钙化是附着点病和肌腱病的固有组成部分，而非一个独立的疾病过程吗？
Is calcification integral to enthesopathy and tendinopathy rather than a separate disease process?
作者信息
Razi Amin, Ring David
机构信息
Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX, USA.
Investigation Performed at the Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
出版信息
J Orthop. 2024 Dec 11;65:46-50. doi: 10.1016/j.jor.2024.12.011. eCollection 2025 Jul.
BACKGROUND
The pathophysiology of enthesopathy and tendinopathy is mucoid degeneration, which includes chondroid metaplasia. The chondroid metaplasia can be associated with calcification. Inflammation is typically absent unless calcification triggers a self-limited immune response representing acute calcific tendinitis. It is therefore important to address the hypothesis that calcific deposits within various entheses and tendons throughout the body are an inconsequential epiphenomenon of enthesopathy and tendinopathy and do not merit a distinct diagnosis or specific treatment.
METHODS
We searched PubMed, Embase, and Web of Science for studies that address the prevalence of calcium in tendons and entheses with or without symptoms of tendinopathy, specifically excluding likely acute calcific tendinitis, and analyzed 35 studies meeting inclusion and exclusion criteria. Response variables included prevalence of calcification in and enthesis or tendon among people with no symptoms, among people seeking care for symptoms, and in the opposite asymptomatic limb, and the association between calcification and rotator cuff degeneration.
RESULTS
Calcification of tendons and entheses was present on between 2.7 % and 8.6 % of radiographs of the shoulder, elbow, and ankle among people without symptoms and not seeking care, with higher percentages in older populations. Calcification was common among patients with symptoms: 44 % for rotator cuff tendinopathy, 25 % for enthesopathy of the origin of the extensor carpi radialis brevis, and 53 % for medial elbow enthesopathy. Most people with calcification had it bilaterally. Among people with calcification of the rotator cuff on MRI, nearly all of them (96 %) had tendon degeneration.
CONCLUSIONS
The collective evidence regarding calcification in tendons and entheses suggests that it is related to mucoid degeneration and is not a separate disease process. Acute calcific tendinitis rapidly runs its course and is treated only to alleviate symptoms. It's not clear that acute calcific tendinitis or rotator cuff tendinopathy with calcification benefit from specific treatment of the calcium deposits.
LEVEL OF EVIDENCE
Not applicable.
背景
附着点病和肌腱病的病理生理学是黏液样变性，其中包括软骨样化生。软骨样化生可伴有钙化。通常不存在炎症，除非钙化引发代表急性钙化性肌腱炎的自限性免疫反应。因此，有必要探讨这样一种假设，即全身各处各种附着点和肌腱内的钙化沉积物是附着点病和肌腱病的一种无关紧要的附带现象，不值得进行单独诊断或特殊治疗。
方法
我们在PubMed、Embase和科学网中检索了有关有或无肌腱病症状的肌腱和附着点中钙含量的研究，特别排除了可能的急性钙化性肌腱炎，并分析了35项符合纳入和排除标准的研究。反应变量包括无症状人群、有症状就医人群以及对侧无症状肢体的附着点或肌腱中钙化的发生率，以及钙化与肩袖退变之间的关联。
结果
在无症状且未就医人群的肩部、肘部和踝部X线片上，肌腱和附着点钙化的发生率在2.7%至8.6%之间，老年人群中的百分比更高。钙化在有症状的患者中很常见：肩袖肌腱病患者中为44%，桡侧腕短伸肌起点附着点病患者中为25%，内侧肘部附着点病患者中为53%。大多数有钙化的人双侧都有。在MRI显示肩袖钙化的人群中，几乎所有人（96%）都有肌腱退变。
结论
关于肌腱和附着点钙化的综合证据表明，它与黏液样变性有关，不是一个单独的疾病过程。急性钙化性肌腱炎病程迅速，仅为缓解症状而进行治疗。目前尚不清楚急性钙化性肌腱炎或伴有钙化的肩袖肌腱病是否能从针对钙沉积物的特殊治疗中获益。
证据水平
不适用。
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