Steadman Philippon Research Institute, Vail, Colorado; Steadman Clinic, Vail, Colorado; Department of Orthopaedic Surgery, University of Kentucky School of Medicine, Lexington, Kentucky, U.S.A.
Steadman Philippon Research Institute, Vail, Colorado.
Arthroscopy. 2019 Oct;35(10):2959-2965. doi: 10.1016/j.arthro.2019.07.006.
The purpose of this study was to evaluate biomechanical and histopathological results of a retrieved acellular human dermal allograft (AHDA) after superior capsule reconstruction (SCR). A 67-year-old man with pseudoparalysis was treated with SCR for an irreparable posterosuperior rotator cuff tear. The patient failed clinically 4.5 months postoperatively and elected to undergo reverse total shoulder arthroplasty (RTSA). At the time of RTSA, the AHDA was harvested. Biomechanical and histopathologic analyses were performed and compared to native grafts. Failure loads for the explanted graft and native grafts 1 and 2 were 158, 790, and 749 N, respectively. The stiffness values were 20.2, 73, and 100.5 N/mm. The displacement at failure for each graft was 10.1, 27.9, and 17.0 mm. Hematoxylin and eosin and Masson's trichrome staining revealed the presence of cells in all portions of the AHDA. The medial portion presented extensive cellular infiltration, the middle portion moderate, and the lateral portion the least infiltration. Although the only identifiable cells in the lateral portions were found in pockets on the interior of the graft, cells were mainly localized on the exterior. Postoperative cell incorporation could be found in acellular dermal allograft after SCR. However, biomechanical properties in the early postoperative phase were inferior compared with unimplanted allografts.
本研究旨在评估经修复上囊重建（SCR）后回收的脱细胞人真皮移植物（AHDA）的生物力学和组织病理学结果。一名 67 岁男性因不可修复的肩袖后上部分撕裂而行 SCR 治疗，术后 4.5 个月出现假性瘫痪，遂选择行反式全肩关节置换术（RTSA）。在进行 RTSA 时，取出了 AHDA。对其进行生物力学和组织病理学分析，并与原生移植物进行比较。已植入和原生移植物 1 及 2 的失效负荷分别为 158、790 和 749N，刚度值分别为 20.2、73 和 100.5N/mm，每个移植物的失效位移分别为 10.1、27.9 和 17.0mm。苏木精和伊红以及 Masson 三色染色显示，AHDA 的所有部分均存在细胞。内侧部分存在广泛的细胞浸润，中间部分中度浸润，外侧部分浸润最少。尽管在外侧部分仅发现存在于移植物内部口袋中的可识别细胞，但细胞主要定位于外部。在 SCR 后，脱细胞真皮移植物中可发现术后细胞浸润。然而，与未植入的移植物相比，术后早期的生物力学性能较差。
