自体髌骨股四头肌肌腱治疗家兔巨大肩袖损伤的实验研究  

Experimental study on patellar quadriceps femoris tendon allograft in the treatment of massive rotator cuff tears in rabbits

作　　者：陈奇 沈子龙 温向伟 王晨 高奥飞 丁明强 余嘉文 潘海乐[2] Qi Chen;Zilong Shen;Xiangwei Wen;Chen Wang;Aofei Gao;Mingqiang Ding;Jiawen Yu;Haile Pan(Department of Orthopedics,Beijing Shunyi Hospital,Beijing 101312,China;Department of Minimally Invasive Surgery for Joint Diseases and Department of Sports Medicine,the 2nd Affiliated Hospital of Harbin Medical University,Harbin 150081,China;Department of Orthopedics,the First Affiliated Hospital of Hebei North University,Shijiazhuang 050051,China)

机构地区：[1]北京市顺义区医院骨二科,101312 [2]哈尔滨医科大学附属第二医院关节疾病微创外科、运动医学科,150081 [3]河北北方学院附属第一医院骨一科,石家庄050051

出　　处：《中华肩肘外科电子杂志》2022年第3期214-220,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的探究应用自体髌骨股四头肌肌腱移植物修复家兔巨大肩袖损伤愈合效果的实验研究。方法将36只成年健康家兔随机分为3组,分别为对照组(n=12)、缝线修复组(n=12)、移植物修复组(n=12)。对照组切开一侧肩关节,暴露肩袖肌腱后缝合伤口;缝线修复组采用经骨缝合方法将切断的肩袖肌腱缝合至肱骨大结节;移植物修复组将自体髌骨股四头肌肌腱移植物缝合至肩袖破裂处,髌骨固定于肱骨大结节,股四头肌肌腱固定于关节盂。术后6周各组处死6只家兔进行生物力学测试,术后8周每组处死6只家兔进行组织形态学分析。结果生物力学研究结果显示移植物修复组的拉力最大值明显大于缝线修复组(P<0.05),其与对照组无明显差异。组织形态学分析显示移植物修复组髌骨与肱骨愈合良好;缝线修复组可见缝合部位腱骨愈合不佳,与肱骨连接处纤维组织较为疏松。结论自体髌骨股四头肌肌腱修复家兔巨大肩袖损伤可在肱骨处以骨-骨愈合方式取代腱-骨愈合,达到更好的愈合强度。Background The rotator cuff is composed of the subscapularis,supraspinatus,infraspinatus,and teres minor muscles and plays a crucial role in the movement of the shoulder joint.Rotator cuff tears are one of the most common causes of shoulder pain and dysfunction.The number of outpatient visits and surgeries for rotator cuff tears is increasing and will continue to rise as the population ages.The incidence of rotator cuff injury in athletes increases dramatically,especially in antagonistic and overhead-throwing sports.Massive rotator cuff tear(MRCT)refers to a rotator cuff defect of more than 5 cm or involving two or more rotator cuff tendons,which cannot be repaired entirely due to tendon retraction,fatty infiltration,or muscle atrophy.It is called an irreparable rotator cuff tear(IRCT).After rotator cuff injury,patients presented with obvious shoulder pain and dysfunction.Superior capsule reconstruction(SCR)for the treatment of IRCT was first proposed by Mihata and has achieved good clinical outcomes.However,there are still some patients with postoperative retears.The main area of retear after rotator cuff injury occurs at the tendon-bone junction in the rotator cuff footmark area.The main reason is that the tendon-bone junction fails to form true tendon-bone healing but scar healing after rotator cuff repair.There are a variety of grafts available for SCR surgery,but all of them are soft grafts.The final healing mode of humeral foot marks is tendon-bone union,and the healing strength is lower than that of the normal tendon-bone junction.Objective To investigate the healing effect of autologous patella quadriceps femoris tendon graft in repairing massive rotator cuff injury in rabbits.Methods Thirty-six healthy adult rabbits were randomly divided into three groups:the control group(n=12),the suture repair group(n=12),and the graft repair group(n=12).In the control group,the shoulder joint was cut open,the rotator cuff tendon was exposed,and the wound was sutured.In the suture repair group,the severed rotator cuff

关 键 词：肩袖损伤 生物力学 腱-骨愈合 骨-骨愈合 

分 类 号：R686.1[医药卫生—骨科学]