辛伐他汀与明胶海绵对兔肩袖修复术后腱-骨愈合的影响

Effects of the complex of simvastatin and gelatin sponge on tendon-bone healing after rotator cuff repair in rabbits

目的探讨局部应用辛伐他汀/明胶海绵复合物对兔肩袖损伤修复术后腱-骨愈合的影响。方法选取24只成年雄性新西兰大白兔,随机分为实验组(n=12)和对照组(n=12)。实验组在肱骨大结节骨槽上填塞辛伐他汀/明胶海绵复合物并将冈上肌缝合回足印区;对照组仅在肱骨大结节骨槽上填塞明胶海绵并缝合回足印区。所有兔子在术后2、4、8周处死行生物力学及HE染色,观察冈上肌腱-骨愈合情况。结果大体观察结果显示:所有兔子术后均存活,切口愈合良好,未见渗液、感染及辛伐他汀不良反应。生物力学结果显示:术后4周实验组腱-骨界面的最大抗拉强度(50.71±3.40)N,刚度(37.81±5.17)N/mm,均高于对照组腱-骨界面的最大抗拉强度(44.25±4.41)N,刚度(30.12±1.54)N/mm,差异有统计学意义(P<0.05)。术后8周实验组腱-骨界面的最大抗拉强度(69.20±6.25)N,刚度(55.86±6.03)N/mm均高于对照组腱-骨界面的最大抗拉强度(50.24±5.89)N,刚度(34.40±2.40)N/mm,差异有统计学意义(P<0.05)。HE染色结果显示实验组2周腱-骨界面见大量新生毛细血管;4周见软骨细胞增生;8周见"潮线"结构以及密集的Sharpey纤维。对照组2周腱-骨界面结合松散,见梭形成纤维细胞增生;4周未见软骨细胞;8周见疏松无序的Sharpey纤维。结论局部应用辛伐他汀/明胶海绵复合物能够促进兔肩袖损伤修复术后腱-骨愈合。

Objective To explore effects of the local application of simvastatin combined with gelatin sponge on the tendon-bone healing after the reconstruction of rotator cuff injury in rabbits. Methods Twenty-four adult male New Zealand white rabbits were randomly divided into the experimental group（ n = 12） and control group（ n = 12）. In the experimental group, the complex of simvastatin/gelatin sponge was stuffed into the bone trough the large tuberosity of the humerus and the supraspinatus was sutured back to the foot print area. In the control group, only gelatin sponge was stuffed into the bone trough the large tuberosity of the humerus and and the supraspinatus was sutured back to the foot print area. To investigate the tendon-bone healing of the supraspinatus, all rabbits sacrificed at 2, 4 and 8 weeks after operation and were subjected to biomechanical and HE staining. Results The gross observation showed that all rabbits survived and the incision healed well after surgery. No exudate, infection or adverse reaction of simvastatin were observed. The biomechanical results revealed that 4 weeks after operation, the maximum tensile strength（ 50.71 ± 3.40） N, and stiffness（ 37.81 ± 5.17） N/mm of the tendon bone interface in the experimental group were higher than the maximum tensile strength（ 44.25 ± 4.41） N, and stiffness（ 30.12 ± 1.54） N/mm of the tendon bone interface in the control group with statistical significance（ P 0.05）. Eight weeks after operation, the maximum tensile strength（ 69.20 ± 6.25） N, and stiffness（ 55.86 ± 6.03） N/mm of the tendon bone interface in the experimental group were higher than the maximum tensile strength（ 50.24 ± 5.89） N, and stiffness（ 34.40 ± 2.40） N/mm of the tendon bone interface in the control group with statistical significance（ P 0.05）. HE staining results in the experimental group： a large number of new capillaries at the tendon-bone interface 2 weeks postoperatively; proliferation of cartilage cells at the tendon-bone interface 4 weeks postoperatively; structure of ＂Tide line＂ and dense Sharpey fiber were observed 8 weeks postoperatively. HE staining results in the control group： the tendon-bone interface was combined loosely and the proliferation of spindle forming fibroblasts can be seen 2 weeks postoperatively; no cartilage cells 4 weeks postoperatively; loose and disordered Sharpey fibers 8 weeks postoperatively. ConclusionsLocal application of simvastatin combined with gelatin sponge significantly promotes tendon-bone healing after the repair of rotator cuff injury in rabbits.