Shchudlo Nathalia, Varsegova Tatyana, Stupina Tatyana, Dolganova Tamara, Shchudlo Michael, Shihaleva Nathalia, Kostin Vadim
Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center "Restorative Traumatology and Orthopaedics", Kurgan 640014, Russia.
Laboratory of Morphology of Federal State Budget Institution, Russian Ilizarov Scientific Center "Restorative Traumatology and Orthopaedics", Kurgan 640014, Russia.
World J Orthop. 2018 Sep 18;9(9):130-137. doi: 10.5312/wjo.v9.i9.130.
To investigate the structural and functional characteristics of palmar hypodermal tissue vascularization in Dupuytren's contracture patients of different age groups.
Eighty-seven Dupuytren's contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old (Y-group, = 22); the others were 55 and older (O-group, = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.
Frequency of cases with rapid development of contracture (less than 5 years) was 13.6% in the Y-group and 40% in the O-group, < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels (more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.
Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.
研究不同年龄组掌腱膜挛缩症患者掌部皮下组织血管形成的结构和功能特征。
87例掌腱膜挛缩症患者接受了部分筋膜切除术。其中22例年龄小于55岁（Y组，n = 22）；其余患者年龄在55岁及以上（O组，n = 65）。在手术切除的代表性组织样本中，对掌腱膜穿支动脉进行组织形态计量学分析，并对皮下血管进行体视学分析。采用激光血流仪法评估手掌皮肤的微循环。
挛缩快速发展（小于5年）的病例在Y组中的发生率为13.6%，在O组中为40%，P < 0.05。Y组掌腱膜穿支动脉的外径和内径减小更为严重。内膜厚度与健康对照组相比增加了3倍，内膜/中膜比值也增加，尤其是在O组。Y组皮下微血管密度的数量和体积增加、大血管（直径大于12μm）百分比以及具有血管外膜炎症浸润迹象的血管百分比均增加。O组具有外膜纤维化的血管百分比高于Y组。与健康对照组和O组相比，Y组的基础毛细血管血流增加，与对照组相比，峰值毛细血管血流增加。
与O组相比，Y组患者供应皮下组织的掌腱膜穿支动脉的收缩性重塑更为严重，但其毛细血管化的代偿性变化更为明显。
