岗上肌肌腱不同修补方法的实验研究

目的研究缝合锚单纯间断缝合法、缝合锚褥式缝合法和Mclaughlin缝合法修补兔岗上肌肌腱损伤的效果。方法选用45只新西兰兔,将其随机分为3组,每组15只。兔的左侧岗上肌肌腱自止点处切断,宽度8mm,建立岗上肌肌腱损伤模型,右侧岗上肌肌腱作为对照。A组采用缝合锚单纯间断缝合法缝合损伤的岗上肌肌腱;B组采用缝合锚褥式缝合法缝合;C组采用传统的Mclaughlin缝合法缝合。观察岗上肌肌腱的愈合情况,比较各组动物的愈合率。每组随机抽取12只动物取其双侧肩胛带标本进行生物力学测试,测定岗上肌肌腱的愈合强度。其余动物取其左侧肩胛带标本硝酸脱钙后HE染色进行组织学观察,观察岗上肌肌腱止点处的愈合情况。结果A、B两组各有1只动物因感染导致修补失败,愈合率为93．33％;C组动物全部愈合,愈合率为100％,3组动物愈合率进行x^2检验,x^2=1．047,其差异没有统计学意义（P〉0．05）。A组岗上肌肌腱愈合后抗拉力最大负荷的平均值为（82．4±20．7）N;B组抗拉力最大负荷平均值为（81．8±20．3）N;C组抗拉力最大负荷平均值为（88．6±17．2）N。采用方差分析的方法进行统计学处理F=0．446,3组之间的差异没有统计学意义（P〉0．05）。组织学研究表明A、B两组肌腱止点处为岗上肌肌腱直接附着于板层骨,C组肌腱止点处为岗上肌肌腱、软骨、板层骨相互移行的结构,但与正常的肌腱止点处相比软骨细胞的数量明显减少。结论缝合锚单纯间断缝合法、缝合锚褥式缝合法与Mclaughlin缝合法对兔岗上肌肌腱修补在愈合率和愈合强度上统计学无明显差别,但Mclaughlin缝合法愈合后强度略大于前两者,组织学上的愈合情况更接近正常肌腱的止点结构。

Effects of different repair methods in treatment of supraspinatus tendon tear: experiment with rabbits

OBJECTIVE: To compare the effects of different repair methods in treatment of supraspinatus tendon tear. METHODS: Forty-five New Zealand rabbits aged 4 approximately 6 months underwent cutting off of the left supraspinatus tendon for the width of 8 mm, and then were randomly divided into 3 equal groups: Group A, undergoing suture anchor simple suture; Group B, undergoing suture anchor mattress suture; and Group C, undergoing transosseous mattress suture. Eight weeks after the operation the rabbits were killed. The shoulder girdles of 12 rabbits randomly selected from each group were used for mechanical test to determine the intensity strength of the supraspinatus tendon, and the left shoulder girdlers of the other rabbits underwent decalcification, HE staining, and histological study to observe the healing of the end point of the supraspinatus tendon. RESULTS: Two rabbits. One in Group A and on in Group B underwent infection. The healing rate was 93.33% for both Groups A and B, and was 100% for Group C, however without significant differences among them (all>0.05). The mean maximum tension loads of the supraspinatus tendon of Groups A, B, and C were 82.39+/-20.70 N, 81.80+/-20.31 N, and 88.58+/-17.24 N respectively, however without significant differences among them (F=0.44, >0.05). Histological examination showed that at the end point the supraspinatus tendons of Groups A and B connected to the lamellar bone and that three-zone structure (tendon, cartilage, and bone) could be found at the end point of the supraspinatus tendon in Group C, but compared with the normal end point, the number of cartilage cells decreased. CONCLUSION: The effects of the 3 suture methods are not significantly different from each other for the repair of supraspinatus tendon in respect to healing rate and healing strength, but compared with the suture anchor simple suture method and suture anchor mattress suture method, the transosseous mattress suture method shows greater post-healing strength of tension and the tendon healing situation is closer to the normal tendon structure.