髌腱自体移植物优于阔筋膜上囊重建:组织病理学和生物力学的比较研究。

IF 2.9 2区 医学 Q1 ORTHOPEDICS
Muhammed Uslu, Erdinç Genc, Ergün Bozdağ, Fatih Yamak, Mehmet Kapicioglu, Serdar Yüksel, Kerem Bilsel
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引用次数: 0

摘要

背景:在治疗不可逆性肩袖(RC)撕裂时,外科医生使用阔筋膜张肌(TFL)或各种同种异体移植物重建肩上囊以阻止进行性关节退变。本研究评估了髌腱(PT)自体移植物与TFL自体移植物在上囊重建(SCR)中的愈合特点,从生物力学和组织学方面进行了检查。方法:采用14只家兔28个肩关节进行实验研究。所有手术组均建立完整切除冈上肌和肩胛下肌的牵缩回撕裂模型。8周后,采用标准化技术进行上囊重建(SCR):右肩植入阔筋膜(FL)自体移植物,左肩植入髌骨肌腱(PT)自体移植物,对照组不进行干预。所有移植物均在关节盂上部和外侧大结节处用骨隧道和骨缝固定。术后观察8周。结果测量包括生物力学测试(负荷失效)和组织病理学分析(肌腱成熟评分、胶原I-III型比率和CD31免疫反应性)。结果:事后两两分析显示,与对照组相比,FL组的负荷-失效值显著降低(P0.05)。细胞度、血管性、胶原连续性和潮纹发育在PT组和对照组之间没有显著差异(P < 0.05),而FL组这些参数显著降低(P < 0.05)。结论:在该兔模型中,与SCR中FL自体移植物相比,PT自体移植物具有更好的生物力学强度、血管性和胶原重塑,表明移植物整合改善。需要进一步的研究,包括基于尸体的研究和临床试验,来验证这些发现,并确定人类SC移植选择的临床相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patellar tendon autografts outperform fascia lata in superior capsular reconstruction: a comparative histopathological and biomechanical study.

Background: In the treatment of irreversible rotator cuff tears, surgeons reconstruct the superior capsule of the shoulder using tensor fascia lata (FL) or various allografts to halt progressive joint degeneration. This study evaluated the healing characteristics of patellar tendon (PT) autograft vs. tensor FL autograft in superior capsular reconstruction (SCR), examining both biomechanical and histological aspects.

Methods: A total of 28 shoulders from 14 rabbits were used in this experimental study. Retracted tear models involving complete resection of both the supraspinatus and subscapularis tendons were created in all surgical groups. After an 8-week retraction period, superior capsular reconstruction (SCR) was performed using standardized techniques: FL autografts were implanted in the right shoulders and PT autografts in the left shoulders, while the control group received no intervention. All grafts were fixed identically with bone tunnels and prolene sutures at the glenoid superiorly and the greater tuberosity laterally. Rabbits were observed for 8 weeks postoperatively. Outcome measures included biomechanical testing (load-to-failure) and histopathological analysis (tendon maturation scoring, collagen type I-III ratio, and cluster of differentiation 31 (CD31) immunoreactivity).

Results: Post hoc pairwise analysis revealed that the load-to-failure values were significantly lower in FL group compared to those in control group (P < .01), suggesting that FL group could not maintain biomechanical stability and tendon-bone integration. No significant difference was found between PT and control groups (P > .05). Cellularity, vascularity, collagen continuity, and tidemark development showed no significant differences between the PT and control groups (P > .05), while these parameters were significantly reduced in the FL group (P < .05). FL group's mean total modified Watkins score was much lower than that of the control group (P = .01), while the PT group nearly equaled the control group. Tendons of PT groups had significantly higher immunoreactivity for collagen type I and type III and CD31 compared to the control group (P = .019, P = .015, and P = .014, respectively).

Conclusions: In this rabbit model, PT autografts showed superior biomechanical strength, vascularity, and collagen remodeling compared to FL autografts in SCR, suggesting improved graft integration. Further studies, including cadaver-based research and clinical trials, are required to validate these findings and establish the clinical relevance of graft choice for SCR in humans.

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来源期刊
CiteScore
6.50
自引率
23.30%
发文量
604
审稿时长
11.2 weeks
期刊介绍: The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.
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