[1]谢求恩 何江 谢心军 徐永贵 郭彦涛 刘鑫 张博.续筋接骨液与自体富血小板血浆促进兔肩袖腱骨界面愈合的实验研究[J].中国中医骨伤科杂志,2020,28(08):1-7.
　Liquid and APRP on Tendon Bone Healing of Rabbit Rotator Cuff XIE Qiuen HE Jiang XIE Xinjun XU Yonggui GUO Yantao LIU Xin ZHANG Bo.Experimental Study on the Auxo-action of Xujin Jiegu[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2020,28(08):1-7.
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续筋接骨液与自体富血小板血浆促进兔肩袖腱骨界面愈合的实验研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第28卷
期数:
2020年08期
页码:
1-7
栏目:
实验研究
出版日期:
2020-08-10

文章信息/Info

Title:
Experimental Study on the Auxo-action of Xujin Jiegu
文章编号:
1005-0205(2020)08-0001-07
作者:
谢求恩1 何江2 谢心军1 徐永贵1 郭彦涛1 刘鑫1 张博2
1湖南中医药大学第一附属医院(长沙,410007) 2湖南中医药大学
Author(s):
Liquid and APRP on Tendon Bone Healing of Rabbit Rotator Cuff XIE Qiuen1 HE Jiang2 XIE Xinjun1 XU Yonggui1 GUO Yantao1 LIU Xin1 ZHANG Bo2
1The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410007,China; 2Hunan University of Traditional Chinese Medicine,Changsha 410208,China.
关键词:
续筋接骨液;  自体富血小板血浆;  肩袖;  腱骨愈合
Keywords:
Xujin Jiegu liquid;  autologous platelet-rich plasma;  rotator cuff;  tendon bone healing
分类号:
R-33
文献标志码:
A
摘要:
目的:探讨续筋接骨液与自体富血小板血浆(APRP)对兔肩袖重建术后腱骨愈合的促进作用及其作用机制。方法:选用45只健康的新西兰大白兔随机分为A,B,C,D,E共5组,每组各9只。A组为正常组,B组为模型组,C组为续筋接骨液组,D组为APRP组,E组为续筋接骨液+APRP组。A组不做任何处理; B组、C组双侧肩关节成功制作出肩袖损伤模型后,B组予以生理盐水灌胃8周,C组予以续筋接骨液灌胃8周; D组、E组在双侧建立肩袖损伤模型并进行肩袖重建手术后予以APRP凝胶局部应用再逐层缝合伤口,术后D组予以生理盐水灌胃8周,E组予以续筋接骨液灌胃8周。分别于2,4,8周处死每组中各3只兔,观察其组织学染色、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)的表达并进行生物力学测定。结果:苏木精-伊红染色结果:正常冈上肌肌腱纤维呈排列规整,可见肌腱纤维、纤维软骨、钙化纤维软骨、骨的典型四层结构。肩袖重建术后第2周,C,D,E组炎性反应明显轻于B组,且有一定量的新生血管生成。肩袖重建术后第4周,B组腱骨面开始疏松结合,C,D,E组结合较B组紧密,且类圆形软骨细胞较模型组明显增多,胶原纤维排列较规整,而E组可见排列较规则的胶原纤维与类圆形软骨细胞相互渗透生长。肩袖重建术后第8周,C,D,E组的腱骨结合面明显较B组紧密,均可见新骨形成。免疫组化结果:VEGF及bFGF在正常兔的肩袖腱骨面几乎不表达。造模后第2周及第4周,B,C,D,E组VEGF及bFGF的表达水平明显高于A组,但C,D,E组VEGF及bFGF高于B组,差异有统计学意义(P<0.05),且E组VEFG及bFGF的表达水平高于C,D组,差异有统计学意义(P<0.05)。造模后第8周,B,C,D,E组VEGF及bFGF的表达水平下降,但仍明显高于A组,差异有统计学意义(P<0.05),而各组之间差异无统计学意义(P>0.05)。生物力学测定结果:B,C,D,E组所有标本最大负荷时均断裂在冈上肌止点缝合处。在各时间点,A组的最大负荷值明显高于B,C,D,E组,差异有统计学意义(P<0.05)。肩袖重建术后第2周,B,C,D,E各组间最大负荷差异均无统计学意义。肩袖重建术后第4周及第8周,C,D,E组的最大负荷值均明显高于B组,差异有统计学意义(P<0.05),C,D组间最大负荷值,差异无统计学意义(P>0.05),E组的值明显高于C,D组,差异有统计学意义(P<0.05)。结论:续筋接骨液与APRP均能促进肩袖腱骨愈合,其作用机制可能与上调VEGF及bFGF的表达有关; 续筋接骨液与APRP联合应用促进肩袖腱骨愈合的能力优于二者单独应用。
Abstract:
Objective:To investigate the effect of Xujin Jiegu liquid and APRP on tendon bone healing after rotator cuff reconstruction in rabbits and its mechanism.Methods:45 healthy New Zealand white rabbits were randomly divided into five groups of A,B,C,D and E,with 9 cases in each group.Group A was the normal group,group B was the model group,group C was the Xujin Jiegu liquid group,group D was the APRP group,and group E was the Xujin Jiegu liquid + APRP group.Group A acceptn one treatment.After the rotator cuff injury models were successfully made in the bilateral shoulder joints of group B and C,group B was administered with saline for 8 weeks,and group C was administered with Xujin Jiegu liquid for 8 weeks.In group D and E,a rotator cuff injury model was established on both sides and rotator cuff reconstruction were performed.APRP gel was applied locally and the wound was well sutured.Group D was administrated with saline for 8 weeks,and group E was administrated with Xujin Jiegu liquid for 8 weeks.3 rabbits in each group were killed at the 2nd,4th and 8th week respectively,and their histological staining,expression of VEGF and bFGF and the biomechanical measurements were detected.Results:HE staining showed that the tendon fibers of normal supraspinatus muscle were arranged regularly,and the typical four-layer structure including tendon fibers,fibrocartilage,calcified fibrocartilage and bone were observed.At the 2nd week after rotator cuff reconstruction,the inflammatory reaction in group C,D and E was significantly lighter than that in group B,and there was a certain amount of neovascularization.At the 4th week after rotator cuff reconstruction,the osseous surface of tendon began to bind loosely in group B.Group C,D and E were more compact than group B,and the number of round chondrocytes in group E was significantly more than that in model group,and the arrangement of collagen fibers was more regular.In group E,the regular arrangement of collagen fibers and round chondrocytes infiltrated into each other.On the 8th week after rotator cuff reconstruction,new bone formation was found in group B,C,D and E,and the tendon bone interface in group C,D and E were more compacted as compared with that of group B.Immunohistochemical results showed that VEGF and bFGF were almost not expressed on the osseous surface of rotator cuff tendon in normal rabbits.At the 2nd and 4th week after modeling,the expression level of VEGF and bFGF in group B,C,D and E were significantly higher than that in group A.The level of VEGF and bFGF in group C,D and E were higher than that in group B(P<0.05),and the expression of VEFG and bFGF in group E were higher than that in group C,D(P<0.05).At the 8th week after modeling,the expression of VEFG and bFGF in group B,C,D and E decreased.But they are still significantly higher than that in group A(P<0.05),but there was no significant difference among group B,C,D and E(P>0.05).Biomechanical results:all specimens in group B,C,D and E were ruptured at the sutures of supraspinatus muscle at the maximum load.At each time point,the maximum load of group A was significantly higher than that of group B,C,D and E(P<0.05).At the 2nd week after rotator cuff reconstruction,there was no significant difference in maximum load among groups B,C,D and E.At the 4th and 8th week after rotator cuff reconstruction,the maximum load values in group C,D and E were significantly higher than those in group B(P<0.05),but there was no significant difference between group C and D(P>0.05).The value in group E was significantly higher than that in group C and D(P<0.05).Conclusion:Both Xujin Jiegu liquid and APRP can promote the healing of the rotator cuff tendon-bone interface,and its mechanism may be related to up-regulating the expression of VEGF and bFGF.The combined application of Xujin Jiegu liquid and APRP is better than only application of two.

参考文献/References:

[1] BEN-NAFA W,MUNRO W.The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis:a systematic review[J].SICOT J,2018,4:11.
[2] 谭明伟,吴美平.肩关节镜下缝合桥技术修复全层肩袖损伤30例[J].中国中医骨伤科杂志,2018,26(1):59-60.
[3] GRAIET H,LOKCHINE A,FRANCOIS P,et al.Use of platelet-rich plasma in regenerative medicine:technical tools for correct quality control[J].BMJ Open Sport Exerc Med,2018,13(1):e000442.
[4] 李梓宸,谢心军,谢求恩,等.针刀松解联合续筋接骨液内服治疗肩袖损伤的临床观察[J].中国中医骨伤科杂志,2019,27(8):32-34.
[5] HASHIMOTO E,OCHIAI N,KENMOKU T,et al.Macroscopic and histologic evaluation of a rat model of chronic rotator cuff tear[J].J Shoulder Elbow Surg,2016,25(12):2025-2033.
[6] LEBASCHI A,DENG X H,ZONG J,et al.Animal models for rotator cuff repair[J].Ann N Y Acad Sci,2016,1383(1):43-57.
[7] 闫明童,翟申浩,褚国庆,等.肩袖肌腱损伤动物模型的建立及初步研究[J].中国运动医学杂志,2019,38(5):406-411.
[8] 李奉龙,姜春岩,鲁谊,等.兔肩袖损伤模型的建立及初步组织学研究[J].中国组织工程研究,2012,16(20):3685-3689.
[9] 叶鹏,李奉龙,姜春岩,等.巨大及不可修复肩袖损伤的治疗进展[J/CD].中华肩肘外科电子杂志,2017,5(3):231-236.
[10] CHIANCA V,ALBANO D,MESSINA C,et al.Rotator cuff calcific tendinopathy:from diagnosis to treatment[J].Acta Biomed,2018,89(1-S):186-196.
[11] 梅杰,季卫平,邹光翼,等.复方夏天无片在关节镜肩袖损伤修复术后应用的疗效分析[J].中成药,2017,39(2):440-442.
[12] KUFFLER D P.Variables affecting the potential efficacy of PRP in providing chronic pain relief[J].J Pain Res,2019,12:109-116.
[13] KADRY M,TAWFIK A,ABDALLAH N,et al.Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo:a comparative study[J].Clin Cosmet Investig Dermatol,2018,11:551-559.
[14] CLENDENEN N,GINDE A.Efficacy of platelet-rich plasma as conservative treatment in orthopaedics[J].Blood Transfus,2018,16(6):473-474.
[15] SINNOTT C,WHITE H M,CUCHNA J W,et al.Autologous blood and platelet-rich plasma injections in the treatment of achilles tendinopathy:a critically appraised topic[J].J Sport Rehabil,2017,26(3):279-285.
[16] ZUMSTEIN M A,LÄDERMANN A,RANIGA S.The biology of rotator cuff healing[J].Orthop Traumatol Surg Res,2017,103(1S):S1-S10.
[17] SHAMS A,EL-SOOPD M,GOOUAL O,et al.Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears[J].Eur J Orthop Surg Traumatol,2016,26(8):837-842.
[18] HURLEY E T,LIM FAT D,MORAN C J,et al.The efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair:a meta-analysis of randomized controlled trials[J].Am J Sports Med,2019,47(3):753-761.
[19] DEPRS-TREMBLAY G,CHEVRIER A,SNOW M,et al.Freeze-dried chitosan-platelet-rich plasma implants improve supraspinatus tendon attachment in a transosseous rotator cuff repair model in the rabbit[J].J Biomater Appl,2019,33(6):792-807.
[20] BENTLEY K,Chakravartula S.The temporal basis of angiogenesis[J].Philos Trans R Soc Lond B Biol Sci,2017,372(1720):20150522.
[21] HEGDE P S,WALLIN J J,MANCAO C.Predictive markers of anti-VEGF and emerging role of angiogenesis inhibitors as immunotherapeutics[J].Semin Cancer Biol,2018,52(2):117-124.
[22] BIAO C.Advances in the treatment of rotator cuff lesions by cytokines[J].Front Biosci,2017,22(3):516-529.

备注/Memo

备注/Memo:
(收稿日期:2020-01-11)基金项目:2017年湖南省教育厅科学研究项目(17C1225)
更新日期/Last Update: 2020-08-10