Ackermann Paul W, Hart David A
Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden.
Department of Orthopedic Surgery, Karolinska University Hospital, SE-17176, Stockholm, Sweden.
Adv Exp Med Biol. 2016;920:293-8. doi: 10.1007/978-3-319-33943-6_28.
Painful and non-healing musculoskeletal disorders, eg. tendinopathy, pose a tremendous burden on society and the quality of life for patients. New advances in the understanding of connective tissue disorders such as tendinopathy reveal that common health problems such as obesity, atherosclerosis, hormonal dysfunctions and diabetes mellitus are closely linked to the metabolism of components of the musculoskeletal system, particularly tendons. As tendons function as multi-component "organ systems" (Muscle-TMJ-Tendon-Enthesis to Bone), tendons can be influenced directly, or indirectly via, for instance, alterations to muscle. However, this volume/set of chapters focus mainly on the tendon.Emerging findings in musculoskeletal research have established important new links in our understanding of tendon metabolism. Thereby, the function of the neuroendocrine/-immune axis, as well as supply of neuro-vascular factors, can be directly linked to the quality of tendon metabolism.Since some conditions, eg. atherosclerosis and diabetes mellitus, are more common in individuals as they age, and aging can also affect pain and tissue repair, convergence of such complications will potentially exert an increasingly significant impact on tendons as the demographics of many societies change with expanding percentages of the populations >60-65 years of age.Comorbidities related to metabolic dysfunction have to be identified early in patients with musculoskeletal disorders, such as acute tendon injuries or chronic tendinopathy, for therapeutic considerations regarding both operative and non-operative treatment protocols. Necessary interactions between researchers and clinicians with different subspecialties have to be initiated in order to optimize tissue metabolism for improved healing potentials.
疼痛且难以愈合的肌肉骨骼疾病，如肌腱病，给社会和患者的生活质量带来了巨大负担。对肌腱病等结缔组织疾病认识的新进展表明，肥胖、动脉粥样硬化、激素功能障碍和糖尿病等常见健康问题与肌肉骨骼系统，尤其是肌腱的成分代谢密切相关。由于肌腱作为多成分的“器官系统”（肌肉-颞下颌关节-肌腱-附着点至骨骼）发挥作用，肌腱可直接受到影响，或通过例如肌肉的改变而间接受到影响。然而，本卷/章节集主要关注肌腱。肌肉骨骼研究中的新发现为我们对肌腱代谢的理解建立了重要的新联系。因此，神经内分泌/免疫轴的功能以及神经血管因子的供应可直接与肌腱代谢的质量相关联。由于某些疾病，如动脉粥样硬化和糖尿病，在个体衰老时更为常见，而且衰老也会影响疼痛和组织修复，随着许多社会人口结构中60 - 65岁以上人口比例的增加，这些并发症的共同作用可能会对肌腱产生越来越大的影响。对于患有肌肉骨骼疾病（如急性肌腱损伤或慢性肌腱病）的患者，必须尽早识别与代谢功能障碍相关的合并症，以便在手术和非手术治疗方案的治疗考虑中加以权衡。必须启动不同亚专业的研究人员和临床医生之间的必要互动，以优化组织代谢，提高愈合潜力。
