Sonnabend D H, Howlett C R, Young A A
Department of Orthopaedic and Traumatic Surgery, Royal North Shore Hospital, Sydney, New South Wales 2065, Australia.
J Bone Joint Surg Br. 2010 Apr;92(4):586-94. doi: 10.1302/0301-620X.92B4.22371.
The establishment of a suitable animal model of repair of the rotator cuff is difficult since the presence of a true rotator cuff anatomically appears to be restricted almost exclusively to advanced primates. Our observational study describes the healing process after repair of the cuff in a primate model. Lesions were prepared and repaired in eight 'middle-aged' baboons. Two each were killed at four, eight, 12 and 15 weeks post-operatively. The bone-tendon repair zones were assessed macroscopically and histologically. Healing of the baboon supraspinatus involved a sequence of stages resulting in the reestablishment of the bone-tendon junction. It was not uniform and occurred more rapidly at the sites of suture fixation than between them. Four weeks after repair the bone-tendon healing was immature. Whereas macroscopically the repair appeared to be healed at eight weeks, the Sharpey fibres holding the repair together did not appear in any considerable number before 12 weeks. By 15 weeks, the bone-tendon junction was almost, but not quite mature. Our results support the use of a post-operative rehabilitation programme in man which protects the surgical repair for at least 12 to 15 weeks in order to allow maturation of tendon-to-bone healing.
由于真正的肩袖在解剖学上几乎仅存在于高等灵长类动物中，因此建立合适的肩袖修复动物模型具有一定难度。我们的观察性研究描述了灵长类动物模型中肩袖修复后的愈合过程。在八只“中年”狒狒身上制造并修复损伤。术后4周、8周、12周和15周分别处死两只狒狒。对骨-肌腱修复区域进行宏观和组织学评估。狒狒冈上肌的愈合经历了一系列阶段，最终实现了骨-肌腱连接的重建。愈合并不均匀，在缝线固定部位比在缝线之间愈合得更快。修复后4周，骨-肌腱愈合不成熟。虽然在8周时宏观上修复似乎已愈合，但在12周之前，将修复部位固定在一起的沙比纤维数量并不多。到15周时，骨-肌腱连接几乎但尚未完全成熟。我们的研究结果支持在人类中使用术后康复计划，该计划至少在12至15周内保护手术修复部位，以使肌腱与骨的愈合成熟。
