Arnoczky S P, Aksan A
Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, Michigan State University, East Lansing 48824, USA.
J Am Acad Orthop Surg. 2000 Sep-Oct;8(5):305-13. doi: 10.5435/00124635-200009000-00004.
Thermal modification (shrinkage) of capsular connective tissue has gained increasing popularity as an adjunctive or even a primary procedure in the arthroscopic treatment of shoulder instability. Although the physical effects of heat on collagenous tissues are well known, the long-term biologic fate of these shrunken tissues is still a matter of debate. The temperatures required to alter the molecular bonding of collagen and thus cause tissue shrinkage (65 degrees C to 70 degrees C) are also known to destroy cellular viability. Therefore, thermally modified tissues are devitalized and must undergo a biologic remodeling process. During this remodeling, the mechanical properties of the treated tissues are altered (decreased stiffness) and can be at risk for elongation if the postoperative rehabilitation regimen is too aggressive. Although anecdotal reports suggest that thermal capsular shrinkage does have a beneficial effect, the exact mechanism responsible for this clinical improvement has yet to be fully defined. The reported improvement could be due to the maintenance of initial capsular shrinkage, secondary fibroplasia and resultant thickening of the joint capsule, a loss of afferent sensory stimulation due to the destruction of sensory receptors, or a combination of all three. The clinical role for thermal modification of connective tissues has not yet been defined, but it appears that it may prove most useful as a stimulant for inducing a biologic repair response.
在肩关节不稳的关节镜治疗中，作为辅助甚至主要手术方式，关节囊结缔组织的热改性（收缩）越来越受到欢迎。尽管热对胶原组织的物理作用已为人熟知，但这些收缩组织的长期生物学转归仍存在争议。已知改变胶原分子键并导致组织收缩所需的温度（65摄氏度至70摄氏度）也会破坏细胞活力。因此，热改性组织失去活力，必须经历生物重塑过程。在此重塑过程中，处理过的组织的力学性能会发生改变（刚度降低），如果术后康复方案过于激进，组织有伸长风险。尽管轶事报道表明热关节囊收缩确实有有益效果，但导致这种临床改善的确切机制尚未完全明确。报道的改善可能归因于初始关节囊收缩的维持、继发性纤维增生以及关节囊随之增厚、感觉受体破坏导致传入感觉刺激丧失，或三者皆有。结缔组织热改性的临床作用尚未明确，但似乎它作为诱导生物修复反应的刺激物可能最有用。
