Zhang Ming-Tao, Liu Jia-Xin, Jia Yao-Fei, Zhang Guang-Rui, Zhou Jian-Ping, Wu Ding, Yun Xiang-Dong
Department of Orthopaedics, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu, China.
Zhongguo Gu Shang. 2022 Jul 25;35(7):697-702. doi: 10.12200/j.issn.1003-0034.2022.07.020.
The incidence of re-tearing after rotator cuff repair is very high. The main reason is that the tendon-osseous junction after the operation is scar healed. In response to this problem, research in recent years has focused on the application of grafts, including cell transplantation, periosteum transplantation, cartilage transplantation, and biosynthetic transplantation. Cell transplantation is mainly a variety of stem cells from different sources. The current research has confirmed that it can achieve better results. The combined application of exosomes and stem cells may be the future development direction. Periosteum transplantation is a promising intervention method, but few clinical applications at present, and there are problems such as limited sources of materials and secondary trauma from the materials. Tissue engineered periostium and artificial bionic periostium may be alternatives to periosteal;cartilage transplantation can promote the regeneration of cartilage at the tendon-osseous junction and facilitate tendon-bone healing. However, there are also limited materials and secondary damage. There is no better solution to this problem. The slow degradation of inorganic composites and the poor effect of single use limit its application; biological derivatives have immunogenicity, poor biomechanics and other issues, there is currently no proper solution; organic synthetic grafts pay more attention to simulating the structure of the physiological tendon-osseointegration zone, and show good results in tendon-bone healing, and have good application prospects. In addition, most of the above-mentioned application research of different grafts stays at the cellular and animal level, and more research is needed in clinical application. This article briefly reviews the application status, advantages, disadvantages and development trends of the above-mentioned different grafts, in order to provide certain guidance for the clinical treatment of rotator cuff tears.
肩袖修复术后再撕裂的发生率非常高。主要原因是术后肌腱-骨交界处为瘢痕愈合。针对这一问题，近年来的研究主要集中在移植物的应用上，包括细胞移植、骨膜移植、软骨移植和生物合成移植。细胞移植主要是各种不同来源的干细胞。目前的研究已证实其能取得较好效果。外泌体与干细胞的联合应用可能是未来的发展方向。骨膜移植是一种有前景的干预方法，但目前临床应用较少，且存在材料来源有限以及取材导致的二次创伤等问题。组织工程骨膜和人工仿生骨膜可能是骨膜的替代物；软骨移植可促进肌腱-骨交界处软骨再生，利于腱骨愈合。然而，同样存在材料有限和二次损伤问题。对此问题尚无更好的解决办法。无机复合材料降解缓慢且单次使用效果不佳限制了其应用；生物衍生材料存在免疫原性、生物力学性能差等问题，目前尚无妥善解决办法；有机合成移植物更注重模拟生理性肌腱-骨整合区的结构，在腱骨愈合方面显示出良好效果，具有良好的应用前景。此外，上述不同移植物的应用研究大多停留在细胞和动物水平，临床应用还需要更多研究。本文简要综述上述不同移植物的应用现状、优缺点及发展趋势，以期为肩袖撕裂的临床治疗提供一定指导。
