Chung Moon Sang, Baek Goo Hyun, Oh Joo Han, Lee Young Ho, Bin Sung Woo, Gong Hyun Sik
Department of Orthopaedics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Seoul, Republic of Korea.
Injury. 2007 Oct;38(10):1139-45. doi: 10.1016/j.injury.2007.05.008. Epub 2007 Sep 18.
If tendon repair after injury is delayed, intramuscular fibrosis occurs and finally results in irreversible muscle contracture. The purpose of this study was to determine the effect of preserving muscle length and excursion on the progression of muscle contracture after tendon injury in a rabbit soleus tenotomy model. Forty rabbits underwent tenotomy of the soleus muscles bilaterally and the tendons were managed according to the five experimental groups (N=40). In group A, the tendon was lengthened maintaining half the excursion. In group B, maximal muscle length was preserved and in group C, resting muscle length was maintained. In group D, the tendon was allowed to retract and undergo fibrosis. In group E, the tendon was partially transected and repaired. Four and 8 weeks postoperatively, soleus muscles were harvested from each hind limb and histomorphometric evaluations were performed to measure the connective tissue areas. Electrophysiological studies were carried out to measure the compound muscle action potential to assess the number of functioning muscle fibres. The results showed that maximal muscle length preservation (group B) was the most protective in preventing muscle contracture within 4 weeks of tenotomy, but this effect was gradually offset by prolonged fixation of the muscle, and 8 weeks after tenotomy, maintenance of excursion (group A) was the most protective. These observations may be helpful in the intra-operative evaluation of muscle contracture in neglected tendon ruptures, and could be applied to the management of acute tendon injuries to prevent muscle contracture when immediate anatomical reconstruction is not possible.
如果损伤后肌腱修复延迟，会发生肌内纤维化，最终导致不可逆的肌肉挛缩。本研究的目的是在兔比目鱼肌切断模型中，确定保持肌肉长度和活动度对肌腱损伤后肌肉挛缩进展的影响。40只兔子双侧比目鱼肌切断，根据五个实验组（N = 40）处理肌腱。A组，延长肌腱并保持一半的活动度。B组，保持最大肌肉长度；C组，保持静息肌肉长度。D组，让肌腱回缩并发生纤维化。E组，肌腱部分横断并修复。术后4周和8周，从每个后肢获取比目鱼肌，进行组织形态计量学评估以测量结缔组织面积。进行电生理研究以测量复合肌肉动作电位，评估功能肌纤维数量。结果表明，在切断后4周内，保持最大肌肉长度（B组）对预防肌肉挛缩最具保护作用，但这种作用会因肌肉长期固定而逐渐抵消，切断后8周，保持活动度（A组）最具保护作用。这些观察结果可能有助于在术中评估被忽视的肌腱断裂中的肌肉挛缩情况，并可应用于急性肌腱损伤的处理，在无法立即进行解剖重建时预防肌肉挛缩。
