Moriscot Anselmo, Miyabara Elen H, Langeani Bruno, Belli Antonio, Egginton Stuart, Bowen T Scott
Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
Sou da Paz Institute, São Paulo, Brazil.
NPJ Regen Med. 2021 Mar 26;6(1):17. doi: 10.1038/s41536-021-00127-1.
One major cause of traumatic injury is firearm-related wounds (i.e., ballistic trauma), common in both civilian and military populations, which is increasing in prevalence and has serious long-term health and socioeconomic consequences worldwide. Common primary injuries of ballistic trauma include soft-tissue damage and loss, haemorrhage, bone fracture, and pain. The majority of injuries are of musculoskeletal origin and located in the extremities, such that skeletal muscle offers a major therapeutic target to aid recovery and return to normal daily activities. However, the underlying pathophysiology of skeletal muscle ballistic trauma remains poorly understood, with limited evidence-based treatment options. As such, this review will address the topic of firearm-related skeletal muscle injury and regeneration. We first introduce trauma ballistics and the immediate injury of skeletal muscle, followed by detailed coverage of the underlying biological mechanisms involved in regulating skeletal muscle dysfunction following injury, with a specific focus on the processes of muscle regeneration, muscle wasting and vascular impairments. Finally, we evaluate novel approaches for minimising muscle damage and enhancing muscle regeneration after ballistic trauma, which may have important relevance for primary care in victims of violence.
创伤性损伤的一个主要原因是与枪支相关的伤口（即弹道创伤），在平民和军事人群中都很常见，其患病率正在上升，并且在全球范围内造成严重的长期健康和社会经济后果。弹道创伤常见的原发性损伤包括软组织损伤和缺失、出血、骨折和疼痛。大多数损伤起源于肌肉骨骼系统，位于四肢，因此骨骼肌成为帮助恢复和回归正常日常活动的主要治疗靶点。然而，骨骼肌弹道创伤的潜在病理生理学仍知之甚少，基于证据的治疗选择有限。因此，本综述将探讨与枪支相关的骨骼肌损伤和再生这一主题。我们首先介绍创伤弹道学和骨骼肌的即时损伤，随后详细阐述损伤后调节骨骼肌功能障碍所涉及的潜在生物学机制，特别关注肌肉再生、肌肉萎缩和血管损伤的过程。最后，我们评估了在弹道创伤后将肌肉损伤降至最低并促进肌肉再生的新方法，这可能对暴力受害者的初级护理具有重要意义。
