全关节镜与小切口修复肩袖撕裂损伤的荟萃分析

BACKGROUND:There are controversies about the efficacy of all-arthroscopic rotator cuff repair versus mini-open for the treatment of rotator cuff injury. OBJECTIVE:To evaluate the efficacy of all-arthroscopic rotator cuff repair versus mini-open for the treatment of rotator cuff injury by conducting a meta-analysis. METHODS: A computer-based online search was conducted in PubMed, Embase, Cochrane Library and CBM databases from January 1966 to November 2015 to screen the relevant articles using the key words of “rotator cuff, arthroscopy, mini-open”. Meta-analysis was performed using Revman5.3 software. RESULTS AND CONCLUSION: A total of 11 studies, including 6 randomized controlled trials and 5 cohort studies, were selected. The meta-analysis results showed that there were no significant differences in the function and strength of the shoulder joint, pain, motor range, recurrence of rotator cuff avulsion, the incidence rate of ankylosis between both two groups (P > 0.05). These results suggest that the efficacy of all- arthroscopic rotator cuff repair does not differ from those of mini-open for the treatment of rotator cuff injury. However, arthroscopic rotator cuff repair induces less soft tissue injury and early incision pain, but better function recovery. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Muscle sizes and moment arms of rotator cuff muscles determined by magnetic resonance imaging

Biomechanical models which require information on, e.g., joint torque and muscle force are useful in the estimation of when and how mechanical overload of the musculoskeletal system may lead to disorders. The aim was to study the reliability and validity of magnetic resonance imaging (MRI) to quantify muscle sizes and moment arms by MRI and to test selected anthropometric measures as predictors of muscle sizes and moment arms. A total of 20 healthy Scandinavian women (age 22-58 years) participated in an MRI scanning of their dominant shoulder. With a PC-based program the reliability and the validity of the MRI measurements was estimated to be high, and mean anatomical cross-sectional areas (ACSA) and muscle lengths were measured to be 4.0, 9.8 and 12.1 cm(2) and 12.0, 12.6 and 12.8 cm for m. supraspinatus, m. infraspinatus and m. subscapularis, respectively. Volumes were calculated to be 48.8, 125.1 and 153.6 cm(3). Moment arms were measured with the upper arm in a neutral position and in a functional position of 34 degrees abduction for m. supraspinatus only, and were 2.4 and 2.6 cm. Physiological cross-sectional area (PCSA) and its fiber force component were estimated from dissected fiber length and pennation angle. MRI volume and PCSA were 1.4-1.7 times higher than dissection data, primarily because of age differences. No external anthropometric measures were found to be predictors of volumes or moment arms.     

Electrospinning for rotator cuff repair

BACKGROUND: The structure of nanofibers prepared by electrospinning technology is similar to that of natural tendon tissue and extracellular matrix, and has the inherent characteristics of nanofibers. OBJECTIVE: To review the structure of various electrospinning scaffolds and their application in tendon and rotator cuff tissue engineering systematically. METHODS: PubMed, CNKI, Wanfang, and Web of Science databases were searched for relevant articles published from 2000 to 2020 with the search terms of “electrospun, tendon, rotator cuff, tissue engineering” in both English and Chinese. Totally 69 articles were finally included for analysis. RESULTS AND CONCLUSION: There are various strategies in manufacturing electrospun scaffolds. Scaffolds differ from material selection, fiber composition, modification and drug loading and many other aspects. Natural and synthetic materials both have their own advantages. Hybrid electrospinning of more than two kinds of materials can produce unique properties. Although non-aligned fibers have better tensile length, aligned fibers have advantages in elastic modulus, fracture strength and biocompatibility. Nanofibrous scaffolds can also be used in drug release, and it may have a modified characteristic and improve rotator cuff and tendon healing. © 2022, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

Passive contribution of the rotator cuff to abduction and joint stability

Purpose  

The purpose of this study is to compare shoulder joint biomechanics during abduction with and without intact non-functioning rotator cuff tissue.     

Feasibility assessment of shear wave elastography to rotator cuff muscle

Pre‐surgical measurement of supraspinatus muscle extensibility is important for rotator cuff repair. The purpose of the present study was to explore the potential feasibility of a shear wave ultrasound elastography (SWE)‐based method, combined with B‐mode ultrasound, to measure the in vivo stiffness of the supraspinatus muscle non‐invasively and thus obtain key information about supraspinatus muscle extensibility. Our investigation comprised two steps. First, we determined the orientation of the supraspinatus muscle fibers in cadaveric shoulders without rotator cuff tear in order to optimize the ultrasound probe positions for SWE imaging. Second, we investigated the feasibility of quantifying the stiffness of the normal supraspinatus muscle by SWE in vivo. The supraspinatus muscle was divided into four anatomical regions: anterior superficial (AS), posterior superficial (PS), anterior deep (AD), and posterior deep (PD). Each region was examined by SWE. The SWE stiffnesses of AD, AS, PD, and PS were 40.0 ± 12.4, 34.0 ± 9.9, 32.7 ± 12.7, 39.1 ± 15.7 kPa, respectively. SWE combined with B‐Mode ultrasound imaging could be a feasible method for quantifying the local stiffness of the rotator cuff muscles. Clin. Anat. 28:213–218, 2015. © 2014 Wiley Periodicals, Inc.     

肩袖损伤的解剖学研究进展

目的 阐述肩袖损伤的解剖学研究进展,为肩袖损伤的临床预防、治疗和康复提供一定的理论基础。方法 以“肩袖损伤”“冈上肌”“肩峰下间隙”“肩胛盂”等为中文关键词,和以“rotator cuff injury”“supraspinatus”“sub-acromial space”“scapular glenoid”等为英文关键词在万方数据库和PubMed数据库检索2014年12月以前有关肩袖损伤的文献,对肩袖损伤解剖学因素相关研究结果进行分析总结。结果 肩袖损伤的相关解剖因素众多,主要有肩峰和肩胛盂形态异常,肩峰下间隙减小、肩袖间隙损伤以及冈上肌本身的结构特点等原因。结论 在肩袖损伤的治疗康复中需要综合考虑相关解剖因素,以达到最佳的治疗康复目的。     

Quantitative morphology of full thickness rotator cuff tears

The occurrence of full thickness rotator cuff tears (RCTs) at time of death, the size and distribution of those tears among the tendons of the rotator cuff, and the anterior to posterior and medial to lateral dimensions of the RCTs were determined. A subset of 57 shoulders from a group of 414 were found to have full thickness rotator cuff tears. The three-dimensional coordinates of specific bony landmarks and points defining the circumference of the RCT were digitized using a Flock of Birds DC electromagnetic tracking device. Bony landmarks were used to determine the separation between adjacent tendons of the rotator cuff. Points describing the circumference of the RCT were used to calculate the area of the tear. The majority of tears occurred in the supraspinatus tendon alone (25), or in both the supraspinatus and infraspinatus tendons (22). The areas of the RCTs ranged from 0.07 cm(2) to 19.17 cm(2) with an average of 4.43 cm(2). The mean anterior to posterior length was 1.95 cm. The mean medial to lateral length was 1.98 cm.     

肩袖损伤诊断与治疗方法的选择

目的 探讨肩袖损伤的临床诊断及治疗方法,并评价治疗效果。 方法 选择我院2004年7月~2008年7月收治的48例肩袖损伤患者,依患者分类采用非手术综合治疗及手术治疗。非手术综合治疗组17例,采取休息制动、中药或非甾体抗炎药口服、外用药物、封闭、牵引等方法。手术组31例采用肩关节外侧切口,切除喙肩韧带,肩峰成形,探查修整肩袖,褥式缝合冈上肌腱、冈下肌腱及肩胛下肌腱,术后肩关节外展位石膏固定。 结果 48例均得到半年以上随访,平均随访13个月,采用UCLA评分系统评价,其中手术治疗组中优20例,良10例,差1例,术后优良率96.8％,非手术综合治疗组优8例,良6例,差3例,优良率82.4%。 结论 对于NeerⅡ、Ⅲ期应积极采用手术治疗,是提高效果的关键。     

Three dimensional reconstruction of the fibrous frame of the rotator cuff

The authors present the methodology and the results of a trial of 3D-reconstruction of the fibrous frame of the rotator cuff taken from high resolution MRI. The acuracy of the method used is discussed. A precise reconstruction of the soft tissues is possible and provides an interesting model to study the mechanical role of the rotator cuff muscles. An example of biomechanical application of the 3D images is given.Work done in the Orthopaedic Research Laboratory Paris-South University, and in the Anatomy Institute of Paris, Paris V University, Prof. J.P. Lassau     

Murine supraspinatus tendon injury model to identify the cellular origins of rotator cuff healing

ABSTRACT

Purpose of this study: To elucidate the origin of cell populations that contribute to rotator cuff healing, we developed a mouse surgical model where a full-thickness, central detachment is created in the supraspinatus. Materials and methods: Three different inducible Cre transgenic mice with Ai9-tdTomato reporter expression (PRG4-9, αSMA-9, and AGC-9) were used to label different cell populations in the shoulder. The defect was created surgically in the supraspinatus. The mice were injected with tamoxifen at surgery to label the cells and sacrificed at 1, 2, and 5 weeks postoperatively. Frozen sections were fluorescently imaged then stained with Toluidine Blue and re-imaged. Results: Three notable changes were apparent postoperatively. (1) A long thin layer of tissue formed on the bursal side overlying the supraspinatus tendon. (2) The tendon proximal to the defect initially became hypercellular and disorganized. (3) The distal stump at the insertion underwent minimal remodeling. In the uninjured shoulder, tdTomato expression was seen in the tendon midsubstance and paratenon cell on the bursal side in PRG4-9, in paratenon, blood vessels, and periosteum of acromion in SMA-9, and in articular cartilage, unmineralized fibrocartilage of supraspinatus enthesis, and acromioclavicular joint in AGC-9 mice. In the injured PRG4-9 and SMA-9 mice, the healing tissues contained an abundant number of tdTomato+ cells, while minimal contribution of tdTomato+ cells was seen in AGC-9 mice. Conclusions: The study supports the importance of the bursal side of the tendon to rotator cuff healing and PRG4 and αSMA may be markers for these progenitor cells.     

Decellularized human dermis to treat massive rotator cuff tears: in vitro evaluations

Interest is increasing in biological scaffolds for tissue regeneration such as extracellular matrix membranes, developed through soft tissue decellularization. Extracellular matrix membranes were developed to heal different tendon and soft tissue lesions that are very frequent in the general population with high health-care costs and patient morbidity. The aim of this research was to evaluate a human dermal matrix (HDM) decellularized by a chemico-physical method. A primary culture of rat tenocytes was performed: tenocytes were seeded on HDM samples and on polystyrene wells as controls (CTR). Cell viability and synthetic activity were evaluated at 3 and 7 days. An in vitro microwound model was used to evaluate HDM bioactivity: after tenocyte expansion, artificial wounds were created, HDM extracts were added, and closure time and decorin synthesis were monitored histomorphometrically at 1, 4, 24, and 72 hr. A significant higher amount of collagen I was observed when cells were cultured on HDM in comparison with that on CTR (3 days: p < 0.0001; 7 days: p < 0.05). In HDM group, fibronectin synthesis was significantly higher at both experimental times (p < 0.0001). At 3 days, proteoglycans and transforming growth factor-β1 releases were significantly higher on HDM (p < 0.0001 and p < 0.005, respectively). The artificial microwound closure time and decorin expression were significantly enhanced by the addition of 50% HDM extract (p < 0.05). In vitro data showed that the decellularization technique enabled the development of a matrix with adequate biological and biomechanical properties.     

Novel nanofiber-based scaffold for rotator cuff repair and augmentation

The debilitating effects of rotator cuff tears and the high incidence of failure associated with current grafts underscore the clinical demand for functional solutions for tendon repair and augmentation. To address this challenge, we have designed a poly(lactide-co-glycolide) (PLGA) nanofiber-based scaffold for rotator cuff tendon tissue engineering. In addition to scaffold design and characterization, the objective of this study was to evaluate the attachment, alignment, gene expression, and matrix elaboration of human rotator cuff fibroblasts on aligned and unaligned PLGA nanofiber scaffolds. Additionally, the effects of in vitro culture on scaffold mechanical properties were determined over time. It has been hypothesized that nanofiber organization regulates cellular response and scaffold properties. It was observed that rotator cuff fibroblasts cultured on the aligned scaffolds attached along the nanofiber long axis, whereas the cells on the unaligned scaffold were polygonal and randomly oriented. Moreover, distinct integrin expression profiles on these two substrates were observed. Quantitative analysis revealed that cell alignment, distribution, and matrix deposition conformed to nanofiber organization and that the observed differences were maintained over time. Mechanical properties of the aligned nanofiber scaffolds were significantly higher than those of the unaligned, and although the scaffolds degraded in vitro, physiologically relevant mechanical properties were maintained. These observations demonstrate the potential of the PLGA nanofiber-based scaffold system for functional rotator cuff repair. Moreover, nanofiber organization has a profound effect on cellular response and matrix properties, and it is a critical parameter for scaffold design.     

关节镜下不同修补术治疗肩袖损伤的临床效果

目的　比较关节镜下全关节镜肩袖修补术与小切口肩袖修补术治疗肩袖损伤的临床效果。 方法　选取2015年2月至2017年12月本院收治的56例肩袖损伤患者,分为观察组（27例）与对照组（29例）,观察组行关节镜下全关节镜肩袖修补术治疗,对照组给予关节镜辅助下小切口肩袖修补术治疗。比较两组患者的疼痛视觉模拟评分（VAS）、美国肘外科医师（ASES）及美国加州大学洛杉矶分校（UCLA）肩关节功能评分、肩关节活动度、肩关节肌力分级等情况。 结果　治疗后,观察组VAS（1.14±0.28）分、ASES（91±5）分、UCLA（34.8±2.7）分,优于对照组的VAS（1.36±0.43）分、ASES（88±5）分、UCLA（32.5±3.1）分,差异有统计学意义,t=2.250、2.544、2.956,均P<0.05;治疗后,观察组内旋（67±6）°、外旋（65±8）°、外展（138±14）°,高于对照组内旋（64±5）°、外旋（62±6）°、外展（133±12）°,t=2.040、2.027、2.064,均P<0.05;治疗后,观察组内旋（4.62±0.64）级、外旋（4.81±0.62）级、外展（4.87±0.56）级,优于对照组内旋（4.26±0.67）级、外旋（4.47±0.60）级、外展（4.51±0.62）级,t=2.053、2.085、2.274,均P<0.05。 结论　关节镜下全关节镜肩袖修补术治疗肩袖损伤的临床疗效更显著,术后恢复快,推广应用价值高。     

生物材料修复肩袖损伤的最新研究热点

文题释义：细胞外基质材料：是指将移植材料经过特殊处理,去除材料中免疫成分但保留原有三维结构及胶原蛋白的一种材料。细胞外基质材料修复肩袖撕裂的作用主要是可以充填肩袖缺损,增强肌腱的强度,还能促进新的腱骨界面形成,促进腱骨界面愈合,降低再撕裂率。肩袖损伤：肩袖是覆盖于肩关节前、上、后方之肩胛下肌、冈上肌、冈下肌、小圆肌等肌腱组织的总称。其位于肩峰和三角肌下方,与关节囊紧密相连。肩袖的功能是上臂外展过程中使肱骨头向关节盂方向拉近,维持肱骨头与关节盂的正常支点关节。肩袖损伤将减弱甚至丧失这一功能,严重影响上肢外展功能。 摘要背景：肩袖损伤是导致成人肩部功能障碍的主要原因,单纯手术缝合后的再撕裂率非常高,而生物材料修复可增加肩袖损伤术后的生物力学性能。目的：阐述肩袖损伤生物修复材料的最新研究及临床应用现状。方法：通过计算机检索PubMed、web of science数据库中关于肩袖损伤修复材料的最新研究,检索词为“Rotator Cuff Injuries;Biological materials;autograft;Extracellular matrix materials;Synthetic materials;biological scaffold;Biological patch;augmentation”。对纳入的57篇文献进行分类比较,探讨各类修复材料的优缺点。结果与结论：目前肩袖损伤的生物修复材料大体可分为未经处理的人体自身组织移植材料、细胞外基质材料和人工合成材料3大类。对于未经处理的人体自身组织移植材料,最新的临床报道显示该种材料常常出现不同的临床效果;细胞外基质材料中,来源于同种异体人源性真皮材料目前报道的效果尚可,大多学者不建议使用猪的小肠黏膜下层补片,同种异体移植物的结果可能优于异种移植物;最新的三维胶原支架和人工合成可吸收材料因其较好的孔隙率及可诱导腱骨组织的愈合,具有较好的应用前景,但大多仍停留在动物实验阶段,需要更多的临床试验来证实其安全性及有效性。目前尚无一种十分安全有效的生物修复材料来治疗肩袖撕裂。随着组织工程技术和材料学的发展,利用生物支架或合成材料的宏观性能结合干细胞或细胞因子的微观性能,有望在未来找到一种令人满意的材料。ORCID: 0000-0002-4570-842X(辛鹏飞);0000-0001-8935-5374(孙友强)中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

肩袖损伤经关节镜辅助小切口和全关节镜肩袖修补的疗效比较

目的研究关节镜辅助小切口及全关节镜肩袖修补术对肩袖损伤的疗效。方法选取2013年5月~2015年5月骨科收治的72例肩袖损伤患者为研究对象,按照随机数字表法进行分组,对照组(36例)进行关节镜下小切口肩袖修补术治疗,研究组(36例)进行全关节镜肩袖修补术治疗。对比归纳两组患者临床治疗情况、住院时间、关节功能恢复等。结果两组手术前后加州大学肩关节(UCLA)评分、美国肩与肘协会(ASES)评分、关节活动度、肌力等比较,0.05,无明显差异;研究组术后视觉疼痛量表(VAS)评分、住院时间优于对照组,0.05,差异显著;组内比较:两组术后VAS评分、UCLA评分、ASES评分、关节活动度、肌力等均优于术前,差异明显(0.05)。结论全关节镜与关节镜辅助小切口肩袖修补对肩袖损伤的治疗近期疗效相当,患者术后肩关节肌力、功能恢复佳;但全关节镜治疗患者术后疼痛轻,恢复迅速,具有较高的临床治疗意义。     

肩袖合并肩胛上神经损伤原因的解剖学研究

目的:探讨肩袖损伤合并肩胛上神经损伤的解剖学原因及其临床意义。方法:在44侧经常规防腐处理的成人尸体上肢标本上解剖观测肩袖和肩胛上神经,观测肩胛上神经及其分支的数目、直径、起始、走行、分布以及与肩袖的解剖关系。结果:肩胛上神经行程迂曲,有起点、入肌点两个固定点,另有肩胛上孔、肩胛下孔两个约束点,在冈盂切迹处形成大约50°左右的转折角,发出冈上肌支44支、冈下肌支44支、上关节支42支、下关节支53支、感觉支37支,分布于冈上肌、冈下肌和肩关节等处。肩胛上神经分别在肩胛上、下孔处贴近肩胛上韧带、肩胛下韧带,活动余地较小,肩部外展活动时神经张力增大,肩袖和肩胛上神经干之间有筋膜相隔。结论:肩胛上神经内在的解剖因素是肩袖合并肩胛上神经损伤的基础,肩袖的牵拉是其受伤的直接原因,肩袖损伤时可合并肩胛上神经损伤。