Karthikeyan Shanmugam, Griffin Damian R, Parsons Nicholas, Lawrence Thomas M, Modi Chetan S, Drew Stephen J, Smith Christopher D
Warwick Medical School, University of Warwick, Coventry, UK; Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Warwick Medical School, University of Warwick, Coventry, UK.
J Shoulder Elbow Surg. 2015 Dec;24(12):1954-60. doi: 10.1016/j.jse.2015.07.014. Epub 2015 Sep 26.
Microvascular blood flow in the tendon plays an important role in the pathogenesis of rotator cuff abnormalities. There are conflicting views about the presence of a hypovascular zone in the supraspinatus tendon. Besides, no studies have looked at the pattern of blood flow around a partial-thickness tear. Our aim was to measure microvascular blood flow in normal and a range of pathologic rotator cuff tendons using laser doppler flowmetry.
A total of 120 patients having arthroscopic shoulder surgery were divided into 4 equal groups on the basis of their intraoperative diagnosis: normal rotator cuff, subacromial impingement syndrome, and partial-thickness or full-thickness rotator cuff tear. Microvascular blood flow was measured at 5 different regions of each cuff using a laser doppler probe. The values were compared to assess variability within and between individuals.
Total blood flow was greater in the normal rotator cuff group compared with the groups with pathologic rotator cuffs, with the largest difference seen in the subacromial impingement group. Within individuals, blood flow was highest at the musculotendinous junction and lowest at the lateral insertional part of the tendon. Among groups, the blood flow was significantly lower at the anteromedial and posteromedial cuff in the groups with impingement and full-thickness tears compared with the group with normal cuff.
Real-time in vivo laser doppler analysis has shown that microvascular blood flow is not uniform throughout the supraspinatus tendon. Blood flow in the pathologic supraspinatus tendon was significantly lower compared with the normal tendon.
肌腱中的微血管血流在肩袖异常的发病机制中起重要作用。关于冈上肌腱中是否存在血管减少区存在相互矛盾的观点。此外，尚无研究观察部分厚度撕裂周围的血流模式。我们的目的是使用激光多普勒血流仪测量正常和一系列病理性肩袖肌腱中的微血管血流。
总共120例行关节镜下肩部手术的患者根据术中诊断分为4组，每组人数相等：正常肩袖、肩峰下撞击综合征、部分厚度或全厚度肩袖撕裂。使用激光多普勒探头在每个肩袖的5个不同区域测量微血管血流。比较这些值以评估个体内部和个体之间的变异性。
与病理性肩袖组相比，正常肩袖组的总血流量更大，肩峰下撞击组的差异最大。在个体内部，血流在肌-腱交界处最高，在肌腱外侧附着部分最低。在各组中，与正常肩袖组相比，撞击组和全厚度撕裂组的肩袖前内侧和后内侧的血流量明显更低。
实时体内激光多普勒分析表明，冈上肌腱内的微血管血流并不均匀。与正常肌腱相比，病理性冈上肌腱中的血流明显更低。
