Rees J D, Wilson A M, Wolman R L
Institute of Orthopaedics and Musculo-Skeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
Rheumatology (Oxford). 2006 May;45(5):508-21. doi: 10.1093/rheumatology/kel046. Epub 2006 Feb 20.
Primary disorders of tendons are common and constitute a high proportion of referrals to rheumatologists. Certain tendons are particularly vulnerable to degenerative pathology; these include the Achilles, patella, elements of the rotator cuff, forearm extensors, biceps brachi and tibialis posterior tendons. Disorders of these tendons are often chronic and can be difficult to manage successfully in the long term. Significant advances have been made in understanding the pathophysiology of these conditions. Histopathological evidence, together with advances in imaging techniques, has made us more appreciative of the degenerative (rather that inflammatory) nature of these conditions. Additionally the presence of neovascularization is now well-recognized in long-standing tendinopathy. We review the mechanical, vascular and developing neural theories that attempt to explain the aetiology of degenerative tendinopathy. We also explore theories of why specific tendons (such as the Achilles and supraspinatus tendons) are particularly prone to degenerative pathology. Traditionally, treatments have placed a heavy emphasis on anti-inflammatory strategies, which are often inappropriate. Recently, however, significant advances in the practical management of tendon disorders have been made. In particular the advent of 'eccentric loading' training programmes has revolutionized the treatment of Achilles tendinopathy in some patients. This concept is currently being extended to include other commonly injured tendons. Other current treatments are reviewed, as are potential future treatments.
肌腱原发性疾病很常见，在转诊给风湿病学家的病例中占很大比例。某些肌腱特别容易发生退行性病变；这些肌腱包括跟腱、髌腱、肩袖的组成部分、前臂伸肌、肱二头肌和胫后肌腱。这些肌腱的疾病通常是慢性的，长期难以成功治疗。在理解这些疾病的病理生理学方面已经取得了重大进展。组织病理学证据以及成像技术的进步，使我们更加认识到这些疾病的退行性（而非炎症性）本质。此外，新生血管的存在在长期肌腱病中已得到充分认识。我们回顾了试图解释退行性肌腱病病因的力学、血管和神经发育理论。我们还探讨了为什么特定肌腱（如跟腱和冈上肌腱）特别容易发生退行性病变的理论。传统上，治疗方法非常强调抗炎策略，但这些策略往往并不合适。然而，最近在肌腱疾病的实际管理方面取得了重大进展。特别是“离心负荷”训练计划的出现，彻底改变了一些跟腱病患者的治疗方法。目前这一概念正在扩展到包括其他常见的受伤肌腱。本文还回顾了当前的其他治疗方法以及潜在的未来治疗方法。
