Hamada K, Tomonaga A, Gotoh M, Yamakawa H, Fukuda H
Department of Orthopaedics, Tokai University School of Medicine, Kanagawa, Japan.
J Orthop Res. 1997 Jan;15(1):24-32. doi: 10.1002/jor.1100150105.
To determine the healing potential and healing process of torn supraspinatus tendons, in situ hybridization was used to localize cells containing alpha 1 type-I procollagen mRNA. Biopsy specimens of torn supraspinatus tendons from 19 patients with complete-thickness tears and 13 patients with incomplete-thickness tears were obtained during surgery. Four macroscopically normal supraspinatus tendons were obtained to serve as normal controls. Specimens were fixed in 10% buffered formalin and embedded in paraffin. A 22-mer oligonucleotide probe was labeled with digoxigenin and used as an in situ marker. The labeled cells were mainly composed of tenocytes and undifferentiated mesenchymal cells. In complete-thickness-tears, the labeled cells at the proximal tendon-stumps in the specimens that were obtained less than 4 months after trauma were significantly more abundant than in the specimens obtained 4 months or more after trauma. However, the number of labeled cells was maintained at the torn portion even in long-standing incomplete-thickness tears. The labeled cells at the margins of concomitant intratendinous extensions of the tears were detected even in the long-standing tears. The intratendinous extensions exhibited more labeled cells than the bursal-side or joint-side layers of the tendon substance in the incomplete-thickness tears (p < 0.05). The torn supraspinatus tendon may possess an intrinsic healing capability in the intermediate and late phases of tendon healing. Incomplete-thickness tears and concomitant intratendinous extensions can continue to rupture after the initial injury.
为了确定冈上肌腱撕裂的愈合潜力和愈合过程，采用原位杂交技术定位含有α1 I型前胶原mRNA的细胞。在手术过程中获取了19例全层撕裂和13例非全层撕裂的冈上肌腱撕裂活检标本。获取4条宏观正常的冈上肌腱作为正常对照。标本用10%缓冲福尔马林固定并石蜡包埋。用洋地黄毒苷标记一个22聚体寡核苷酸探针并用作原位标记物。标记细胞主要由腱细胞和未分化的间充质细胞组成。在全层撕裂中，创伤后不到4个月获取的标本中，近端肌腱残端的标记细胞明显比创伤后4个月或更长时间获取的标本中丰富。然而，即使在长期的非全层撕裂中，撕裂部位的标记细胞数量也保持稳定。即使在长期撕裂中，也能在撕裂伴随的腱内延伸边缘检测到标记细胞。在非全层撕裂中，腱内延伸处的标记细胞比肌腱实质的滑囊侧或关节侧层更多（p<0.05）。冈上肌腱撕裂在肌腱愈合的中晚期可能具有内在的愈合能力。非全层撕裂和伴随的腱内延伸在初始损伤后可能会继续破裂。
