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.

附着点是肌腱向骨骼传递力的重要部位，肌腱的胶原纤维通过纤维软骨插入骨骼。然而，观察损伤附着点修复过程的报道却很少。从1997年开始，我们针对具有特色解剖结构的附着点修复过程开展了基础研究。这项研究的结果是，进入骨骼的胶原纤维的修复过程根据肌腱重新附着的骨骼表面而有所不同。对远端肌腱末端的肌腱修复在愈合期间恢复了四层附着点，而对钙化纤维软骨层的肌腱修复则大大延迟了纤维发育成骨。根据骨小梁的重塑而发展出与松质表面的纤维连接。基于这些结果，在临床环境中，将肩袖植入松质骨的传统手术方法被证明是合理的（J Shoulder Elbow Surg，2001，出版中）。此外，明确胶原蛋白附着到松质骨中的精细过程松质骨，我们采用扫描电镜观察。因此，在术后两周内，通过形成新的胶原纤维和编织骨，开始将新形成的胶原纤维连接到松质骨中。术后四周，排列整齐的胶原纤维聚集成束并连接成编织骨。术后六周，胶原蛋白束变得致密且排列良好，形成与骨骼的牢固连接。这是第一篇报道肌腱锚定到松质骨的早期过程（J Orthop Res，2001，出版中）。根据这些研究，我们从组织学上观察了肌腱修复到松质骨的过程，并认识到良好的血液供应和足够的张力诱导肌腱到骨骼的愈合过程。在未来的研究中，我们应该考虑一种理想的方法来重建靠近骨的缺损肌腱。