关节周围软组织在创伤后肘挛缩大鼠模型中持续性运动丧失中的作用。
The Role of Periarticular Soft Tissues in Persistent Motion Loss in a Rat Model of Posttraumatic Elbow Contracture.
机构信息
Departments of Biomedical Engineering (C.L.D. and S.P.L.), Mechanical Engineering & Materials Science (R.M.C. and S.P.L.), and Orthopaedic Surgery (A.M.C. and S.P.L.), Washington University in St. Louis, St. Louis, Missouri.
出版信息
J Bone Joint Surg Am. 2019 Mar 6;101(5):e17. doi: 10.2106/JBJS.18.00246.
BACKGROUND
Elbow injuries disrupt the surrounding periarticular soft tissues, which include the muscles, tendons, capsule, ligaments, and cartilage. Damage to these tissues as a result of elbow trauma causes clinically significant contracture in 50% of patients. However, it is unclear which of these tissues is primarily responsible for the decreased range of motion. We hypothesized that all tissues would substantially contribute to elbow contracture after immobilization, but only the capsule, ligaments, and cartilage would contribute after free mobilization, with the capsule as the primary contributor at all time points.
METHODS
Utilizing a rat model of posttraumatic elbow contracture, a unilateral soft-tissue injury was surgically induced to replicate the damage that commonly occurs during elbow joint dislocation. After surgery, the injured limb was immobilized for 42 days. Animals were evaluated after either 42 days of immobilization (42 IM) or 42 days of immobilization with an additional 21 or 42 days of free mobilization (42/21 or 42/42 IM-FM). For each group of animals, elbow mechanical testing in flexion-extension was completed post-mortem with (1) all soft tissues intact, (2) muscles/tendons removed, and (3) muscle/tendons and anterior capsule removed. Total extension was assessed to determine the relative contributions of muscles/tendons, capsule, and the remaining intact tissues (i.e., ligaments and cartilage).
RESULTS
After immobilization, the muscles/tendons and anterior capsule contributed 10% and 90% to elbow contracture, respectively. After each free mobilization period, the muscles/tendons did not significantly contribute to contracture. The capsule and ligaments/cartilage were responsible for 47% and 52% of the motion lost at 42/21 IM-FM, respectively, and 26% and 74% at 42/42 IM-FM, respectively.
CONCLUSIONS
Overall, data demonstrated a time-dependent response of periarticular tissue contribution to elbow contracture, with the capsule, ligaments, and cartilage as the primary long-term contributors.
CLINICAL RELEVANCE
The capsule, ligaments, and cartilage were primarily responsible for persistent motion loss and should be considered during development of tissue-targeted treatment strategies to inhibit elbow contracture following injury.
背景
肘部损伤会破坏周围的关节周围软组织，包括肌肉、肌腱、囊、韧带和软骨。肘部创伤导致这些组织损伤，导致 50%的患者出现明显的临床挛缩。然而，目前尚不清楚哪些组织是运动范围减小的主要原因。我们假设所有组织在固定后都会对肘部挛缩产生实质性的影响，但只有在自由活动后，囊、韧带和软骨才会产生影响，而且囊在所有时间点都是主要贡献者。
方法
利用创伤后肘部挛缩的大鼠模型，通过手术诱导单侧软组织损伤，模拟肘部关节脱位时常见的损伤。手术后，患肢固定 42 天。在固定 42 天（42IM）后或固定 42 天并进行 21 天或 42 天的自由活动（42/21 或 42/42IM-FM）后，对动物进行评估。对于每组动物，在进行尸体死后的弯曲-伸展机械测试时，保留（1）所有的软组织完整，（2）去除肌肉/肌腱，以及（3）去除肌肉/肌腱和前囊。评估总伸展度，以确定肌肉/肌腱、囊和剩余完整组织（即韧带和软骨）的相对贡献。
结果
固定后，肌肉/肌腱和前囊分别对肘部挛缩的贡献为 10%和 90%。在每个自由活动期后，肌肉/肌腱对挛缩没有明显的贡献。囊和韧带/软骨分别对 42/21IM-FM 时的运动损失贡献了 47%和 52%，对 42/42IM-FM 时的运动损失贡献了 26%和 74%。
结论
总的来说，数据显示关节周围组织对肘部挛缩的贡献具有时间依赖性，囊、韧带和软骨是主要的长期贡献者。
临床相关性
囊、韧带和软骨是导致运动持续丧失的主要原因，在制定针对组织的治疗策略以抑制创伤后肘部挛缩时，应考虑这些组织。
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