组织工程修复肩袖损伤促进腱骨愈合的研究进展

Progress in tissue-engineering for tendon-to-bone healing after rotator cuff repair

肩关节已成为继腰背、膝关节之后运动系统疼痛的第三大好发部位[1],特别是在60岁以上的老年人群中,肩袖损伤是引起肩关节疼痛的最主要原因[2],并且常伴有功能减退及睡眠障碍等。普通人群调查显示[3],肩袖全层撕裂的患病率为22.1%（147/664）,其中无症状患者约为有症状的两倍,并随年龄的增长而增加[4-9]。肩袖损伤的处理是复杂的,

Rotator cuff injury, considered as a resource of pain, disability and dyssomnia to serious decline in the quality of life, is a common disorder of the shoulder joint. Basic principles of rotator cuff repair aim at achieving high initial fixation strength, maintaining mechanical stability and restoring the anatomic healing of the cuff tendon. After the routine surgical procedure for rotator cuff repair, the biology and histology of the normal enthesis are not restored. Tendon-to-bone healing occurs with a fibrovascular scar tissue interface that is mechanically inferior to the native insertion site, which may lead to high re-rupture rate. For these reasons, new approaches are required to improve structural healing. Tissue engineering strategies have been suggested to improve the biological environment around the bone-tendon interface and to promote regeneration of the native insertion site. Although experimental applications of growth factors and scaffolds on animal models demonstrate promising results, techniques which can be used in human rotator cuff repair are still very limited. Tissue engineering to improve tendon-to-bone healing has bright future and requires more research before its clinical applications. This review will outline therapies of growth factors, scaffolds and stem cells in tendon healing and rotator cuff repair.