Where tendons and ligaments meet bone: attachment sites ('entheses') in relation to exercise and/or mechanical load
Where tendons and ligaments meet bone: attachment sites ('entheses') in relation to exercise and/or mechanical load
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DOI：
10.1111/j.1469-7580.2006.00540.x
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发表时间：
2006-04-01
影响因子：
2.4
通讯作者：
Milz, S
中科院分区：
文献类型：
--
作者：
Benjamin, M;Toumi, H;Milz, S
附着点（附着点、骨腱连接点、骨韧带连接点）是肌腱和韧带与骨连接区域的应力集中点。因此，他们通常会受到过度使用损伤（附着点病），这在许多运动中都有很好的记录。在这篇综述中，我们重点介绍了连接处硬组织侧和软组织侧附着点的结构-功能相关性。特别注意的是影响形式和功能的机械因素，从而探索终结点和运动之间的关系。适应机械应力的分子参数表示进行评估，并解释了附着点分类的基础。应用“附着点器官”的概念（一个集合的组织邻近的附着点本身，共同服务的共同功能的应力消散），以了解附着点被认为是和新的作用，脂肪组织在附着点进行审查。附着点处脂肪的不同位置是有区别的，可能的功能包括空间填充和本体感觉。附着点的基本锚固作用被认为是详细和比较附着点和其他生物“锚固”网站之间进行了探讨。强调了附着点的自我修复能力，并回顾了运动中常见的一系列附着点病（例如网球肘、高尔夫球肘、跳投膝、足底筋膜炎和跟腱插入腱病）。注意力被提请退化，而不是炎症，在运动中的大多数附着点病的性质。生物力学因素有助于发展的附着点疾病的审查和考虑的重要性，作为一个整体的肌肉肌腱骨单位的认识。骨骨刺的形成与骨关节炎性滑膜关节的其他变化平行。
Entheses (insertion sites, osteotendinous junctions, osteoligamentous junctions) are sites of stress concentration at the region where tendons and ligaments attach to bone. Consequently, they are commonly subject to overuse injuries (enthesopathies) that are well documented in a number of sports. In this review, we focus on the structure-function correlations of entheses on both the hard and the soft tissue sides of the junction. Particular attention is paid to mechanical factors that influence form and function and thus to exploring the relationship between entheses and exercise. The molecular parameters indicative of adaptation to mechanical stress are evaluated, and the basis on which entheses are classified is explained. The application of the 'enthesis organ' concept (a collection of tissues adjacent to the enthesis itself, which jointly serve the common function of stress dissipation) to understanding enthesopathies is considered and novel roles of adipose tissue at entheses are reviewed. A distinction is made between different locations of fat at entheses, and possible functions include space-filling and proprioception. The basic anchorage role of entheses is considered in detail and comparisons are explored between entheses and other biological 'anchorage' sites. The ability of entheses for self-repair is emphasized and a range of enthesopathies common in sport are reviewed (e.g. tennis elbow, golfer's elbow, jumper's knee, plantar fasciitis and Achilles insertional tendinopathies). Attention is drawn to the degenerative, rather than inflammatory, nature of most enthesopathies in sport. The biomechanical factors contributing to the development of enthesopathies are reviewed and the importance of considering the muscle-tendon-bone unit as a whole is recognized. Bony spur formation is assessed in relation to other changes at entheses which parallel those in osteoarthritic synovial joints.