骨膜补片加强修复促进肩袖腱骨愈合

Autologous periosteum patch enhances tendon-bone healing in rotator cuff repair

背景:最新研究表明,肩袖补片可降低肌腱和骨之间的张力,可为生长因子和细胞生长提供制成的附着点,促进肩袖止点的生物学重建,然而何种材料作为肩袖补片是最安全有效的尚无明确共识。目的:探讨自体骨膜补片加强修复对肩袖腱骨愈合的影响。方法:取48只新西兰白兔,建立单侧肩袖急性肩袖损伤模型,随机分2组修复,对照组进行单纯缝合固定修复,实验组在对照组基础上进行自体骨膜补片加强修复,修复后4,8,12周取肱骨近端标本,进行组织学观察与生物力学测试。结果与结论:①组织学观察:实验组修复后4周可见大量胶原纤维连接和炎性细胞浸润,间充质细胞增生明显,有少量软骨细胞;修复后8周可见膜内化骨,大量新生软骨细胞;修复后12周可见肌腱与骨结合紧密,无间隙,软骨细胞排列规整,类似正常的腱骨界面结构。对照组修复后4周可见疏松结缔组织填充;修复后8周止点处可见大量成纤维细胞,少量胶原纤维连接,少量软骨细胞形成;修复后12周可见胶原纤维连接,软骨细胞排列紊乱;②生物力学测试:两组最大负荷随时间增加逐渐增大,实验组修复后不同时间点的最大负荷高于对照组(P<0.05);③结果表明:自体骨膜补片可有效促进肩袖腱骨愈合。

BACKGROUND:The latest research shows that the rotator cuff patch can reduce tendon-bone tension,provide the point of attachment for growth factor and cell growth,and promote biological reconstruction of the rotator cuff,but what kind of material as the rotator cuff patch is the most effectively and safety is unclear.OBJECTIVE:To investigate the effect of autologous periosteum patch on the tendon-bone healing in rotator cuff repair.METHODS:Forty-eight New Zealand white rabbits were selected to make acute unilateral rotator cuff injury models and then randomly divided into two groups:control group treated with simple suture repair and experimental group treated with autologous periosteum patch on the basis of suture repair.At4,8,12weeks after repair,proximal humerus specimens were taken,and the histological observation and biomechanical testing were recorded.RESULTS AND CONCLUSION:(1)Histological observation:At4weeks after repair,the experimental group showed a large amount of interconnected collagen fibers and infiltrated inflammatory cells and a small amount of cartilage cells,and mesenchymal stem cells proliferated remarkably.At8weeks after repair,the experimental group showed a large amount of cartilage cells.At12weeks,in the experimental group,the tendon bone interface was similar to normal with regular arrangement of cartilage cells.In the control group,loose connective tissues were seen at4weeks;a large amount of fibroblasts appeared at the ending point,a small amount of collagen fibers were connected and a small amount of chondrocytes were formed at8weeks after repair;collagen fibers were connected and chondrocytes were disordered at12weeks after repair.(2)Biomechanical test:The maximum load of the two groups increased gradually with time,and the maximum load of the experimental group was higher than that of the control group at different time points(P<0.05).To conclude,the autologous periosteum patch can effectively promote the tendon-bone healing in rotator cuff repair.