Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, U.S.A..
Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
Arthroscopy. 2020 Aug;36(8):2057-2068. doi: 10.1016/j.arthro.2020.03.039. Epub 2020 Apr 16.
To classify subacromial bursal tissue using intraoperative and in vitro characteristics from specimens harvested during arthroscopic shoulder surgery.
Subacromial bursa was harvested over the rotator cuff from 48 patients (57 ± 10 years) undergoing arthroscopic shoulder surgery. Specimens were characterized intraoperatively by location (over rotator cuff tendon or muscle), tissue quality (percent of either fatty or fibrous infiltration), and vascularity before complete debridement. Nucleated cell counts were determined after 3 weeks incubation and histological sections were reviewed for degree of fatty infiltration and vascularity. Mesenchymal stem cell surface markers were counted via flow cytometry (n = 3) and cellular migration was observed using a fluoroscopic assay (n = 3).
Intraoperatively, muscle bursa was found most often to have >50% fatty infiltration (n = 39), whereas tendon bursa showed majority fibrous tissue (n = 32). Cellular proliferation did not significantly differ according to intraoperative tissue quality. Intraoperative vascularity was associated with greater proliferation for highly vascular samples (P = 0.023). Tendon bursa demonstrated significantly greater proliferation potential than muscle bursa (P = 0.00015). Histologic assessment of fatty infiltration was moderately correlated with gross tissue fattiness (ρ = -0.626, P = 7.14 × 10). Flow cytometry showed that 90% to 100% of bursal cells were positive for MSC surface markers. Peak cellular migration rates occurred between 18 and 30 hours' incubation.
Intraoperative and in vitro subacromial bursa characteristics were not found to reliably correlate with the degree of cellular proliferation. However, the anatomic location of subacromial bursa was consistently predictive of increased proliferation potential. Bursa-derived nucleated cells were confirmed to include mesenchymal stem cells with migratory potential.
The anatomic distinction between muscle and tendon bursa provides a simple classification for predicting cellular activity.
通过关节镜肩手术中采集的标本的术中及体外特征，对肩盂下囊组织进行分类。
从 48 例（57±10 岁）行关节镜肩手术的患者中采集肩盂下囊。标本在完全清创前，术中根据位置（肩袖肌腱或肌肉上方）、组织质量（脂肪或纤维浸润的百分比）和血管分布进行特征描述。在孵育 3 周后测定有核细胞计数，并对脂肪浸润和血管分布程度进行组织学切片检查。通过流式细胞术（n=3）计数间充质干细胞表面标志物，并通过荧光测定法观察细胞迁移（n=3）。
术中发现，肌肉囊最常出现>50%的脂肪浸润（n=39），而肌腱囊显示出大部分纤维组织（n=32）。根据术中组织质量，细胞增殖没有显著差异。术中血管分布与高血管样本的增殖显著相关（P=0.023）。与肌肉囊相比，肌腱囊具有更高的增殖潜力（P=0.00015）。脂肪浸润的组织学评估与大体组织的脂肪含量呈中度相关（ρ=-0.626，P=7.14×10）。流式细胞术显示，90%至 100%的囊细胞均为间充质干细胞表面标志物阳性。孵育 18 至 30 小时后出现细胞迁移的峰值。
术中及体外肩盂下囊特征与细胞增殖程度无可靠相关性。然而，肩盂下囊的解剖位置始终可以预测增殖潜力的增加。证实肩下囊来源的有核细胞包含具有迁移潜力的间充质干细胞。
肌肉和肌腱囊的解剖学区别为预测细胞活性提供了一种简单的分类方法。
