Huang Chun-Yuh, Wang Vincent M, Pawluk Robert J, Bucchieri John S, Levine William N, Bigliani Louis U, Mow Van C, Flatow Evan L
Research Service and Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Miami, FL, USA.
J Orthop Res. 2005 Jul;23(4):924-30. doi: 10.1016/j.orthres.2004.02.016. Epub 2005 Jan 25.
Disorders of the rotator cuff, particularly tears of the rotator cuff tendons, cause significant shoulder disability. Among numerous factors thought to be responsible for the initiation and progression of supraspinatus tears are those related to the tendon's biomechanical properties. We hypothesized that in supraspinatus tendons subjected to tensile loading a strain gradient (difference) exists between the articular and bursal tendon surfaces, that regional strain differences exist on each of these two tendon surfaces, and that tendon surface strains vary with glenohumeral abduction. To test these hypotheses, the intrinsic inhomogeneous deformational characteristics of the articular and bursal surfaces of eight intact human cadaveric supraspinatus tendons were studied at three glenohumeral abduction angles using a novel multiple strain measuring system which simultaneously recorded surface marker displacements on two opposing soft tissue surfaces. Under applied tensile loads, the articular surface exhibited greater strain at 22 degrees (7.4+/-2.6% vs. 1.3+/-0.7%, p=0.0002) and 63 degrees (6.4+/-1.6% vs. 2.7+/-1.2%, p=0.0001) whereas the bursal surface exhibited greater strain at 90 degrees (7.6+/-2.8% vs. 4.9+/-0.4%, p=0.013). At all abduction angles, insertion strains were higher than those of the mid-tendon and tendon-muscle junction regions. The existence of inhomogeneous surface strains in the intact supraspinatus tendon demonstrates that intratendinous shear occurs within the tendon. The higher strain on the articular side of the tendon, especially at the insertion region, suggests a propensity for tears to initiate in the articular tendinous zone.
肩袖疾病,尤其是肩袖肌腱撕裂,会导致严重的肩部功能障碍。在众多被认为与冈上肌撕裂的发生和发展有关的因素中,有一些与肌腱的生物力学特性相关。我们假设,在承受拉伸负荷的冈上肌肌腱中,关节面和滑囊面之间存在应变梯度(差异),这两个肌腱表面各自存在区域应变差异,并且肌腱表面应变会随着盂肱关节外展而变化。为了验证这些假设,我们使用一种新型的多应变测量系统,在三个盂肱关节外展角度下,研究了八个完整的人体尸体冈上肌肌腱的关节面和滑囊面的固有非均匀变形特征,该系统同时记录两个相对软组织表面上的表面标记位移。在施加拉伸负荷时,关节面在22度(7.4±2.6% 对 1.3±0.7%,p = 0.0002)和63度(6.4±1.6% 对 2.7±1.2%,p = 0.0001)时表现出更大的应变,而滑囊面在90度时表现出更大的应变(7.6±2.8% 对 4.9±0.4%,p = 0.013)。在所有外展角度下,止点处的应变均高于肌腱中部和肌腱 - 肌肉交界处的应变。完整冈上肌肌腱中存在不均匀的表面应变表明肌腱内部发生了剪切。肌腱关节侧的较高应变,尤其是在止点区域,表明撕裂倾向于在关节肌腱区域起始。