CAJ | 학술논문

目的：探讨应力丧失在急性肩袖损伤后修复过程中的作用机制。方法选用成年雄性SD大鼠24只，随机分为肉毒素组和生理盐水组（ n＝12）。将冈上肌腱于大结节止点处横断后原位缝合，建立大鼠冈上肌腱损伤模型。肉毒素组于造模后冈上肌肌注肉毒素A，生理盐水组于同侧冈上肌注射等量生理盐水。分别于术后4周和12周取材，比较两组肌腱－骨界面的胶原、纤维软骨、血管内皮生长因子（ VEGF）以及破骨细胞特异性的抗酒石酸染色（ TRAP）的表达情况。结果术后4周，生理盐水组的肌腱－骨界面的胶原、纤维软骨、TRAP和VEGF的表达优于肉毒素组，其中VEGF的免疫组化评分结果，肉毒素组和生理盐水组的分值分别为（4．2±1．6）和（8．2±2．8）分（t＝3．83， P＜0．05）。术后12周，因肉毒素组应力逐渐恢复，可见肉毒素组腱骨界面逐渐得到修复。结论应力丧失能抑制血管内皮生长因子的表达，增加局部破骨细胞活动从而抑制肩袖损伤后的肌腱－骨界面的修复。
목적：탐토응력상실재급성견수손상후수복과정중적작용궤제。방법선용성년웅성SD대서24지，수궤분위육독소조화생리염수조（ n＝12）。장강상기건우대결절지점처횡단후원위봉합，건립대서강상기건손상모형。육독소조우조모후강상기기주육독소A，생리염수조우동측강상기주사등량생리염수。분별우술후4주화12주취재，비교량조기건－골계면적효원、섬유연골、혈관내피생장인자（ VEGF）이급파골세포특이성적항주석산염색（ TRAP）적표체정황。결과술후4주，생리염수조적기건－골계면적효원、섬유연골、TRAP화VEGF적표체우우육독소조，기중VEGF적면역조화평분결과，육독소조화생리염수조적분치분별위（4．2±1．6）화（8．2±2．8）분（t＝3．83， P＜0．05）。술후12주，인육독소조응력축점회복，가견육독소조건골계면축점득도수복。결론응력상실능억제혈관내피생장인자적표체，증가국부파골세포활동종이억제견수손상후적기건－골계면적수복。
Objective To explore the role and mechanism of stress loss in the repair process of the actue rotator cuff injury .Methods Twenty-four adult male SD rats were randomly assigned to the “Botox group” (12 cases) and the “Saline group” (12 cases).The supraspinatus tendon was cut off at the osteotendinous junction ( OTJ ) and then sutured in situ .Botulinum toxin A was used to paralyze the supraspinatus after the surgery in the Botox group , while the same amount of saline was injected at the same side of the control group .All the animals were sacrificed in four weeks and 12 weeks after the operation . Collagen fiber , fibrocartilage and immunohistochemical stainning of vascular endothelial growth factor (VEGF), osteoclast specific tartrate resistant acid phosphatase (TRAP) were compared between the two groups.Results Significant differences between the two groups in histology and expression of VEGF and TRAP presented in four weeks after the operation;the immunohistochemical staining scores of VEGF in the botox group and the saline group were (4.2 ±1.6) and (8.2 ±2.8) points, respectively ( t=3.83, P<0.05).With the gradual recovery of the stress , the tendon-bone interface of the Botox group was restored gradually 12 weeks after the surgery .Conclusion Stress loss can inhibit the expression of VEGF , and increase the number of osteoclasts locally , which results in the inhibition of the tendon-bone healing .