Kataoka Takeshi, Kokubu Takeshi, Muto Tomoyuki, Mifune Yutaka, Inui Atsuyuki, Sakata Ryosuke, Nishimoto Hanako, Harada Yoshifumi, Takase Fumiaki, Ueda Yasuhiro, Kurosawa Takashi, Yamaura Kohei, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
J Orthop Surg Res. 2018 Aug 13;13(1):200. doi: 10.1186/s13018-018-0900-4.
Fascia lata augmentation of massive rotator cuff tears has shown good clinical results. However, its biological effect during the early healing process is not clearly understood. The purpose of the study was to evaluate the biological efficacy of fascia lata augmentation during the early healing process of rotator cuff tears using a rabbit rotator cuff defect model.
The infraspinatus tendon was resected from the greater tuberosity of a rabbit to create a rotator cuff tear. The tendon edge was directly sutured to the humeral head. The rotator cuff repaired site was augmented with a fascia lata autograft (augmentation group, group A). The rotator cuff defect in the contralateral shoulder was repaired without augmentation (reattachment group, group R). A group with intact rotator cuff was set as the control group. Histological examinations and mechanical analysis were conducted 4 and 8 weeks postoperatively.
In the HE staining, the tendon maturing score of group A was higher than that of group R at 4 weeks postoperatively. In the safranin O staining, proteoglycan staining at the repaired enthesis in group A at 4 weeks postoperatively was stronger than that in group R. Picrosirius red staining showed that type III and type I collagen in group A was more strongly expressed than that in group R at 4 weeks postoperatively. The ultimate failure load of the infraspinatus tendon-humeral head complex in group A was statistically higher than that in group R at 4 weeks postoperatively. The ultimate failure load of group A was similar to that of the control group.
The biological and mechanical contribution of fascia lata augmentation for massive rotator cuff tears was analyzed in this study. Type III collagen was reported to be expressed during the tendon healing process. Although the biological action similar to natural ligament healing occurred around the fascia lata grafts, type III collagen was gradually replaced by type I collagen as the tissue matured. Our results suggest that fascia lata augmentation could stimulate biological healing and provide initial fixation strength of the repaired rotator cuff.
阔筋膜增强修复巨大肩袖撕裂已显示出良好的临床效果。然而，其在早期愈合过程中的生物学效应尚不清楚。本研究的目的是使用兔肩袖缺损模型评估阔筋膜增强在肩袖撕裂早期愈合过程中的生物学功效。
从兔的大结节处切除冈下肌腱以制造肩袖撕裂。将肌腱边缘直接缝合至肱骨头。肩袖修复部位用自体阔筋膜增强（增强组，A组）。对侧肩部的肩袖缺损在不进行增强的情况下进行修复（重新附着组，R组）。将肩袖完整的一组设为对照组。术后4周和8周进行组织学检查和力学分析。
在苏木精-伊红染色中，术后4周A组的肌腱成熟评分高于R组。在番红O染色中，术后4周A组修复的附着点处蛋白聚糖染色比R组更强。天狼星红染色显示，术后4周A组的III型和I型胶原表达比R组更强。术后4周A组冈下肌腱-肱骨头复合体的极限破坏载荷在统计学上高于R组。A组的极限破坏载荷与对照组相似。
本研究分析了阔筋膜增强对巨大肩袖撕裂的生物学和力学贡献。据报道，III型胶原在肌腱愈合过程中表达。尽管阔筋膜移植物周围发生了类似于天然韧带愈合的生物学作用，但随着组织成熟，III型胶原逐渐被I型胶原取代。我们的结果表明，阔筋膜增强可以刺激生物学愈合并为修复的肩袖提供初始固定强度。
