BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain uncl...BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain unclear.AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.METHODS We performed a systematic electronic database search on PubMed,EMBASE,and Cochrane Library.Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria.Biomechanical studies were assessed for main results and conclusions.Included clinical studies were evaluated for quality of methodology.Data including study characteristics,cohort demographics,and outcomes were extracted.A meta-analysis was conducted of the clinical outcomes.RESULTS According to our inclusion and exclusion criteria,a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion(ROM)after LHBT transposition for MIRCTs.A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes,consisting of 253 patients.The results indicated that compared to other surgical methods for MIRCTs,LHBT transposition had advantages of more significant improvement in ROM(forward flexion mean difference[MD]=6.54,95%confidence interval[CI]:3.07-10.01;external rotation[MD=5.15,95%CI:1.59-8.17];the acromiohumeral distance[AHD][MD=0.90,95%CI:0.21-1.59])and reducing retear rate(odds ratio=0.27,95%CI:0.15-0.48).No significant difference in American Shoulder and Elbow Surgeons score,visual analogue scale score,and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.CONCLUSION In general,SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs,both in terms of biomechanical and clinical outcomes,with comparable clinical outcomes,improved ROM,AHD,and reduced the retear rates compared to conventional SCR and other established techniques.More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.展开更多
BACKGROUND Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair.We propose using a synthetic polypropylene mesh to increase the tensile strength of rota...BACKGROUND Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair.We propose using a synthetic polypropylene mesh to increase the tensile strength of rotator cuff repairs.We hypothesize that using a polypropylene mesh to bridge the repair of large rotator cuff tears will increase the ultimate failure load of the repair.AIM To investigate the mechanical properties of rotator cuff tears repaired with a polypropylene interposition graft in an ovine ex-vivo model.METHODS A 20 mm length of infraspinatus tendon was resected from fifteen fresh sheep shoulders to simulate a large tear.We used a polypropylene mesh as an interposition graft between the ends of the tendon for repair.In seven specimens,the mesh was secured to remnant tendon by continuous stitching while mattress stitches were used for eight specimens.Five specimens with an intact tendon were tested.The specimens underwent cyclic loading to determine the ultimate failure load and gap formation.RESULTS The mean gap formation after 3000 cycles was 1.67 mm in the continuous group,and 4.16 mm in the mattress group(P=0.001).The mean ultimate failure load was significantly higher at 549.2 N in the continuous group,426.4 N in the mattress group and 370 N in the intact group(P=0.003).CONCLUSION The use of a polypropylene mesh is biomechanically suitable as an interposition graft for large irreparable rotator cuff tears.展开更多
目的:探讨肩关节镜下应用改良Chinese-way技术治疗巨大肩袖撕裂的临床疗效。方法:自2019年1月至2022年6月采用肩关节镜下改良Chinese-way技术治疗22例巨大肩袖撕裂患者,其中男10例,女12例;年龄46~76(64.14±7.45)岁;病程5~14(8.32&#...目的:探讨肩关节镜下应用改良Chinese-way技术治疗巨大肩袖撕裂的临床疗效。方法:自2019年1月至2022年6月采用肩关节镜下改良Chinese-way技术治疗22例巨大肩袖撕裂患者,其中男10例,女12例;年龄46~76(64.14±7.45)岁;病程5~14(8.32±2.42)个月;19例采用完全修补,3例采用部分修补。分别于术前和术后1年采用视觉模拟评分(visual analogue scale,VAS)、加州大学洛杉矶分校(University of California Los Angeles,UCLA)评分评价疼痛与肩关节功能;并观察术后并发症情况,影像学随访重建组织结构的完整性,肩峰下间隙大小。结果:22例患者获得随访,时间12~34(17.14±5.93)个月。MRI随访4例发生再撕裂(患者对功能满意,未进一步处理)外,其余均未出现切口感染、周围神经损伤、锚钉松动脱落等并发症。术前及术后1年VAS分别为(8.05±1.12)分和(1.82±1.50)分;UCLA评分分别为(7.45±1.65)分和(31.41±2.87)分,差异均有统计学意义(P<0.05)。结论:肩关节镜下改良Chinese-way技术修补巨大肩袖撕裂,可明显缓解疼痛,改善肩关节功能,早期临床疗效满意。展开更多
目的基于托法原则研究探索姜黄素靶向内核苷酸结合寡聚化结构域样受体家族含热蛋白结构域蛋白3(nucleotidebinding domain and leucine-rich repeat protein 3,NLRP3)/炎症小体炎症因子白细胞介素1β(recombinant human interleukin-1β...目的基于托法原则研究探索姜黄素靶向内核苷酸结合寡聚化结构域样受体家族含热蛋白结构域蛋白3(nucleotidebinding domain and leucine-rich repeat protein 3,NLRP3)/炎症小体炎症因子白细胞介素1β(recombinant human interleukin-1β,IL-1β)炎性通路对巨大肩袖撕裂中肌肉脂肪浸润的抑制作用及机制。方法构建30只大鼠肩关节慢性巨大肩袖撕裂模型,并根据姜黄素给入的剂量不同将30只大鼠模型分为3组,即普通膳食组、姜黄素混合膳食低剂量组、姜黄素混合膳食高剂量组,每组各有大鼠模型10只。对30只大鼠肩关节慢性巨大肩袖撕裂模型分别进行药物干预后,获取3组大鼠模型在第2、3、4周的肩关节固定脱钙组织切片,分别检测3组大鼠模型的脂肪浸软程度,并对大鼠巨大肩袖撕裂肌肉组织中NLRP3、IL-1β指标进行检测,探讨姜黄素对巨大肩袖撕裂中肌肉脂肪浸润的抑制作用。结果相比于普通膳食组,姜黄素混合膳食低剂量组和高剂量组的炎症因子水平均明显下降,且姜黄素混合膳食高剂量组下降的具有明显的特征性,差异有统计学意义(P<0.05)。结论根据托法理论的治疗原则,利用姜黄素治疗巨大肩袖撕裂能够有效地干预该疾病的脂肪浸润,这主要是由于姜黄素治疗能够通过对NLRP3炎症小体进行有效地抑制,减少IL-1β的生成,从而能够有效地减轻骨骼肌炎性损伤,能够通过NLRP3/IL-1β炎性通路抑制骨骼肌干细胞的脂肪分化,减少慢性过程中肌肉的脂肪浸润,从而改善肩袖肌腱肌肉的生物活力。展开更多
Electrospun fibers,with proven ability to promote tissue regeneration,are widely being explored for rotator cuff repairing.However,without post treatment,the microstructure of the electrospun scaffold is vastly differ...Electrospun fibers,with proven ability to promote tissue regeneration,are widely being explored for rotator cuff repairing.However,without post treatment,the microstructure of the electrospun scaffold is vastly different from that of natural extracellular matrix(ECM).Moreover,during mechanical loading,the nanofibers slip that hampers the proliferation and differentiation of migrating stem cells.Here,electrospun nanofiber scaffolds,with crimped nanofibers and welded joints to biomimic the intricate natural microstructure of tendon-to-bone insertion,were prepared using poly(ester-urethane)urea and gelatin via electrospinning and double crosslinking by a multi-bonding network densification strategy.The crimped nanofiber scaffold(CNS)features bionic tensile stress and induces chondrogenic differentiation,laying credible basis for in vivo experimentation.After repairing a rabbit massive rotator cuff tear using a CNS for 3 months,the continuous translational tendon-to-bone interface was fully regenerated,and fatty infiltration was simultaneously inhibited.Instead of micro-CT,μCT was employed to visualize the integrity and intricateness of the three-dimensional microstructure of the CNS-induced-healed tendon-to-bone interface at an ultra-high resolution of less than 1μm.This study sheds light on the correlation between nanofiber post treatment and massive rotator cuff repair and provides a general strategy for crimped nanofiber preparation and tendon-to-bone interface imaging characterization.展开更多
基金the National Natural Science Foundation of China,No.81972125 and No.82172510.
文摘BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain unclear.AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.METHODS We performed a systematic electronic database search on PubMed,EMBASE,and Cochrane Library.Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria.Biomechanical studies were assessed for main results and conclusions.Included clinical studies were evaluated for quality of methodology.Data including study characteristics,cohort demographics,and outcomes were extracted.A meta-analysis was conducted of the clinical outcomes.RESULTS According to our inclusion and exclusion criteria,a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion(ROM)after LHBT transposition for MIRCTs.A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes,consisting of 253 patients.The results indicated that compared to other surgical methods for MIRCTs,LHBT transposition had advantages of more significant improvement in ROM(forward flexion mean difference[MD]=6.54,95%confidence interval[CI]:3.07-10.01;external rotation[MD=5.15,95%CI:1.59-8.17];the acromiohumeral distance[AHD][MD=0.90,95%CI:0.21-1.59])and reducing retear rate(odds ratio=0.27,95%CI:0.15-0.48).No significant difference in American Shoulder and Elbow Surgeons score,visual analogue scale score,and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.CONCLUSION In general,SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs,both in terms of biomechanical and clinical outcomes,with comparable clinical outcomes,improved ROM,AHD,and reduced the retear rates compared to conventional SCR and other established techniques.More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.
文摘BACKGROUND Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair.We propose using a synthetic polypropylene mesh to increase the tensile strength of rotator cuff repairs.We hypothesize that using a polypropylene mesh to bridge the repair of large rotator cuff tears will increase the ultimate failure load of the repair.AIM To investigate the mechanical properties of rotator cuff tears repaired with a polypropylene interposition graft in an ovine ex-vivo model.METHODS A 20 mm length of infraspinatus tendon was resected from fifteen fresh sheep shoulders to simulate a large tear.We used a polypropylene mesh as an interposition graft between the ends of the tendon for repair.In seven specimens,the mesh was secured to remnant tendon by continuous stitching while mattress stitches were used for eight specimens.Five specimens with an intact tendon were tested.The specimens underwent cyclic loading to determine the ultimate failure load and gap formation.RESULTS The mean gap formation after 3000 cycles was 1.67 mm in the continuous group,and 4.16 mm in the mattress group(P=0.001).The mean ultimate failure load was significantly higher at 549.2 N in the continuous group,426.4 N in the mattress group and 370 N in the intact group(P=0.003).CONCLUSION The use of a polypropylene mesh is biomechanically suitable as an interposition graft for large irreparable rotator cuff tears.
文摘目的:探讨肩关节镜下应用改良Chinese-way技术治疗巨大肩袖撕裂的临床疗效。方法:自2019年1月至2022年6月采用肩关节镜下改良Chinese-way技术治疗22例巨大肩袖撕裂患者,其中男10例,女12例;年龄46~76(64.14±7.45)岁;病程5~14(8.32±2.42)个月;19例采用完全修补,3例采用部分修补。分别于术前和术后1年采用视觉模拟评分(visual analogue scale,VAS)、加州大学洛杉矶分校(University of California Los Angeles,UCLA)评分评价疼痛与肩关节功能;并观察术后并发症情况,影像学随访重建组织结构的完整性,肩峰下间隙大小。结果:22例患者获得随访,时间12~34(17.14±5.93)个月。MRI随访4例发生再撕裂(患者对功能满意,未进一步处理)外,其余均未出现切口感染、周围神经损伤、锚钉松动脱落等并发症。术前及术后1年VAS分别为(8.05±1.12)分和(1.82±1.50)分;UCLA评分分别为(7.45±1.65)分和(31.41±2.87)分,差异均有统计学意义(P<0.05)。结论:肩关节镜下改良Chinese-way技术修补巨大肩袖撕裂,可明显缓解疼痛,改善肩关节功能,早期临床疗效满意。
文摘目的基于托法原则研究探索姜黄素靶向内核苷酸结合寡聚化结构域样受体家族含热蛋白结构域蛋白3(nucleotidebinding domain and leucine-rich repeat protein 3,NLRP3)/炎症小体炎症因子白细胞介素1β(recombinant human interleukin-1β,IL-1β)炎性通路对巨大肩袖撕裂中肌肉脂肪浸润的抑制作用及机制。方法构建30只大鼠肩关节慢性巨大肩袖撕裂模型,并根据姜黄素给入的剂量不同将30只大鼠模型分为3组,即普通膳食组、姜黄素混合膳食低剂量组、姜黄素混合膳食高剂量组,每组各有大鼠模型10只。对30只大鼠肩关节慢性巨大肩袖撕裂模型分别进行药物干预后,获取3组大鼠模型在第2、3、4周的肩关节固定脱钙组织切片,分别检测3组大鼠模型的脂肪浸软程度,并对大鼠巨大肩袖撕裂肌肉组织中NLRP3、IL-1β指标进行检测,探讨姜黄素对巨大肩袖撕裂中肌肉脂肪浸润的抑制作用。结果相比于普通膳食组,姜黄素混合膳食低剂量组和高剂量组的炎症因子水平均明显下降,且姜黄素混合膳食高剂量组下降的具有明显的特征性,差异有统计学意义(P<0.05)。结论根据托法理论的治疗原则,利用姜黄素治疗巨大肩袖撕裂能够有效地干预该疾病的脂肪浸润,这主要是由于姜黄素治疗能够通过对NLRP3炎症小体进行有效地抑制,减少IL-1β的生成,从而能够有效地减轻骨骼肌炎性损伤,能够通过NLRP3/IL-1β炎性通路抑制骨骼肌干细胞的脂肪分化,减少慢性过程中肌肉的脂肪浸润,从而改善肩袖肌腱肌肉的生物活力。
基金supported by Instrumental Analysis Center of Shanghai Jiao Tong University.This work was supported by the National Natural Science Foundation of China[Grant No.81902186,81671920,31972923,81871753,81772341]National Key Research and Development Program of China[Grant No.2018YFC1106200,2018YFC1106201,2018YFC1106202]Technology Support Project of Science and Technology Commission of Shanghai Municipality of China[Grant No.19441901700,19441901701,19441901702,18441902800].
文摘Electrospun fibers,with proven ability to promote tissue regeneration,are widely being explored for rotator cuff repairing.However,without post treatment,the microstructure of the electrospun scaffold is vastly different from that of natural extracellular matrix(ECM).Moreover,during mechanical loading,the nanofibers slip that hampers the proliferation and differentiation of migrating stem cells.Here,electrospun nanofiber scaffolds,with crimped nanofibers and welded joints to biomimic the intricate natural microstructure of tendon-to-bone insertion,were prepared using poly(ester-urethane)urea and gelatin via electrospinning and double crosslinking by a multi-bonding network densification strategy.The crimped nanofiber scaffold(CNS)features bionic tensile stress and induces chondrogenic differentiation,laying credible basis for in vivo experimentation.After repairing a rabbit massive rotator cuff tear using a CNS for 3 months,the continuous translational tendon-to-bone interface was fully regenerated,and fatty infiltration was simultaneously inhibited.Instead of micro-CT,μCT was employed to visualize the integrity and intricateness of the three-dimensional microstructure of the CNS-induced-healed tendon-to-bone interface at an ultra-high resolution of less than 1μm.This study sheds light on the correlation between nanofiber post treatment and massive rotator cuff repair and provides a general strategy for crimped nanofiber preparation and tendon-to-bone interface imaging characterization.
