CAJ | 학술논문

目的应用兔建立急性肩袖损伤模型,研究不同时间手术修复对冈上肌腱-骨愈合、腱-骨界面胶原纤维的生长分布以及生物力学特性的影响.方法取90只骨骼成熟的雄性新西兰大耳白兔,均行右侧冈上肌切断术,建立急性肩袖损伤模型.随机分为3组:早期修复组,术后1周行腱-骨缝合；晚期修复组,术后4周进行修复；不修复组,作为对照.分别于术后2、4、8周通过HE染色观察腱－骨愈合情况,通过苦味酸天狼星红染色计算Ⅰ型/Ⅲ型胶原面积比,代表胶原纤维生长分布情况:测量术侧和健侧冈上肌断裂的最大负荷,并计算二者的百分比.结果各组均未观察到明显的冈上肌脂肪浸润和萎缩变性.早期和晚期修复组在8周时形成了新的冈上肌止点.在早期修复组和晚期修复组,8周时Ⅰ型/Ⅲ型胶原比(2.02±0.77和2.06±0.58)显著大于2周时(1.10±0.24和1.14 ±0.50;t =3.082、3.655,P＜0.01).各组冈上肌术侧/健侧最大负荷百分比在2、4及8周的情况:早期修复组(38％±11％、66％±7％、89％±4％)和晚期修复组(41％±16％、63％±7％、89％±9％)均显著高于不修复组(14％±6％、32％±4％、56％±12％),差异具有统计学意义(早期修复组:t=3.311、8.549、5.719；晚期修复组:t＝ 3.713、8.063、6.044；P＜0.01)；各组在8周时的冈上肌术侧/健侧最大负荷百分比显著高于4周(t =3.878 ～4.613,P＜0.01)和2周时(t＝7.158 ～10.024,P＜0.01).结论急性肩袖损伤在4周内修复可形成新止点,提高腱-骨界面Ⅰ型胶原的比例,恢复冈上肌的生物力学强度.
목적 응용토건립급성견수손상모형,연구불동시간수술수복대강상기건-골유합、건-골계면효원섬유적생장분포이급생물역학특성적영향.방법 취90지골격성숙적웅성신서란대이백토,균행우측강상기절단술,건립급성견수손상모형.수궤분위3조:조기수복조,술후1주행건-골봉합；만기수복조,술후4주진행수복；불수복조,작위대조.분별우술후2、4、8주통과HE염색관찰건－골유합정황,통과고미산천랑성홍염색계산Ⅰ형/Ⅲ형효원면적비,대표효원섬유생장분포정황:측량술측화건측강상기단렬적최대부하,병계산이자적백분비.결과 각조균미관찰도명현적강상기지방침윤화위축변성.조기화만기수복조재8주시형성료신적강상기지점.재조기수복조화만기수복조,8주시Ⅰ형/Ⅲ형효원비(2.02±0.77화2.06±0.58)현저대우2주시(1.10±0.24화1.14 ±0.50;t =3.082、3.655,P＜0.01).각조강상기술측/건측최대부하백분비재2、4급8주적정황:조기수복조(38％±11％、66％±7％、89％±4％)화만기수복조(41％±16％、63％±7％、89％±9％)균현저고우불수복조(14％±6％、32％±4％、56％±12％),차이구유통계학의의(조기수복조:t=3.311、8.549、5.719；만기수복조:t＝ 3.713、8.063、6.044；P＜0.01)；각조재8주시적강상기술측/건측최대부하백분비현저고우4주(t =3.878 ～4.613,P＜0.01)화2주시(t＝7.158 ～10.024,P＜0.01).결론 급성견수손상재4주내수복가형성신지점,제고건-골계면Ⅰ형효원적비례,회복강상기적생물역학강도.
Objectives To establish the animal model of acute rotator cuff tear in rabbits,and study the effect of timing of surgical repair on healing of tendon-bone interface,formation and distribution of collagens in the supraspinatus tendon insertion and biomechanical properties of supraspinatus. Methods Supraspinatus tenotomy was performed in the right shoulder of 90 skeletally matured male New Zealand white rabbits to establish the animal model of acute rotator cuff tear.The rabbits were randomly divided into 3 groups:group of early repair,repaired at 1 week after tenotomy; group of late repair,repaired at 4 weeks after tenotomy; and group without repair,used as control.At 2 weeks,4 weeks and 8 weeks after repair,healing of tendon-bone interface was observed by HE staining.Collagens were observed by Sirius Red F 3B (SR) in saturated carbazotic acid staining.The areas of type Ⅰ and Ⅲ collagens were measured by using imaging analysis software and the ratio of type Ⅰ and Ⅲ collagens were calculated. Failure loads of supraspinatus on both sides were measured.The percentage of failure loads of the surgical side was calculated and contralateral supraspinatus were uninjured.Results There was no obvious fatty infiltration and muscle atrophy in supraspinatus in all groups. At 8 weeks,the formation of a new enthesis of supraspinatus in groups of early and late repair were observed.In groups of early and late repair,the ratio of areas of type Ⅰ and Ⅲ collagens at 8 weeks (2.02 ± 0.77 and 2.06 ± 0.58 ) was larger than that at 2 weeks ( 1.10 ± 0.24 and 1.14 ± 0.50,t =3.082,3.655,P ＜ 0.01 ).At 2,4 and 8 weeks,the percentages of failure loads of the surgical side and uninjured contralateral supraspinatus in group of early repair( 38％ ±11％,66％ ±7％,89％ ±4％)and group of late repair(41％ ± 16％,63％ ±7％,89％ ±9％) were both higher than that in group without repair ( 14％ ±6％,32％ ±4％,56％ ± 12％ ) ; the differences were all statistically significant( group of early repair:t =3.311,8.549,5.719;group of late repair:t =3.713,8.063,6.044;P ＜ 0.01 ).The percentage of failure loads of the surgical side and uninjured contralateral supraspinatus at 8 weeks was higher than those at 4 weeks (t =3.878-4.613,P ＜0.01 ) and 2 weeks (t =7.158-10.024,P ＜ 0.01 ) in all groups.Conclusions Surgical repair within 4 weeks of acute rotator cuff tear lead to formation of a new enthesis of supraspinatus,improvement of both ratio of type Ⅰ collagen in the supraspinatus tendon insertion and biomechanical properties of supraspinatus.