UNASSIGNED:对于不可修复的巨大肩袖撕裂(IMRCTs)患者,已证明上囊重建(SCR)是一种有价值的治疗方法。然而,内侧冈上肌(SSP)肌腱撕裂,作为动态稳定器,在常规SCR中没有处理,SSP肌腱的动力没有恢复。
UNASSIGNED:为了评估大鼠模型中动态SCR(dSCR)对筋膜-骨愈合的影响,并比较使用自体阔筋膜(FL)的dSCR和SCR在IMRCT患者中的短期临床有效性。
未经评估:对照实验室研究和队列研究;证据水平,3.
UNASSIGNED:将50只大鼠随机分为2组:dSCR组和SCR组(每组25只)。首先,创建了慢性IMRCT,然后使用自体胸腰椎筋膜(TLF)移植物对两组的肌腱撕裂进行SCR。在dSCR组中,SSP肌腱的残余物被缝合到TLF移植物的内侧部分,但在SCR组中没有。在术后1、2、4、8和16周评估组织学切片。在临床研究中,22名患者(9个SCR,13dSCR)进行了分析。肩关节功能的恢复,包括活动范围(ROM),视觉模拟量表(VAS),美国肩肘外科医师得分,恒定的分数,加州大学洛杉矶分校的分数,肩关节距离(AHD),和脂肪渗透,在手术前和最后一次随访时进行评估。
UNASSIGNED:大鼠模型中筋膜-骨连接的组织学分析显示,两组中TLF逐渐迁移到肩袖缺损上方的肌腱样组织中,dSCR组在第4周时筋膜-骨界面的改良肌腱成熟评分高于SCR组(12.20±1.30vs14.60±1.52;P=.004),8周(19.60±1.14vs22.20±1.10;P=0.019),和16周(23.80±0.84vs26.20±0.84P=.024)。dSCR组显示较早的纤维软骨细胞形成和血管生成。在临床研究中,所有22例患者在手术后至少完成了12个月的随访,SCR组为22.89±7.59个月,dSCR组为25.62±7.32个月。两组患者的ROM均有显著改善,肩关节功能评分,和AHD。在最后一次随访中,外展(56.67°±27.39°vs86.54°±30.37°;P=.029),外旋(25.00°±9.35°vs33.08°±8.55°;P=.049),内旋锥等级(-2.78±2.44vs-4.38±1.12;P=.049),VAS(-3.00±0.87vs-3.92±0.95;P=.031)和常数(47.89±15.39vs59.15±9.74;P=.048)得分,与SCR组相比,dSCR组的AHD改善程度(3.06±1.41mmvs4.38±1.35mm;P=0.039)显着改善。末次随访脂肪浸润结果显示,常规SCR组(P=.036)和dSCR组(P=.001)与术前结果相比均有显著改善。然而,两组间差异无统计学意义(P=0.511).
UNASSIGNED:dSCR可以促进大鼠模型中筋膜到骨的更快愈合,dSCR技术可以为IMRCT患者提供更好的治疗选择。
UNASSIGNED:dSCR可能在某种意义上恢复SSP的动态,然后改善SSP中的脂肪浸润。
Superior capsular reconstruction (SCR) has been demonstrated to be a valuable treatment for patients with irreparable massive rotator cuff tears (IMRCTs). However, the torn medial supraspinatus (SSP) tendons, which acted as dynamic stabilizers, were left untreated in conventional SCR, and the dynamic force from the SSP tendon was not restored.
To evaluate the effect of dynamic SCR (dSCR) on fascia-to-bone healing in a rat model, and to compare the short-term clinical effectiveness of dSCR and SCR using autologous fascia lata (FL) in patients with IMRCTs.
Controlled laboratory study and cohort study; Level of evidence, 3.
A total of 50 rats were divided randomly into 2 groups: the dSCR group and the SCR group (25 rats per group). First, chronic IMRCTs were created, and then the torn tendons in both groups were subjected to SCR using autologous thoracolumbar fascial (TLF) grafts. The remnant of the SSP tendon was sutured to the medial part of the TLF graft in the dSCR group but not in the SCR group. Histologic sections were assessed at 1, 2, 4, 8, and 16 weeks postoperatively. In the clinical study, 22 patients (9 SCR, 13 dSCR) were analyzed. The recovery of shoulder function, including the active range of motion (ROM), visual analog scale (VAS), American Shoulder and Elbow Surgeons score, Constant score, and University of California Los Angeles score, acromiohumeral distance (AHD), and fatty infiltration, was evaluated before surgery and at the last follow-up.
Histologic analysis of the fascia-to-bone junction in the rat model showed that the TLF gradually migrated into tendon-like tissue over the rotator cuff defects in both groups, and the modified tendon maturation score of the fascia-to-bone interface in the dSCR group was higher than that in the SCR group at 4 weeks (12.20 ± 1.30 vs 14.60 ± 1.52; P = .004), 8 weeks (19.60 ± 1.14 vs 22.20 ± 1.10; P = .019), and 16 weeks (23.80 ± 0.84 vs 26.20 ± 0.84 P = .024). The dSCR group showed earlier fibrocartilage cell formation and angiogenesis. In the clinical study, all 22 patients completed a minimum of 12 months of follow-up after surgery, and the mean follow-up duration was 22.89 ± 7.59 months in the SCR group and 25.62 ± 7.32 months in the dSCR group. The patients in both groups showed significant improvements in terms of ROM, shoulder function scores, and AHD. At the last follow-up, abduction (56.67°± 27.39° vs 86.54°± 30.37°; P = .029), external rotation (25.00°± 9.35° vs 33.08°± 8.55°; P = .049), internal rotation cone rank (-2.78 ± 2.44 vs -4.38 ± 1.12; P = .049), VAS (-3.00 ± 0.87 vs -3.92 ± 0.95; P = .031) and Constant (47.89 ± 15.39 vs 59.15 ± 9.74; P = .048) scores, and the AHD improvement degree (3.06 ± 1.41 mm vs 4.38 ± 1.35 mm; P = .039) in the dSCR group were significantly improved compared with those in the SCR group. The results of fatty infiltration at the last follow-up showed that there was significant improvement compared with the preoperative results in both the conventional SCR (P = .036) and the dSCR (P = .001) groups. However, there were no significant differences between the 2 groups (P = .511).
dSCR can promote faster fascia-to-bone healing in a rat model, and the dSCR technique could provide a preferable treatment option for patients with IMRCTs.
dSCR might restore the dynamic of SSP in some sense and then improve the fatty infiltration in the SSP.