在欧洲,每年进行大约100000到500000个肌腱修复。这些手术与术后并发症的发生率相当高(从6%到11%)。自体微移植物(AAMG)和基质血管分数(SVF)已显示可改善60%至70%的治疗啮齿动物的肌腱愈合。这项研究的目的是评估AAMG在患有肌腱病的绵羊模型中的作用。我们使用绵羊模型是因为,作为一种大型动物,他们更像人类。假设与对照组相比,注射SVF可以改善肌腱愈合,减少炎症和基质降解,同时增加肌腱损伤早期的抗炎表达和胶原合成。16只2至5岁的亚平宁羊接受了500UII型胶原酶注射到两个常见的跟骨肌腱(CCT)中以诱发肌腱病。15天后(T0),每只绵羊随机接受1例CCT至2.5mL通过机械破碎获得的AAMG,对侧CCT未接受治疗.临床,生态,在4周(T1)和8周(T2)后进行超声检查。组织学,免疫组织化学,实时聚合酶链反应(RT-PCR),在T2进行生物力学评估。在T2时,治疗组的最终肌腱直径(9.1±1.4mm)和硬度表达(62%)与原始健康肌腱(8.1±1.1mm;100%)相似,与对照组相比显着恢复(9.5±1.7mm;39%)。此外,治疗组的组织学分析显示纤维取向评分有所改善,纤维水肿评分,浸润性炎症过程,坏死评分(4.3±3.3)与对照组(8.8±2.9)比较。免疫组织化学,治疗组显示胶原1、因子VIII的高表达和胶原3的显著低表达。通过RT-PCR分析证实了这些数据。研究结果表明,通过机械破坏获得的AAMG具有安全性,高效,和可靠的技术,增强肌腱愈合。
In Europe, approximatively 100 000 to 500 000 tendon repairs are performed every year. These procedures are associated with a considerable rate of postoperative complications (from 6% to 11%). Autologous micro-grafts (AAMG) and stromal vascular fraction (SVF) have been shown to improve tendon healing in 60% to 70% of treated rodents. The purpose of this
study was to evaluate the effects of AAMG in a sheep model with tendinopathy. We used sheep models because, as a large animal, they are more comparable to humans. The hypothesis was that SVF injection would improve tendon healing compared with the control group, reducing inflammatory and matrix degrading, while increasing anti-inflammatory expression and collagen synthesis in the early stage of tendon injury. Sixteen Apennine sheep aged 2 to 5 years underwent 500 UI type I collagenase injection into both common calcaneal tendons (CCT) to induce tendinopathy. After 15 days (T0), one CCT in every ovine underwent randomly to 2.5 mL of AAMG obtained by mechanical disruption and the contralateral CCTs received no treatment. Clinical, ecographic, and sonographic evaluations were performed after 4 weeks (T1) and 8 weeks (T2). Histological, immunohistochemical, real-time polymerase chain reaction (RT-PCR), and biomechanical evaluations were performed at T2. At T2, the treated group showed a final tendon diameter (9.1 ± 1.4 mm) and a hardness expression (62%) that were similar to the original healthy tendon (8.1 ± 1.1 mm; 100%), with a significant recovery compared with the control group (9.5 ± 1.7 mm; 39%). Moreover, histological analysis of the treated group revealed an improvement in the fiber orientation score, fiber edema score, infiltrative-inflammatory process, and necrosis score (4.3 ± 3.3) compared with control group (8.8 ± 2.9). Immunohistochemically, the treated group showed high expression of collagen 1, Factor VIII and significantly low expression of collagen 3. These data were confirmed by RT-PCR analysis. The
study findings suggested that AAMGs obtained through mechanical disruption present a safe, efficient, and reliable technique, enhancing tendon healing.