Derwin Kathleen A, Baker Andrew R, Codsi Michael J, Iannotti Joseph P
Department of Biomedical Engineering, Lerner Research Institute and Orthopaedic Research Center, The Cleveland Clinic, Cleveland, OH 44195, USA.
J Shoulder Elbow Surg. 2007 Sep-Oct;16(5 Suppl):S140-8. doi: 10.1016/j.jse.2007.04.002. Epub 2007 Jun 8.
Animal shoulder models are used to systematically investigate the factors influencing rotator cuff injury and repair. Each model has advantages and disadvantages that must be considered in the context of the specific research questions being asked. This study evaluated the utility of the canine model for studies of acute, full-thickness rotator cuff tendon injury and repair. We found that time-zero failure load is dependent on the suture type and configuration used for repair. Acute, full-width tendon repairs fail anatomically within the first days after surgery in the canine model, regardless of suture type, suture configuration, or postoperative protocol. Robust scar tissue forms in the gap between the failed tendon end and the humerus, which can be visually, mechanically, and histologically misconstrued as tendon if an objective test of repair connectivity is not performed. We conclude that a full-width injury and repair model in the canine will provide a rigorous test of whether a new repair strategy or postoperative protocol, such as casting or temporary muscle paralysis, can maintain repair integrity in a high-load environment. Alternatively, a partial-width tendon injury model allows loads to be shared between the tendon repair and the remaining intact portion of the infraspinatus tendon and prohibits complete tendon retraction. Thus a partial-width injury in the canine may model the mechanical environment of many single tendon tears in the human injury condition and warrants further investigation.
动物肩部模型用于系统研究影响肩袖损伤和修复的因素。每种模型都有其优缺点,在提出特定研究问题时必须加以考虑。本研究评估了犬类模型在急性、全层肩袖肌腱损伤和修复研究中的实用性。我们发现,零时失效负荷取决于用于修复的缝线类型和配置。在犬类模型中,无论缝线类型、缝线配置或术后方案如何,急性、全宽肌腱修复在术后头几天内会在解剖学上失败。在失败的肌腱末端与肱骨之间的间隙中会形成坚固的瘢痕组织,如果不进行修复连接性的客观测试,从视觉、力学和组织学角度看,该瘢痕组织可能会被误解为肌腱。我们得出结论,犬类的全宽损伤和修复模型将对新的修复策略或术后方案(如石膏固定或临时肌肉麻痹)能否在高负荷环境中维持修复完整性提供严格测试。另外,部分宽度肌腱损伤模型可使负荷在肌腱修复与冈下肌腱的其余完整部分之间分担,并防止肌腱完全回缩。因此,犬类的部分宽度损伤可能模拟人类损伤情况下许多单肌腱撕裂的力学环境,值得进一步研究。