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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Muscle Injury Induced At the Time of Acute and Chronic Rotator Cuff Repair
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Muscle Injury Induced At the Time of Acute and Chronic Rotator Cuff Repair

机译：急性和慢性肩袖修复时引起的肌肉损伤

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Objectives: Rotator cuff tears are a common source of shoulder pain and disability. Even after surgical repair of these tears, many patients continue to have reduced shoulder function and a progression of intramuscular fatty degeneration. Previous work in a sheep model demonstrated that a slow, progressive lengthening of chronically torn cuff muscles followed by surgical repair of the tendon reversed fatty degeneration and improved muscle function. As patients with chronic cuff tears often experience a shortening of the muscle fibers, it is possible that repairing the torn tendon to its original anatomical footprint induces a massive stretch-induced muscle injury that could contribute to poor outcomes after repair. Evans Blue Dye (EBD) is a water soluble, membrane impermeable dye, that is used to identify muscle fibers that have suffered an injury to their plasma membrane. We hypothesized that, compared with acutely torn and repaired rotator cuff muscles, the substantial stretch that is required to repair a chronically torn and shortened rotator cuff would result in significant muscle fiber damage. Methods: This study was approved by our IACUC. Male Sprague-Dawley retired breeder rats (n=30) were placed into 5 groups: control, sham surgery, acute tear no repair, acute tear and repair, chronic tear no repair and chronic tear and repair, with each modality performed bilaterally (Fig 1A). An intraperitoneal injection of 1% EBD was administered 24 hours before the harvest surgery. At harvest, the supraspinatus muscles of each rat were removed and the length and mass of each muscle was measured. To determine EBD+ fibers the supraspinatus muscles were snap frozen in OCT and the muscles were cryosectioned and incubated with WGA-Lectin-AF488 to mark the extracellular matrix (ECM), DAPI to identify nuclei and EBD was used to identify the fibers with a damaged sarcolemma (Fig 1B-C). A one-way ANOVA (p<0.05) and Tukey’s post-hoc sorting was used to evaluate the differences between groups. Results: Compared with controls, rats that had a chronic supraspinatus tear but did not undergo repair had a 35% decrease in muscle mass compared to controls, while rats that had a chronic tear and also underwent repair had a 24% decrease in wet mass compared to controls (Fig 1D). Both groups of rats that underwent a chronic tear experienced an approximate 20% decrease in supraspinatus length when compared to the muscle length of other groups (Fig 1E). In the sham, acute and chronic tear and repair groups there were a greater number of EBD+ fibers in the mid-distal region of the muscle than in the mid-proximal region (Fig 1F). At the mid-distal end of the control and chronic tear no repair groups there were very few EBD+ fibers, in the sham 27% of the fibers were EBD+ and the remaining groups had almost 90% EBD+ fibers (Fig 1F). At the mid-proximal portion of the muscle the chronic tear and repair group had nearly 70% EBD+ fibers while none of the other groups showed a significant increase in EBD+ fibers over the control group (Fig 1G). Conclusion: A massive injury to muscle fibers is induced when the tendons of chronically torn rotator cuffs are repaired to their anatomical footprint. The repair of chronically torn cuff muscles results in extensive injury throughout the muscle that may contribute to poor long-term surgical outcomes even in the setting of a structurally intact repair. Therapeutic interventions that protect the muscle fiber plasma membrane may improve outcomes in patients with rotator cuff tears.
机译：目的：肩袖撕裂是肩部疼痛和残疾的常见原因。即使在对这些眼泪进行手术修复后，许多患者仍会肩部功能下降，并出现肌肉内脂肪变性的进展。先前在绵羊模型中的工作表明，慢性撕裂的袖带肌肉缓慢，渐进地延长，然后进行肌腱的手术修复可逆转脂肪变性并改善肌肉功能。由于患有慢性袖带撕裂的患者通常会经历肌肉纤维的缩短，因此将撕裂的肌腱修复至其原始的解剖结构可能会引起巨大的牵拉性肌肉损伤，从而可能导致修复后的不良预后。 Evans Blue Dye（EBD）是一种水溶性的，不透膜的染料，用于鉴定肌肉纤维质膜受损。我们假设，与急性撕裂和修复的肩袖肌肉相比，修复慢性撕裂和缩短的袖带所需的大量拉伸会导致明显的肌纤维损伤。方法：本研究得到我们的IACUC的批准。将Sprague-Dawley雄性退休种鼠（n = 30）分为5组：对照组，假手术，急性泪液不修复，急性泪液和修复，慢性泪液不修复和慢性泪液和修复，每种方式都在两侧进行（图1A）。收获手术前24小时腹腔注射1％EBD。在收获时，去除每只大鼠的棘上肌，并测量每只肌肉的长度和质量。为了确定EBD +纤维，在OCT中将棘上肌速冻，并将其冷冻切片，并与WGA-Lectin-AF488一起孵育以标记细胞外基质（ECM），使用DAPI识别核，并使用EBD来识别肌膜受损的纤维（图1B-C）。采用单向方差分析（p <0.05）和Tukey的事后排序来评估组之间的差异。结果：与对照组相比，具有慢性上睑上睑撕裂但未进行修复的大鼠的肌肉质量较对照组降低了35％，而具有慢性撕裂且还进行了修复的大鼠的湿质量降低了24％。控件（图1D）。与其他组的肌肉长度相比，两组经历了慢性撕裂的大鼠的棘上肌长度减少了大约20％（图1E）。在假，急，慢性撕裂和修复组中，与中近端相比，在肌肉的中远端区域中存在更多的EBD +纤维（图1F）。在对照和慢性撕裂的中远端，没有修复组的EBD +纤维很少，假手术组中有27％的纤维是EBD +，其余的组几乎有90％的EBD +纤维（图1F）。在肌肉的近端中部，慢性撕裂和修复组的EBD +纤维接近70％，而其他组均未显示EBD +纤维比对照组明显增加（图1G）。结论：长期撕裂的肩袖肌腱修复至其解剖足迹后，会对肌肉纤维造成巨大伤害。慢性撕裂袖口肌的修复会导致整个肌肉的广泛损伤，即使在结构上完整的修复过程中，也可能导致长期不良的手术结果。保护肌纤维质膜的治疗性干预措施可以改善肩袖撕裂患者的预后。

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