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Restoration of the enthesis of the rotator cuff

肩袖附着点的恢复

基本信息

批准号：
10671370
负责人：
AOKI Mitsuhiro
金额：
$ 1.79万
依托单位：
Department of Physical Therapy, Sapporo Medical University School of Health Sciences
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1998
资助国家：
日本
起止时间：
1998 至 2000
项目状态：
已结题

项目摘要

Enthesis is an important site of force transmission through tendon to bone, and collagen fibers of tendons insert into bone via fibrocartilage. However, there were few reports in which repair process of injured enthesis was observed. From 1997, we instituted basic research for repair process of enthesis which has characteristic anatomical structure. As a result of this research, repair process of collagen fibers which enter into bone varies according to the surface of bone on which tendon is re-attached. Tendon repair to distal tendon ends restored the four-layered enthesis in the healing period, whereas tendon repair to the calcified fibrocartilage layer considerably delayed fiber development into bone. Fiber connection to cancellous surface developed according to the remodeling of trabecular bone. Based on these results, in clinical settings, the traditional surgical procedure of the rotator cuff into cancellous bone was proved to be reasonable (J Shoulder Elbow Surg, 2001, in press).Furthermore, to make clear the fine the process of collagen attachment into cancellous bone, we introduced scanning electron microscope observation. In consequence, connection of newly formed collagen fibers into cancellous bone initiated by forming both new collagen fibers and woven bone at two postoperative weeks. At four postoperative weeks, aligned collagen fibers gathered in bundle and connected into woven bone. At six postoperative weeks, collagen bundles became dense and well aligned forming secure connection to bone. This is the first report in which early process of tendon anchoring into cancellous bone was demonstrated (J Orthop Res, 2001, in press).According to these studies, we observed repair process of tendon into cancellous bone histologically, and realized that good blood supply and adequate tension induced healing process of tendon to bone. In future study, we should consider an ideal method to reconstruct defected tendon close to bone.

肌腱连接是肌腱向骨传递力的重要部位，肌腱中的胶原纤维通过纤维软骨进入骨中。然而，观察到损伤的末端修复过程的报道很少。从1997年开始，我们开展了具有独特解剖结构的口腔修复过程的基础研究。本研究的结果是，进入骨骼的胶原纤维的修复过程因肌腱重新附着在骨表面的不同而不同。远端肌腱修复在愈合期恢复了四层融合，而对钙化的纤维软骨层的肌腱修复大大延缓了纤维向骨的发育。纤维与松质骨表面的连接是随着松质骨的改建而形成的。基于这些结果，在临床环境下，传统的肩袖植入松质骨的手术方法被证明是合理的(J肩肘外科，2001，在新闻中)。此外，为了了解胶原附着到松质骨中的精细过程，我们引入了扫描电子显微镜观察。因此，新形成的胶原纤维在术后两周通过形成新的胶原纤维和编织骨而开始与松质骨连接。术后4周，排列整齐的胶原纤维聚集成束并连接成编织骨。术后6周，胶原束变得致密，排列良好，与骨形成安全的连接。这是第一个关于肌腱锚定到松质骨的早期过程的报道(J Orthop res，2001)。根据这些研究，我们从组织学上观察了肌腱到松质骨的修复过程，并认识到良好的血液供应和足够的张力可以促进肌腱到骨的愈合过程。在以后的研究中，我们应该考虑一种理想的方法来重建接近骨的肌腱缺损区。