采用含骨髓间充质干细胞的可吸收材料在兔模型中进行肩袖再生。

Rotator cuff regeneration using a bioabsorbable material with bone marrow-derived mesenchymal stem cells in a rabbit model.

机构信息

Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima City, 734-8551, Japan.

出版信息

Am J Sports Med. 2012 Jun;40(6):1259-68. doi: 10.1177/0363546512442343. Epub 2012 Apr 6.

DOI:10.1177/0363546512442343

PMID:22491821

Abstract

BACKGROUND

Rotator cuff regeneration using tissue engineering techniques is a challenging treatment in elderly patients with irreparable rotator cuff tears.

HYPOTHESIS

A polyglycolic acid sheet scaffold with seeded mesenchymal stem cells (MSCs) may enhance the expression of type I collagen products and increase the mechanical strength of the regenerated tendon in vivo.

STUDY DESIGN

Controlled laboratory study.

METHODS

A surgically created defect of infraspinatus tendons of rabbits was reconstructed with 2 different materials, a polyglycolic acid (PGA) sheet alone (PGA group) (n = 34) and a PGA sheet seeded with autologously cultured MSCs (MSC group) (n = 34). The authors created a tendon defect model without embedding any graft as the control model (control group) (n = 34). The rabbits were sacrificed at 4, 8, and 16 weeks after the operation and then were histologically evaluated. The rabbits were also biomechanically evaluated by measuring the ultimate failure loads and Young's modulus at 4 and 16 weeks following implantation.

RESULTS

In the MSC group, the fibrocartilage layers and Sharpey fibers were found regularly in the insertion site at 8 weeks compared with the PGA group. In control group, thin membranes with many fibroblasts arranged in an irregular pattern linked the end of the torn cuff to the bone without any Sharpey fibers and type I collagen. A large volume of type I collagen was found in comparison with type III collagen at 16 weeks in the MSC group, whereas type III collagen was more prevalent than type I in the PGA group. The tendon maturing score in the MSC group had higher values than the PGA and control groups at 8 and 16 weeks (mean values were 21.0 ± 0.89, 24.0 ± 2.53 in the MSC group; 16.7 ± 2.25, 21.3 ± 2.42 in the PGA group; and 10.2 ± 0.98, 12.2 ± 1.72 in the control group, respectively) (P < .05). The results of the mechanical analysis revealed that the regenerated tendons in the MSC group had better tensile strength than in the PGA and control groups at 16 weeks (mean values were 3.04 ± 0.54 in the MSC group, 2.38 ± 0.63 in the PGA group, and 1.58 ± 0.13 in the control group) (P < .05).

CONCLUSION

Bone marrow-derived MSCs were able to regenerate tendon-bone insertions and the tendon belly, including the production of type I collagen, and increased the mechanical strength of the regenerated rotator cuff tendon.

CLINICAL RELEVANCE

Rotator cuff regeneration using MSCs is a promising treatment for massive rotator cuff defects.

摘要

背景

使用组织工程技术修复肩袖撕裂是老年患者极具挑战性的治疗方法。

假设

聚乙二醇酸片支架与种子间充质干细胞（MSCs）联合使用可能会增强 I 型胶原产物的表达，并增加体内再生肌腱的机械强度。

研究设计

对照实验室研究。

方法

通过两种不同的材料重建兔冈下肌腱的手术性缺损，即单独聚乙二醇酸（PGA）片（PGA 组）（n = 34）和 PGA 片上接种自体培养 MSCs（MSC 组）（n = 34）。作为对照模型（对照组）（n = 34），作者在没有植入任何移植物的情况下创建了一个肌腱缺损模型。术后 4、8 和 16 周，对兔子进行组织学评估，然后进行生物力学评估，通过测量植入后 4 和 16 周时的极限失效载荷和杨氏模量来评估。

结果

在 MSC 组中，与 PGA 组相比，在 8 周时，插入部位可发现规则排列的纤维软骨层和 Sharpey 纤维。在对照组中，没有 Sharpey 纤维和 I 型胶原，只有排列不规则的许多成纤维细胞组成的薄膜将撕裂的肩袖末端与骨骼相连。在 MSC 组中，16 周时发现大量 I 型胶原，而在 PGA 组中 III 型胶原比 I 型胶原更常见。8 周和 16 周时，MSC 组的肌腱成熟评分高于 PGA 组和对照组（平均值分别为 21.0 ± 0.89、24.0 ± 2.53 在 MSC 组；16.7 ± 2.25、21.3 ± 2.42 在 PGA 组；10.2 ± 0.98、12.2 ± 1.72 在对照组）（P <.05）。力学分析结果显示，MSC 组的再生肌腱在 16 周时的拉伸强度优于 PGA 组和对照组（平均值分别为 3.04 ± 0.54 在 MSC 组，2.38 ± 0.63 在 PGA 组，1.58 ± 0.13 在对照组）（P <.05）。