2 equal groups.The operative repair was performed at one week after injury in group A and at 4 weeks in group B.At 2,4 and 8 weeks after operation,healing of tendon-bone interface was observed by H.E.staining,collagens were observed by Sirius Red F 3B (SR) in saturated carbazotic acid staining and areas of type Ⅰ and Ⅲ collagens were measured by imaging analysis software.Failure loads of supraspinatus on both sides were measured.All data were compared at the same time between the 2 groups.Clinically,from January 2008 to January 2011,51 patients with massive RCT without fatty infiltration and atrophic degeneration were arthroscopically repaired.They were divided into 3 groups according to different operative timings:an acute group (n =18) in which operation was conducted in less than 6 weeks,a subacute group (n =17) in which operation was conducted in 6 weeks to 3 months and a chronic group (n =16) in which operation was conducted in more than 3 months.All the shoulders were repaired using the double-row technique.The range of motion (ROM),visual analog scale (VAS) for pain,Constant-Murley score,University of California,Los Angeles (UCLA) score,simple shoulder test (SST) score were recorded and compared among the 3 groups at the last follow-up.Results The animal experiments showed no significant differences between the 2 groups at any time point histologically and biomechanically (P ＞ 0.05).The data showed significant differences in group A between 2 weeks and 4/8 weeks and in group B between 2/4weeks and 8 weeks (P ＜ 0.05).Clinically,follow-ups from 12 to 18 months (average,18 months) showed the 51 patients were cured with no complications.There were significant difference

关 键 词：肩关节 创伤和损伤 组织学 生物力学 临床对照试验 

分 类 号：R687[医药卫生—骨科学]