单排技术与线桥技术修复兔全层肩袖损伤的比较

A comparison of suture bridge and single row techniques in repair of full-thickness rotator cuff tears in a rabbit model

目的 比较单排技术与线桥技术修复兔全层肩袖损伤的治疗效果. 方法 取骨骼成熟的雄性新西兰大白兔76只,体质量为2.5～3.0 kg,平均2.8 kg,均为12个月龄.将兔冈上肌肌腱在足印区处切断制作兔全层肩袖模型,并随机分成2组（n=38）：采用单排技术修复肩袖损伤（单排组）和线桥技术修复肩袖损伤（线桥组）,手术肩均为右侧肩关节,左肩关节作对照组不予任何处理.术后第2、4、8周取材,显微镜下观察、修补肩袖的愈合情况,并在术后第8周进行生物力学实验,分析2种方法的优、缺点. 结果 线桥组在术后第2、4、8周时,修复肩袖的前1/3区域与中1/3区域腱-骨联合部比较,在软骨生长、胶原纤维形态方面均无明显差异;而单排组修复肩袖的中1/3区域腱-骨联合部软骨生长、胶原纤维形态均较前1/3区域成熟,差异明显.在术后第8周,修复冈上肌的腱-骨界面最大失效负荷线桥组[（134.59±17.69） N]明显大于单排组[（72.23±12.08） N],差异有统计学意义（P＜0.05）,但线桥组仍小于正常对照组[（192.61±9.42） N],差异有统计学意义（P＜0.05）.术后第8周时单排组2只兔出现肩袖再撕裂,而线桥组无一只兔出现失败. 结论 线桥技术修复肩袖是一种可行、可靠的修复方法,较单排修复技术具有更优的愈合效果.

Objective To compare suture bridge and single row techniques in repair of rotator cuff tears in a rabbit model.Methods Seventy-six mature male New Zealand white rabbits were used in this study.The 12-month old rabbits,weighing from 2.5 to 3.0 kg （average,2.8 kg）,were made models of full-thickness rotator cuff tear by cutting off at the foot print the supraspinatus tendon.The models were randomly divided into 2 even groups （n =38 each）.Their right shoulders were repaired by suture bridge and single row techniques respectively in the 2 groups,with their left shoulders untreated as controls.The rabbits were then sacrificed at the 2nd,4th and 8th weeks after surgery for histological comparisons of healing under microscopy.Biomechanical comparisons were made at the 8th week to analyze advantages and disadvantages of the two methods.Results At 2,4 and 8 weeks postoperatively,there were no significant differences between the anterior and middle 1/3 zones of bone-tendon junction regarding cartilage growth or collagen fiber morphology in the suture bridge group,while the cartilage growth and collagen fiber morphology in the middle 1/3 zone of bone-tendon junction were significantly more mature than in the anterior 1/3 zone in the single row group.At the 8th postoperative week,the load to failure in the suture bridge group （134.59 ± 17.69 N） was significantly higher than that in the single row group （72.23 ± 12.08 N） （P 〈 0.05）,but remained significantly lower than that in the control group （192.61 ± 9.42 N） （P 〈 0.05）.Conclusion The suture bridge technique is a feasible and reliable method for repair of rotator cuff tear and has a better healing effect than the single row technique.