共查询到20条相似文献,搜索用时 15 毫秒
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Hironori Yamazaki Nobuyasu Ochiai Tomonori Kenmoku Seiji Ohtori Takahisa Sasho Masayuki Miyagi Tetsuhiro Ishikawa Hiroto Kamoda Sumihisa Orita Yuu Sasaki Takeshi Yamaguchi Takehiro Kijima Kazuhisa Takahashi 《Journal of orthopaedic research》2014,32(2):286-290
The cause of pain following rotator cuff tear has not been fully elucidated. The purpose of this study was to evaluate behavior and inflammatory cytokines in a rat unstabilized rotator cuff defect (UCD) model. Forty‐five Sprague–Dawley rats were divided into three groups: sham; UCD; and stabilized rotator cuff defect (SCD). Gait analysis was examined using CatWalk. Tumor necrosis factor (TNF)‐α, interleukin(IL)‐1β, and IL‐6 were measured within the subacromial bursa and the glenohumeral joint synovium at 21 and 56 days after surgery using an enzyme‐linked immunosorbent assay (ELISA). Stride length, print area and contact intensity in the UCD group was significantly lower than in the sham group after surgery. Stride length, print area and contact intensity in the SCD group was significantly higher than in the UCD group. In contrast, TNF‐α, IL‐1β, and IL‐6 in the UCD group was significantly higher than in the sham group at days 21 and 56. However, TNF‐α, IL‐1β, and IL‐6 in the SCD group was significantly lower than in the UCD group at days 21 and 56. The present results suggest that SCD is effective not only in improving shoulder function but also in reducing inflammatory cytokines, which may serve as one source of pain due to rotator cuff tear. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:286–290, 2014. 相似文献
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BackgroundIt is undetermined how effective superior capsule/capsular reconstruction (SCR) is, and which factors influence clinical outcomes.Questions/purposes(1) To identify which factors influence outcomes in SCR, (2) to evaluate the effect of graft integrity on clinical outcomes, and (3) to compare SCR to other procedures for irreparable rotator cuff tears.MethodsPubMed and EMBASE databases were searched for clinical SCR studies. Data on specific factors that influenced outcomes, that compared outcomes between intact/torn graft groups, or compared SCR to alternative treatments for irreparable tears were extracted by two investigators. Random-effects meta-analysis was performed to compare outcomes between intact vs torn SCR grafts.Results394 articles were identified. 100 full-text articles were screened. 13 studies were included for scoping review. Eight studies were meta-analyzed. Better clinical scores were found in younger patients, with intact/repairable subscapularis, without acetabulization/arthritis, who played sports. In patients with irreparable tears without arthritis, SCR produced similar clinical scores at 2 years as shoulder arthroplasty and partial infraspinatus repair, and greater improvements in ASES and Constant scores than latissimus dorsi tendon transfer. Intact grafts produced better VAS (mean difference [MD] = 0.97, 95% confidence interval [-1.45–0.50], P < 0.0001, I2 = 67%, n [patients] = 261), ASES (MD = 8.29, [2.89–13.70], P = 0.003, I2 = 74%, n = 281), external rotation (MD = 4.49, [0.36–8.61], P = 0.03, I2 = 0%, n = 240), and acromiohumeral distance (MD = 2.45, [0.96–3.94], P = 0.001, I2 = 92%, n = 260) than torn grafts.ConclusionsPatients who underwent SCR for irreparable rotator cuff tears were more likely to have better clinical outcomes if they were younger, had intact/repairable subscapularis, without acetabulization/arthritis, played sports and had intact grafts. 相似文献
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Yasuharu Tomita Jiro Ozaki Goro Sakurai Tosinori Kondo Kimio Nakagaki Susumu Tamai 《Journal of orthopaedic science》1997,2(5):295-300
This study was undertaken to identify and quantitate neural elements in the human subacromial bursa. Biopsy specimens of subacromial
bursae were obtained from patients with rotator cuff tears and from cadavers of patients with no history of shoulder disorder
(controls). We used a modified gold chloride method to characterize neural elements within the subacromial bursa. The population
of intrabursal neural elements was calculated by computerized image analysis. The subacromial bursa demonstrated an extensive
neural network: four morphological types of mechanoreceptors and many free nerve endings were identified. In general, there
was an inverse relationship between the population density of neural elements and the extent of cuff tear. The population
density of neural elements of the subacromial bursa associated with massive cuff tear was significantly lower than that observed
in control shoulders. With regard to clinical symptoms, a significant correlation was established between the population density
of neural elements in the subacromial bursa and shoulder pain at rest. Our investigation strongly suggests that the subacromial
bursa is intimately involved in the perception of shoulder pain, providing an anatomical basis for afferent neural input in
proprioceptive reflex ares. 相似文献
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Bartl C Kouloumentas P Holzapfel K Eichhorn S Wörtler K Imhoff A Salzmann GM 《International journal of shoulder surgery》2012,6(1):1-8
Background:
Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit.Materials and Methods:
During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST) and a pain visual analog scale (VAS). At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol.Results:
The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05). Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs.Conclusions:
Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did not equal that of the contralateral shoulder after 6 years.Level of evidence:
Level IV 相似文献14.
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Hawkes DH Alizadehkhaiyat O Kemp GJ Fisher AC Roebuck MM Frostick SP 《Journal of orthopaedic research》2012,30(7):1140-1146
Adaptive muscle activation strategies following a massive rotator cuff tear (MRCT) are inadequately understood, and the relationship among muscles during everyday activities has not been considered. Thirteen healthy subjects comprised the control group, and 11 subjects with a MRCT the patient group. Upper limb function was assessed using the Functional Impairment test‐hand, neck, shoulder, and arm (FIT‐HaNSA). Electromyography (EMG) was recorded from 13 shoulder muscles, comprising five muscle groups, during a shelf‐lifting task. Mean FIT‐HaNSA scores were significantly lower in MRCT patients (p ≤ 0.001), reflecting a severe functional deficit. In MRCT patients, EMG signal amplitude was significantly higher for the biceps brachii‐brachioradialis (p < 0.001), upper trapezius‐serratus anterior (p = 0.025), muscle groups and for the latissimus dorsi (p = 0.010), and teres major (p = 0.007) muscles. No significant differences in the correlation among muscle groups were identified, pointing to an unchanged neuromuscular strategy following a tear. In MRCT patients, a reorganization of muscle activation strategy along the upper limb kinetic chain is aimed at reducing demand on the glenohumeral joint. Increased activation of the latissimus dorsi and teres major muscles is an attempt to compensate for the deficient rotator cuff. Re‐education towards an alternate neuromuscular control strategy appears necessary to restore function. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1140–1146, 2012 相似文献
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目的研究自体腘绳肌腱修复兔巨大肩袖缺损腱骨愈合的早期实验效果。方法将40只成年雄性新西兰大白兔随机分为3组,分别为正常组(n=8)、模型组(n=8)和实验组(n=24)。正常组相同方式饲养但不予手术处理;模型组将大白兔双前肢肱骨头大结节处切取1.5 cm×1.0 cm的肩袖组织缺损,不予缝合修补后直接缝合皮肤;实验组在模型组的基础上用自体腘绳肌腱修复巨大肩袖缺损。实验组分别于术后第8、16、24周时安乐死8只大白兔后取出双肩标本。将标本处理后分别进行组织形态学分析和生物力学研究测试。结果组织形态学分析结果显示:实验组术后24周腱骨界面胶原纤维明显增多,腱骨隧道连接处可见Sharpey纤维、纤维软骨细胞及纤维软骨等腱骨愈合成分。生物力学研究结果显示实验组肌腱最大负荷随时间延长呈持续增大趋势(各时间点之间比较,P<0.05),术后24周可以获得较强的力学强度。结论应用自体腘绳肌腱修复兔巨大肩袖缺损可以获得良好的腱骨愈合。 相似文献