| Objective: to investigate the maximum load of tendon bone interface,the changes of fibroblasts and extracellular matrix,and the changes of IL-1 β,IL-6 and TNF-α in acromial bursa after transplantation of muscle fascia patch in the treatment of giant rotator cuff tear.Methods: There were 50 SPF male SD rats of 8 weeks old,of which 5rats were used as normal group,15 rats were divided into 3 groups according to the time sequence of 2 weeks,4 weeks and 6 weeks,5 rats in each group.The remaining rats were divided into fascia patch transplantation group and simple suture group,15 rats in each group,and then divided into 3 groups according to 2 weeks,4 weeks and 6 weeks after intervention,with 5 rats in each group.One week after the success of the model,direct suture and myofascial patch transplantation were performed in the direct suture group and patch group.2 weeks,4 weeks and 6 weeks after intervention,the tissue from the upper humerus to the ventral part of the superior muscle of the superior humerus was taken for pathological observation and biomechanical examination.The acromial descending capsule of rats was completely removed for ELASA detection,and the changes of IL-1 β,IL-6 and TNF-αcytokines in SAB were observed.Results: Compared with the normal group,the maximum load of the tendon-bone interface in the patch suture group was slightly lower than that in the normal group at 2 weeks,4 weeks and 6 weeks after intervention(p < 0.05).The maximum load at the tendon-bone interface in the direct suture group was also lower than that in the normal group at 2 weeks,4 weeks and 6 weeks after intervention(p < 0.05).The maximum load at the tendon-bone interface in the direct suture group was also lower than that in the normal group at 2 weeks,4weeks and 6 weeks after intervention,and the difference was statisticallysignificant(p < 0.05).However,with the extension of time,the maximum load of patch suture group and direct suture group increased gradually.Compared with the direct suture group,the maximum load of the tendon-bone interface in the patch suture group was significantly better than that in the patch suture group at 2 weeks,4 weeks and 6 weeks after intervention(p < 0.05).After 2weeks of intervention,there were fibroblasts,a large number of collagen fiber connections and inflammatory cell infiltration in both the patch suture group and the direct suture group.There were still gaps in the tendon-bone interface in the direct suture group,and there were more inflammatory cells in the direct suture group than in the patch group.After 4 weeks,there was still inflammatory cell infiltration in the two groups,but there was no significant difference between the two groups,and there was no significant difference between the two groups.There were a large number of fibroblasts proliferation and some irregular muscle fibers at the tendon interface in the patch suture group,and the formation of extracellular matrix in the muscle fiber space,and the number of fibroblasts and extracellular matrix at the tendon interface in the patch suture group was slightly more than that in the direct suture group.At 6weeks,the tendon bone and tendon interface in the experimental group were closely combined,there was no space,the fibroblasts at the tendon interface were arranged neatly,the muscle fibers at the tendon interface were arranged regularly,and there was a large amount of extracellular matrix in the tissue space.In the direct suture group,the fibroblasts at the tendon bone interface were neatly arranged,part of the muscle fibers were produced,and the tissue space was filled with extracellular matrix.Compared with the normal group,the expressions of IL-1 β,IL-6 and TNF-α in subacromial bursa were significantly increased at 2 and 4 weeks after intervention in simple amputation group,direct suture group and patch suture group,but there was no significant difference at 6 weeks after intervention.The expressions of IL-1 β,IL-6 and TNF-α in subacromial bursadecreased with time in patch suture group and direct suture group,while IL-1β,IL-6 and TNF-α in subacromial bursa increased significantly in simple amputation group.There were significant differences between patch suture group and direct suture group and simple amputation group(p < 0.05).The expressions of IL-1 β,IL-6 and TNF-α in subacromial bursa at 2 and 4 weeks after intervention in patch suture group were significantly lower than those in direct suture group(p < 0 05).Six weeks after intervention,there was no significant difference in the three cytokines between the two groups(p > 0.05).Conclusion:Muscle fascia patch transplantation for the treatment of giant rotator cuff tear can reduce the tension between tendons and bones,promote the healing of tendon-bone interface,promote cell proliferation and differentiation and extracellular matrix secretion,and induce collagen fiber formation,so as to provide early stability.Both patch transplantation group and simple suture group could reduce the expression of IL-1 β,IL-6 and TNF-α in acromial bursa,but the concentration of three inflammatory factors in patch transplantation group decreased faster than that in direct suture group. |
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