Fukuda H, Hamada K, Nakajima T, Tomonaga A
Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan.
Clin Orthop Relat Res. 1994 Jul(304):60-7.
Histologic sections from 17 en bloc surgical specimens were studied to clarify the pathogenesis of intratendinous tears of the rotator cuff. The specimens consisted of the bony insertion, the partially torn area, and the musculotendinous junction of the supraspinatus tendon. An intratendinous tear alone was present in two patients, and was associated with bursal side cuff tears in seven patients and joint side cuff tears in eight. There were 13 men and 4 women, whose average age was 49.8 years. Trauma was noted in all intratendinous tears and combined intratendinous and joint side cuff tears and in two of the seven patients who had intratendinous plus bursal side tears. All patients exhibited clinical evidence of subacromial impingement. Histologic sections were stained with azan and hematoxylin and eosin. Microscopically, the sections demonstrated several abnormalities in addition to degeneration. The intratendinous tears was located in the midlayer of the tendon in 15 specimens and eccentrically in two, the axis of which were parallel to tendon fibers in all. The intratendinous tears continued to local disruptions of the enthesis in 11 cases. The inner surface of the tear appeared smooth in 16 specimens. Despite the presence of granulation tissue and vessel proliferation near the intratendinous tears, there was no evidence of closure of the defect in any specimen. Intratendinous tears develop between superficial and deep layers of the degenerated rotator cuff. Shear within the tendon appears to be responsible in pathogenesis. Concomitant subacromial bursitis is very common.
对17例整块手术切除标本的组织学切片进行研究，以阐明肩袖肌腱内撕裂的发病机制。标本包括骨附着点、部分撕裂区域以及冈上肌腱的肌-腱交界处。仅存在肌腱内撕裂的患者有2例，合并滑囊侧肩袖撕裂的有7例，合并关节侧肩袖撕裂的有8例。患者共13名男性和4名女性，平均年龄49.8岁。所有肌腱内撕裂以及合并肌腱内和关节侧肩袖撕裂的病例均有外伤史，在7例合并肌腱内和滑囊侧撕裂的患者中有2例有外伤史。所有患者均有肩峰下撞击的临床证据。组织学切片用偶氮胭脂红、苏木精和伊红染色。显微镜下，切片除显示退变外，还存在几种异常情况。15例标本的肌腱内撕裂位于肌腱中层，2例位于偏心位置，所有撕裂的轴线均与肌腱纤维平行。11例肌腱内撕裂延续至附着点局部破坏。16例标本撕裂的内表面看起来光滑。尽管在肌腱内撕裂处附近有肉芽组织和血管增生，但在任何标本中均未发现缺损闭合的证据。肌腱内撕裂发生于退变肩袖的浅层和深层之间。肌腱内的剪切力似乎是发病机制中的原因。同时存在的肩峰下滑囊炎非常常见。
