Garrett W E
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Sports Med. 1996;24(6 Suppl):S2-8.
One of the most common injuries seen in the office of the practicing physician is the muscle strain. Until recently, little data were available on the basic science and clinical application of this basic science for the treatment and prevention of muscle strains. Studies in the last 10 years represent action taken on the direction of investigation into muscle strain injuries from the laboratory and clinical fronts. Findings from the laboratory indicate that certain muscles are susceptible to strain injury (muscles that cross multiple joints or have complex architecture). These muscles have a strain threshold for both passive and active injury. Strain injury is not the result of muscle contraction alone, rather, strains are the result of excessive stretch or stretch while the muscle is being activated. When the muscle tears, the damage is localized very near the muscle-tendon junction. After injury, the muscle is weaker and at risk for further injury. The force output of the muscle returns over the following days as the muscle undertakes a predictable progression toward tissue healing. Current imaging studies have been used clinically to document the site of injury to the muscle-tendon junction. The commonly injured muscles have been described and include the hamstring, the rectus femoris, gastrocnemius, and adductor longus muscles. Injuries inconsistent with involvement of a single muscle-tendon junction proved to be at tendinous origins rather than within the muscle belly. Important information has also been provided regarding injuries with poor prognosis, which are potentially repairable surgically, including injuries to the rectus femoris muscle, the hamstring origin, and the abdominal wall. Data important to the management of common muscle injuries have been published. The risks of reinjury have been documented. The early efficacy and potential for long-term risks of nonsteroidal antiinflammatory agents have been shown. New data can also be applied to the field with respect to the beneficial effects of warm-up, temperature, and stretching on the mechanical properties of muscle. These benefits potentially reduce the risks of strain injury to the muscle. Fortunately, many of the factors protecting muscle, such as strength, endurance, and flexibility, are also essential for maximum performance. Future studies should delineate the repair and recovery process emphasizing not only the recovery of function, but also the susceptibility to reinjury during the recovery phase.
执业医师诊所中最常见的损伤之一是肌肉拉伤。直到最近，关于肌肉拉伤治疗和预防的基础科学及其临床应用的可用数据还很少。过去10年的研究代表了从实验室和临床前沿对肌肉拉伤损伤进行调查的行动方向。实验室研究结果表明，某些肌肉易受拉伤损伤（跨越多个关节或结构复杂的肌肉）。这些肌肉对于被动和主动损伤都有一个应变阈值。拉伤损伤并非仅由肌肉收缩导致，相反，拉伤是肌肉在被激活时过度拉伸或伸展的结果。当肌肉撕裂时，损伤非常局限于肌腱连接处附近。损伤后，肌肉会变弱且有再次受伤的风险。随着肌肉朝着组织愈合进行可预测的进展，肌肉的力量输出在接下来的几天内会恢复。目前的影像学研究已在临床上用于记录肌腱连接处的损伤部位。已描述了常见受伤的肌肉，包括腘绳肌、股直肌、腓肠肌和长收肌。与单一肌腱连接处受累不符的损伤被证明发生在肌腱起点而非肌腹内。还提供了关于预后不良但可能可通过手术修复的损伤的重要信息，包括股直肌损伤、腘绳肌起点损伤和腹壁损伤。已发表了对常见肌肉损伤管理很重要的数据。再次受伤的风险已被记录。非甾体抗炎药的早期疗效和长期风险潜力也已得到证实。关于热身、温度和拉伸对肌肉力学性能的有益影响的新数据也可应用于该领域。这些益处可能会降低肌肉拉伤损伤的风险。幸运的是，许多保护肌肉的因素，如力量、耐力和柔韧性，对于最佳表现也至关重要。未来的研究应阐明修复和恢复过程，不仅要强调功能的恢复，还要强调恢复阶段再次受伤的易感性。
