Şahin Ercan, Kalem Mahmut, Zehir Sinan, Songur Murat, Demirtaş Mehmet
Bülent Ecevit University Faculty of Medicine, Department of Orthopedics and Traumatology, Zonguldak, Turkey.
Ankara University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.
Acta Orthop Traumatol Turc. 2015;49(4):447-52. doi: 10.3944/AOTT.2015.14.0296.
Rotator cuff repair is associated with multiple complications, significant morbidity, and reintervention, which could be mitigated by postoperative chemodeneveration with botulinum toxin-A (BTX-A). This study evaluated the antinociceptive and paralytic effects of BTX-A on an experimental supraspinatus repair rat model and its effect on functional outcomes (running performance).
Thirty rats were grouped into the surgical repair group (group A), repair + intramuscular BTX-A group (group B), or control group (group C). At the end of the 3-month follow-up, running performance of the rats on a motorized treadmill was evaluated in four time periods (0-30 min, 30-60 min, 60-90 min, and 90-110 min), and penalty points (i.e., number of shock stimuli per lane) were recorded. Afterwards, the supraspinatus muscles were removed and evaluated histologically.
Regarding running performance, group B received significantly fewer penalty points than did group A (p<0.05). The penalty points received were not significantly different between groups B and C in the first three time periods, but were significantly higher in group B at the 90-110-min interval than in group C. On necropsy, all repaired tendons were intact, with no sign of failure at the repair site. Histological evaluation revealed marked degeneration and necrosis of muscles in both repair groups, which was much less evident in group B. Groups A and B had less fatty infiltration than group C.
BTX-A injections resulted in a better function based on running performance, probably due to decreased tissue tension at the repair site and less pain. Further studies on humans are needed to demonstrate this effect clinically.
肩袖修复术会引发多种并发症、显著的发病率以及再次干预，而术后使用A型肉毒毒素（BTX-A）进行化学去神经支配可能会减轻这些问题。本研究评估了BTX-A对实验性大鼠冈上肌修复模型的镇痛和麻痹作用及其对功能结局（跑步能力）的影响。
将30只大鼠分为手术修复组（A组）、修复+肌肉内注射BTX-A组（B组）或对照组（C组）。在3个月的随访结束时，在四个时间段（0-30分钟、30-60分钟、60-90分钟和90-110分钟）评估大鼠在电动跑步机上的跑步能力，并记录罚分（即每条跑道的电击刺激次数）。之后，切除冈上肌并进行组织学评估。
在跑步能力方面，B组的罚分明显少于A组（p<0.05）。在前三个时间段，B组和C组的罚分没有显著差异，但在90-110分钟时间段，B组的罚分明显高于C组。尸检时，所有修复的肌腱均完整，修复部位无失败迹象。组织学评估显示，两个修复组的肌肉均有明显的变性和坏死，而B组则不太明显。A组和B组的脂肪浸润少于C组。
基于跑步能力，注射BTX-A可带来更好的功能，这可能是由于修复部位的组织张力降低和疼痛减轻。需要对人类进行进一步研究以在临床上证实这种效果。
