肩峰下滑囊在肩袖肌腱愈合中的研究进展
Research Progress on the Subacromial Bursa in the Healing of the Rotator Cuff Tendons
摘要: 肩袖损伤是导致肩关节疼痛及功能障碍的常见原因，其术后愈合质量一直是临床治疗的难点。近年研究发现，肩峰下滑囊(subacromial bursa, SAB)炎症调节维持修复微环境的平衡，并分泌多种细胞因子以促进血管生成与组织再生。其内富含的间充质干细胞具备分化潜能，同时保留或利用SAB的生物增强手术策略为提高肩袖愈合提供了新思路。此外，SAB来源外泌体的治疗潜力、力学生物学对SAB细胞功能的调控作用，以及单细胞组学等新技术的应用，进一步丰富了对SAB功能的认知；各信号通路间的相互作用则构成了SAB调控肩袖愈合的复杂分子网络。本文总结了相关基础与临床研究，以期为未来治疗策略的优化提供理论依据。
Abstract: Rotator cuff injuries are a common cause of shoulder pain and functional impairment, and the quality of postoperative healing has long been a challenge in clinical treatment. Recent studies have found that inflammation in the subacromial bursa (SAB) helps regulate the maintenance of a balanced repair microenvironment and secretes various cytokines to promote angiogenesis and tissue regeneration. The mesenchymal stem cells it contains possess differentiation potential, and strategies that preserve or utilize the bioenhancing properties of the SAB provide new ideas for improving rotator cuff healing. In addition, the therapeutic potential of SAB-derived exosomes, the regulatory role of mechanobiology in SAB cell function, and the application of new technologies such as single-cell omics have further enriched the understanding of SAB function; the interaction between various signaling pathways constitutes a complex molecular network by which SAB regulates rotator cuff healing. This article summarizes related basic and clinical research, aiming to provide a theoretical basis for optimizing future treatment strategies.
文章引用：吴佳龙, 黄俊杰, 吴相杰. 肩峰下滑囊在肩袖肌腱愈合中的研究进展[J]. 临床医学进展, 2026, 16(6): 2423-2434. https://doi.org/10.12677/acm.2026.1662465

参考文献

[1] Zhang, X., Wang, D., Wang, Z., Ling, S.K., Yung, P.S., Tuan, R.S., et al. (2022) Clinical Perspectives for Repairing Rotator Cuff Injuries with Multi-Tissue Regenerative Approaches. Journal of Orthopaedic Translation, 36, 91-108. [Google Scholar] [CrossRef] [PubMed]
[2] Oliva, F., Piccirilli, E., Bossa, M., Giai Via, A., Colombo, A., Chillemi, C., et al. (2016) I.S.MU.L.T-Rotator Cuff Tears Guidelines. Muscle Ligaments and Tendons Journal, 5, 227-263.
[3] Kennedy, M.S., Nicholson, H.D. and Woodley, S.J. (2022) The Morphology of the Subacromial and Related Shoulder Bursae. An Anatomical and Histological Study. Journal of Anatomy, 240, 941-958. [Google Scholar] [CrossRef] [PubMed]
[4] 任树军, 杨阳, 刘俊桐, 等. 超声引导下针刀结合臭氧治疗肩峰下滑囊炎40例[J]. 中国中医骨伤科杂志, 2021, 29(6): 71-73.
[5] 单帅, 姚小强, 郑先丽, 等. 肩峰下滑囊在肩袖损伤中的作用研究进展[J]. 甘肃医药, 2023, 42(4): 304-306.
[6] Ishii, H., Brunet, J.A., Welsh, R.P. and Uhthoff, H.K. (1997) “Bursal Reactions” in Rotator Cuff Tearing, the Impingement Syndrome, and Calcifying Tendinitis. Journal of Shoulder and Elbow Surgery, 6, 131-136. [Google Scholar] [CrossRef] [PubMed]
[7] Chillemi, C., Petrozza, V., Franceschini, V., Garro, L., Pacchiarotti, A., Porta, N., et al. (2016) The Role of Tendon and Subacromial Bursa in Rotator Cuff Tear Pain: A Clinical and Histopathological Study. Knee Surgery, Sports Traumatology, Arthroscopy, 24, 3779-3786. [Google Scholar] [CrossRef] [PubMed]
[8] Põldoja, E., Rahu, M., Kask, K., Weyers, I. and Kolts, I. (2017) Blood Supply of the Subacromial Bursa and Rotator Cuff Tendons on the Bursal Side. Knee Surgery, Sports Traumatology, Arthroscopy, 25, 2041-2046. [Google Scholar] [CrossRef] [PubMed]
[9] Minkwitz, S., Thiele, K., Schmock, A., Bormann, N., Nguyen, T.H., Moroder, P., et al. (2021) Histological and Molecular Features of the Subacromial Bursa of Rotator Cuff Tears Compared to Non-Tendon Defects: A Pilot Study. BMC Musculoskeletal Disorders, 22, Article No. 877. [Google Scholar] [CrossRef] [PubMed]
[10] Millar, N.L., Wei, A.Q., Molloy, T.J., Bonar, F. and Murrell, G.A.C. (2009) Cytokines and Apoptosis in Supraspinatus Tendinopathy. The Journal of Bone and Joint Surgery. British volume, 91, 417-424. [Google Scholar] [CrossRef] [PubMed]
[11] Tamburini, L.M., Levy, B.J., McCarthy, M.B., Kriscenski, D.E., Cote, M.P., Applonie, R., et al. (2021) The Interaction between Human Rotator Cuff Tendon and Subacromial Bursal Tissue in Co-Culture. Journal of Shoulder and Elbow Surgery, 30, 1494-1502. [Google Scholar] [CrossRef] [PubMed]
[12] Mimpen, J.Y., Snelling, S.J.B., Carr, A.J. and Dakin, S.G. (2021) Interleukin-17 Cytokines and Receptors: Potential Amplifiers of Tendon Inflammation. Frontiers in Bioengineering and Biotechnology, 9, Article ID: 795830. [Google Scholar] [CrossRef] [PubMed]
[13] Marshall, B.P., Ashinsky, B.G., Ferrer, X.E., Kunes, J.A., Innis, A.C., Luzzi, A.J., et al. (2024) The Subacromial Bursa Modulates Tendon Healing after Rotator Cuff Injury in Rats. Science Translational Medicine, 16, eadd8273. [Google Scholar] [CrossRef] [PubMed]
[14] Miura, Y., Endo, K. and Sekiya, I. (2024) Histological and Biochemical Changes in a Rat Rotator Cuff Tear Model with or without the Subacromial Bursa. Tissue and Cell, 88, Article 102370. [Google Scholar] [CrossRef] [PubMed]
[15] Millar, N.L., Murrell, G.A.C. and McInnes, I.B. (2017) Inflammatory Mechanisms in Tendinopathy—Towards Translation. Nature Reviews Rheumatology, 13, 110-122. [Google Scholar] [CrossRef] [PubMed]
[16] Serhan, C.N. (2014) Pro-Resolving Lipid Mediators Are Leads for Resolution Physiology. Nature, 510, 92-101. [Google Scholar] [CrossRef] [PubMed]
[17] Klatte-Schulz, F., Bormann, N., Bonell, A., Al-Michref, J., Nguyen, H.L., Klöckner, P., et al. (2023) Pro-Resolving Mediators in Rotator Cuff Disease: How Is the Bursa Involved? Cells, 13, Article 17. [Google Scholar] [CrossRef] [PubMed]
[18] Dakin, S.G., Martinez, F.O., Yapp, C., Wells, G., Oppermann, U., Dean, B.J.F., et al. (2015) Inflammation Activation and Resolution in Human Tendon Disease. Science Translational Medicine, 7, 311ra173. [Google Scholar] [CrossRef] [PubMed]
[19] Klatte-Schulz, F., Thiele, K., Scheibel, M., Duda, G.N. and Wildemann, B. (2022) Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research. Cells, 11, 663. [Google Scholar] [CrossRef] [PubMed]
[20] HajAssaad, A., Willacy, R. and Wilson, R. (2020) A Systematic Review of the Histological and Molecular Changes in the Sub-Acromial Bursa in Rotator Cuff Disease. Journal of Surgical Orthopaedic Advances, 29, 1-4. [Google Scholar] [CrossRef] 
[21] Lafont, J.E., Poujade, F., Pasdeloup, M., Neyret, P. and Mallein-Gerin, F. (2016) Hypoxia Potentiates the BMP-2 Driven COL2A1 Stimulation in Human Articular Chondrocytes via P38 MAPK. Osteoarthritis and Cartilage, 24, 856-867. [Google Scholar] [CrossRef] [PubMed]
[22] Greiner, S., Ide, J., Van Noort, A., Mochizuki, Y., Ochi, H., Marraffino, S., et al. (2015) Local Rhbmp-12 on an Absorbable Collagen Sponge as an Adjuvant Therapy for Rotator Cuff Repair—A Phase 1, Randomized, Standard of Care Control, Multicenter Study. The American Journal of Sports Medicine, 43, 1994-2004. [Google Scholar] [CrossRef] [PubMed]
[23] Kabuto, Y., Morihara, T., Sukenari, T., Kida, Y., Oda, R., Arai, Y., et al. (2015) Stimulation of Rotator Cuff Repair by Sustained Release of Bone Morphogenetic Protein-7 Using a Gelatin Hydrogel Sheet. Tissue Engineering Part A, 21, 2025-2033. [Google Scholar] [CrossRef] [PubMed]
[24] Chen, G., Deng, C. and Li, Y. (2012) TGF-β and BMP Signaling in Osteoblast Differentiation and Bone Formation. International Journal of Biological Sciences, 8, 272-288. [Google Scholar] [CrossRef] [PubMed]
[25] Özdemir, E., Karaguven, D., Turhan, E. and Huri, G. (2021) Biological Augmentation Strategies in Rotator Cuff Repair. Medicinski Glasnik, 18, 186-191. [Google Scholar] [CrossRef] [PubMed]
[26] Apte, R.S., Chen, D.S. and Ferrara, N. (2019) VEGF in Signaling and Disease: Beyond Discovery and Development. Cell, 176, 1248-1264. [Google Scholar] [CrossRef] [PubMed]
[27] Karaman, S., Leppänen, V. and Alitalo, K. (2018) Vascular Endothelial Growth Factor Signaling in Development and Disease. Development, 145, dev151019. [Google Scholar] [CrossRef] [PubMed]
[28] Wang, X., Freire Valls, A., Schermann, G., Shen, Y., Moya, I.M., Castro, L., et al. (2017) YAP/TAZ Orchestrate VEGF Signaling during Developmental Angiogenesis. Developmental Cell, 42, 462-478.e7. [Google Scholar] [CrossRef] [PubMed]
[29] Pulkkinen, H.H., Kiema, M., Lappalainen, J.P., Toropainen, A., Beter, M., Tirronen, A., et al. (2021) BMP6/TAZ-Hippo Signaling Modulates Angiogenesis and Endothelial Cell Response to VEGF. Angiogenesis, 24, 129-144. [Google Scholar] [CrossRef] [PubMed]
[30] Zhang, J., Liu, Z., Li, Y., You, Q., Yang, J., Jin, Y., et al. (2020) FGF2: A Key Regulator Augmenting Tendon-to-Bone Healing and Cartilage Repair. Regenerative Medicine, 15, 2129-2142. [Google Scholar] [CrossRef] [PubMed]
[31] Tokunaga, T., Shukunami, C., Okamoto, N., Taniwaki, T., Oka, K., Sakamoto, H., et al. (2015) FGF-2 Stimulates the Growth of Tenogenic Progenitor Cells to Facilitate the Generation of tenomodulin-Positive Tenocytes in a Rat Rotator Cuff Healing Model. The American Journal of Sports Medicine, 43, 2411-2422. [Google Scholar] [CrossRef] [PubMed]
[32] Zhang, C., Li, Q., Deng, S., Fu, W., Tang, X., Chen, G., et al. (2016) bFGF-and Capp-Loaded Fibrin Clots Enhance the Bioactivity of the Tendon-Bone Interface to Augment Healing. The American Journal of Sports Medicine, 44, 1972-1982. [Google Scholar] [CrossRef] [PubMed]
[33] Jo, C.H., Chai, J.W., Jeong, E.C., Oh, S., Kim, P.S., Yoon, J.Y., et al. (2018) Intratendinous Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A First-in-Human Trial. Stem Cells, 36, 1441-1450. [Google Scholar] [CrossRef] [PubMed]
[34] Jo, C.H., Chai, J.W., Jeong, E.C., Oh, S. and Yoon, K.S. (2020) Intratendinous Injection of Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A 2‐Year Follow‐Up Study. Arthroscopy, 36, 971-980. [Google Scholar] [CrossRef] [PubMed]
[35] 宋娜. 肩峰下滑囊间充质干细胞多能性的探讨及PEDF蛋白在成骨分化过程中的作用[D]: [博士学位论文]. 长春: 吉林大学, 2013.
[36] Kriscenski, D.E., Lebaschi, A., Tamburini, L.M., McCarthy, M.B.R., Cote, M.P., Kumbar, S.G., et al. (2022) Characterization of Murine Subacromial Bursal-Derived Cells. Connective Tissue Research, 63, 287-297. [Google Scholar] [CrossRef] [PubMed]
[37] Utsunomiya, H., Uchida, S., Sekiya, I., Sakai, A., Moridera, K. and Nakamura, T. (2013) Isolation and Characterization of Human Mesenchymal Stem Cells Derived from Shoulder Tissues Involved in Rotator Cuff Tears. The American Journal of Sports Medicine, 41, 657-668. [Google Scholar] [CrossRef] [PubMed]
[38] Song, N., Armstrong, A.D., Li, F., Ouyang, H. and Niyibizi, C. (2014) Multipotent Mesenchymal Stem Cells from Human Subacromial Bursa: Potential for Cell Based Tendon Tissue Engineering. Tissue Engineering Part A, 20, 239-249. [Google Scholar] [CrossRef] [PubMed]
[39] Aydın, A., Duruksu, G., Erman, G., Subaşı, C., Aksoy, A., Ünal, Z.S., et al. (2014) Neurogenic Differentiation Capacity of Subacromial Bursal Tissue—Derived Stem Cells. Journal of Orthopaedic Research, 32, 151-158. [Google Scholar] [CrossRef] [PubMed]
[40] Morikawa, D., Johnson, J.D., Kia, C., McCarthy, M.B.R., Macken, C., Bellas, N., et al. (2019) Examining the Potency of Subacromial Bursal Cells as a Potential Augmentation for Rotator Cuff Healing: An in Vitro Study. Arthroscopy, 35, 2978-2988. [Google Scholar] [CrossRef] [PubMed]
[41] Baldino, J.B., Muench, L.N., Kia, C., Johnson, J., Morikawa, D., Tamburini, L., et al. (2020) Intraoperative and in Vitro Classification of Subacromial Bursal Tissue. Arthroscopy, 36, 2057-2068. [Google Scholar] [CrossRef] [PubMed]
[42] Muench, L.N., Baldino, J.B., Berthold, D.P., Kia, C., Lebaschi, A., Cote, M.P., et al. (2020) Subacromial Bursa-Derived Cells Demonstrate High Proliferation Potential Regardless of Patient Demographics and Rotator Cuff Tear Characteristics. Arthroscopy, 36, 2794-2802. [Google Scholar] [CrossRef] [PubMed]
[43] Morikawa, D., Hawthorne, B.C., McCarthy, M.B.R., Bellas, N., Johnson, J.D., Trudeau, M.T., et al. (2021) Analysis of Patient Factors Affecting in Vitro Characteristics of Subacromial Bursal Connective Tissue Progenitor Cells during Rotator Cuff Repair. Journal of Clinical Medicine, 10, Article 4006. [Google Scholar] [CrossRef] [PubMed]
[44] Lu, V., Tennyson, M., Zhang, J. and Khan, W. (2021) Mesenchymal Stem Cell-Derived Extracellular Vesicles in Tendon and Ligament Repair—A Systematic Review of in Vivo Studies. Cells, 10, Article 2553. [Google Scholar] [CrossRef] [PubMed]
[45] Sun, H., Pratt, R.E., Hodgkinson, C.P. and Dzau, V.J. (2020) Sequential Paracrine Mechanisms Are Necessary for the Therapeutic Benefits of Stem Cell Therapy. American Journal of Physiology-Cell Physiology, 319, C1141-C1150. [Google Scholar] [CrossRef] [PubMed]
[46] Liu, C., Sui, H., Li, Z., Sun, Z., Li, C., Chen, G., et al. (2025) THBS1 in Macrophage-Derived Exosomes Exacerbates Cerebral Ischemia-Reperfusion Injury by Inducing Ferroptosis in Endothelial Cells. Journal of Neuroinflammation, 22, Article No. 48. [Google Scholar] [CrossRef] [PubMed]
[47] 王凯, 李卓扬, 林向进. 外泌体在肩袖损伤修复中的作用[J]. 浙江实用医学, 2020, 25(3): 221-225.
[48] 许洁, 吴鹏, 许纲, 等. 冲击波治疗调节TGF-β1/Smads信号通路对大鼠肩袖损伤肌腱止点处异常骨重构及生物力学的影响[J]. 河北医药, 2025, 47(10): 1633-1637.
[49] 张圣军, 宗同岩. 肱二头肌长头腱在巨大肩袖撕裂修复术中的应用研究进展[J]. 中国当代医药, 2026, 33(4): 187-190.
[50] 付航, 王璐璐, 翟琳辉, 等. 基于质谱的单细胞蛋白质组学研究进展[J]. 质谱学报, 2026, 47(3): 313-330.
[51] 徐红, 李勇, 荣锦. 血清TGF-β1、PDGF、IGF-1及VEGF表达水平与四肢骨缺损愈合的相关性研究[J]. 分子诊断与治疗杂志, 2026, 18(3): 579-582.
[52] 李义杰, 郑宁宁, 薛泽款, 等. MSCs旁分泌VEGF-C、TGF-β1对LEPCs分化及成管的影响[J]. 兵团医学, 2025, 23(2): 1-6+121-123.
[53] Freislederer, F., Dittrich, M. and Scheibel, M. (2019) Biological Augmentation with Subacromial Bursa in Arthroscopic Rotator Cuff Repair. Arthroscopy Techniques, 8, e741-e747. [Google Scholar] [CrossRef] [PubMed]
[54] Bhatia, D.N. (2021) Arthroscopic Bursa‐Augmented Rotator Cuff Repair: A Vasculature‐Preserving Technique for Subacromial Bursal Harvest and Tendon Augmentation. Arthroscopy Techniques, 10, e1203-e1209. [Google Scholar] [CrossRef] [PubMed]
[55] Morikawa, D., Muench, L.N., Baldino, J.B., Kia, C., Johnson, J., Otto, A., et al. (2020) Comparison of Preparation Techniques for Isolating Subacromial Bursa‐Derived Cells as a Potential Augment for Rotator Cuff Repair. Arthroscopy, 36, 80-85. [Google Scholar] [CrossRef] [PubMed]
[56] Pancholi, N. and Gregory, J.M. (2020) Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Minced Autologous Subacromial Bursa. Arthroscopy Techniques, 9, e1519-e1524. [Google Scholar] [CrossRef] [PubMed]
[57] Dei Giudici, L. and Castricini, R. (2020) Local Autologous Stem Cells Application in Rotator Cuff Repairs: “LASCA” Technique. Arthroscopy Techniques, 9, e1571-e1575. [Google Scholar] [CrossRef] [PubMed]
[58] Gregory, J.M., Ybarra, C., Liao, Z., Kumaravel, M., Patel, S. and Warth, R.J. (2023) Clinical Outcomes of Rotator Cuff Repair with Subacromial Bursa Reimplantation: A Retrospective Cohort Study. JSES International, 7, 763-767. [Google Scholar] [CrossRef] [PubMed]
[59] Muench, L.N., Kia, C., Berthold, D.P., Uyeki, C., Otto, A., Cote, M.P., et al. (2020) Preliminary Clinical Outcomes Following Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Subacromial Bursa, Concentrated Bone Marrow Aspirate, and Platelet‐Rich Plasma. Arthroscopy, Sports Medicine, and Rehabilitation, 2, e803-e813. [Google Scholar] [CrossRef] [PubMed]
[60] Muench, L.N., Uyeki, C.L., Mancini, M.R., Berthold, D.P., McCarthy, M.B. and Mazzocca, A.D. (2021) Arthroscopic Rotator Cuff Repair Augmented with Autologous Subacromial Bursa Tissue, Concentrated Bone Marrow Aspirate, Platelet‐Rich Plasma, Platelet‐Poor Plasma, and Bovine Thrombin. Arthroscopy Techniques, 10, e2053-e2059. [Google Scholar] [CrossRef] [PubMed]

为你推荐