Degree of tendon degeneration and stage of rotator cuff disease
Degree of tendon degeneration and stage of rotator cuff disease
复制标题
DOI：
10.1007/s00167-016-4376-7
复制
发表时间：
2017-07-01
影响因子：
3.8
通讯作者：
Kim, Ji Eun
中科院分区：
文献类型：
--
作者：
Jo, Chris Hyunchul;Shin, Won Hyoung;Kim, Ji Eun
虽然已知肌腱退行性变是肌腱套疾病的重要原因，但很少有研究客观地证明肌腱退行性变与肌腱套疾病之间的关联。本研究的目的是探讨肌腱退变与肩袖疾病分期的关系。研究共纳入48例患者：12例为肌腱病变，12例为部分层撕裂（pRCT）， 12例为全层撕裂（fRCT）， 12例为对照组。使用直径为3mm的活组织检查打孔器，从肌腱外侧边缘和肌肉肌腱连接处之间的中间部分采集全层冈上肌腱样本。采集的样品经苏木精和伊红染色后，采用7个参数的半定量分级量表进行评估。两组患者在年龄、性别、症状持续时间和kelgren - lawrence分级方面无显著差异，但整体脂肪变性指数除外。这7个参数在组间均有显著差异，可分为早期反应（纤维结构和排列）、逐渐反应（细胞核变圆）、撕裂后反应（细胞结构、血管结构和染色）和晚期反应（透明化）。对照组（6.08 +/- 1.16）和肌腱病变组（6.67 +/- 1.83）的退变总分无显著差异（n.s）。但pRCT组评分（10.42 +/- 1.31）高于肌腱病变组（P < 0.001）， fRCT组评分（12.33 +/- 1.15）高于pRCT组（P = 0.009）。本研究表明，随着肩袖疾病阶段从肌腱病变到pRCT，再到fRCT，冈上肌腱退变增加。肌腱病变的退行性变程度与正常、衰老肌腱无明显差异，明显的退行性变从pRCT阶段开始。该研究的临床意义在于，治疗肩袖疾病的策略和目标应针对其阶段，以防止肌腱病变和pRCT的疾病进展，并恢复fRCT的结构完整性。诊断，一级。
While tendon degeneration has been known to be an important cause of rotator cuff disease, few studies have objectively proven the association of tendon degeneration and rotator cuff disease. The purpose of this study was to investigate changes of tendon degeneration with respect to the stage of rotator cuff disease.A total of 48 patients were included in the study: 12 with tendinopathy, 12 with a partial-thickness tear (pRCT), 12 with a full-thickness tear (fRCT), and 12 as the control. A full-thickness supraspinatus tendon sample was harvested en bloc from the middle portion between the lateral edge and the musculotendinous junction of the tendon using a biopsy punch with a diameter of 3 mm. Harvested samples were evaluated using a semi-quantitative grading scale with 7 parameters after haematoxylin and eosin staining.There was no significant difference in age, gender, symptom duration, and Kellgren-Lawrence grade between the groups except for the global fatty degeneration index. All of the seven parameters were significantly different between the groups and could be categorized as follows: early responders (fibre structure and arrangement), gradual responder (rounding of the nuclei), after-tear responders (cellularity, vascularity, and stainability), and late responder (hyalinization). The total degeneration scores were not significantly different between the control (6.08 +/- 1.16) and tendinopathy (6.67 +/- 1.83) (n.s.). However, the score of pRCT group (10.42 +/- 1.31) was greater than that of tendinopathy (P < 0.001), and so was the score of fRCT (12.33 +/- 1.15) than that of pRCT (p = 0.009).This study showed that the degeneration of supraspinatus tendon increases as the stage of rotator cuff disease progresses from tendinopathy to pRCT, and then to fRCT. The degree of degeneration of tendinopathy was not different from that of normal but aged tendons, and significant tendon degeneration began from the stage of pRCT. The clinical relevance of the study is that strategies and goals of the treatment for rotator cuff disease should be specific to its stage, in order to prevent disease progression for tendinopathy and pRCT, as well to restore the structural integrity for fRCT.Diagnostic, Level I.