Michelsson J E, Aho H J, Kalimo H, Haltia M
Division of Orthopaedic Surgey and Traumatology, University Central Hospital, Helsinki, Finland.
APMIS. 1990 Apr;98(4):336-44. doi: 10.1111/j.1699-0463.1990.tb01041.x.
The authors have previously shown that passive daily mobilization of the rabbit hind limb immobilized with the knee in extension leads to necrosis of the deep thigh muscles and myositis ossificans-like periosteal bone formation. In this study the effect of immobilization alone on the rabbit hind limb muscles was examined similarly to that of immobilized limbs. Serum creatine kinase activities increased significantly and intravenously administered Evans blue albumin showed increased vascular permeability in the deep vastus intermedius muscle even on day 1. Necrotic fibers were clearly present in the deep part of the vastus intermedius muscle on day 5 in light and electron microscopy and in enzyme histochemistry. Fibrosis and atrophy were found later. The superficial portion of the vastus intermedius and the deep contralateral nonimmobilized vastus intermedius showed degenerative changes. Bone formation was not noted. The conclusion was that the deep vastus intermedius muscle composed almost exclusively of type I fibers is exceptionally prone to damage when immobilized in a shortened position. Contact of the necrotic muscle with the underlying periosteum is not alone sufficient to induce heterotopic ossification. The additional trauma caused by daily mobilization is needed for the myositis ossificans-like bone formation.
作者之前已经表明，对膝关节伸直固定的兔后肢进行每日被动活动，会导致大腿深部肌肉坏死以及骨化性肌炎样的骨膜骨形成。在本研究中，单独固定对兔后肢肌肉的影响与固定肢体的影响类似。血清肌酸激酶活性显著增加，静脉注射伊文思蓝白蛋白显示，即使在第1天，股中间肌深部的血管通透性就已增加。在第5天，光镜、电镜和酶组织化学检查发现股中间肌深部明显存在坏死纤维。纤维化和萎缩随后出现。股中间肌浅部和对侧未固定的股中间肌深部出现退行性改变。未观察到骨形成。结论是，几乎完全由I型纤维组成的股中间肌深部在缩短位置固定时特别容易受损。坏死肌肉与下方骨膜的接触不足以单独诱导异位骨化。骨化性肌炎样骨形成需要每日活动引起的额外创伤。
