Department of Orthopaedic Surgery, University Hospital of Munich (LMU)-Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany.
J Orthop Res. 2013 May;31(5):716-23. doi: 10.1002/jor.22260. Epub 2012 Dec 13.
We hypothesized that a temporary rotator cuff paralysis using botulinum-neurotoxin A (BoNtA) would lead to an improved tendon-to-bone healing after repair of supraspinatus lesions. One hundred sixty Sprague-Dawley rats were randomly assigned to either the BoNtA or the control (saline) group. BoNtA/saline-solution was injected into the supraspinatus muscle 1 week prior to surgery. A supraspinatus defect was made; we distinguished between a lesion with normal and increased repair load. Furthermore, one subgroup had the operated shoulder immobilized in a cast. Histologic analysis and biomechanical testing followed. Specimens from the BoNtA-group, which were treated with an increased repair load, showed less cellularity and more organization in the interface tissue compared to the saline control group. In addition, we found that the collagen 1-3 quotient in the BoNtA specimen was significantly (p = 0.0051) higher than in the control group. Ultimate load at failure between the groups was not significantly different (p > 0.05). We did not observe any significant differences between the mobilized and immobilized specimen (p = 0.2079). The study shows that tendon-to-bone healing after rotator cuff repair can be altered positively using BoNtA pre-operatively. Tears with increased repair load seem to benefit the most-at least histologically.
我们假设使用肉毒杆菌神经毒素 A（BoNtA）暂时性地使肩袖瘫痪，将有助于改善冈上肌腱修复后的腱骨愈合。160 只 Sprague-Dawley 大鼠被随机分为 BoNtA 组或对照组（生理盐水）。BoNtA/生理盐水溶液在手术前 1 周注射到冈上肌。制造冈上肌腱缺损；我们区分了具有正常和增加修复负荷的病变。此外，一组手术肩被固定在石膏中。随后进行组织学分析和生物力学测试。与生理盐水对照组相比，在接受增加修复负荷治疗的 BoNtA 组标本中，界面组织的细胞数量更少，组织化程度更高。此外，我们发现 BoNtA 标本中的胶原 1-3 比值明显（p=0.0051）高于对照组。两组间的失效极限载荷无显著差异（p>0.05）。我们没有观察到固定和活动标本之间有任何显著差异（p=0.2079）。该研究表明，使用 BoNtA 进行术前治疗可以积极改变冈上肌腱修复后的腱骨愈合。具有增加修复负荷的撕裂似乎受益最大——至少在组织学上是这样。
