Histological Evidence of Muscle Degeneration in Advanced Human Rotator Cuff Disease
Histological Evidence of Muscle Degeneration in Advanced Human Rotator Cuff Disease
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DOI：
10.2106/jbjs.16.00335
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发表时间：
2017-02-01
影响因子：
5.3
通讯作者：
Ward, Samuel R.
中科院分区：
文献类型：
--
作者：
Gibbons, Michael C.;Singh, Anshu;Ward, Samuel R.
背景：大量肩袖撕裂后肩袖肌肉的细胞重塑尚不清楚。本研究的目的是提供组织学证据，以阐明晚期人类肩袖疾病的肌肉丢失模式，并评估组织水平的变化与非侵入性成像所见的关系。方法：取23例接受逆行全肩关节置换术的患者的肩袖肌肉活组织标本，以评估严重肩袖疾病的肌肉成分。结果：标本主要由致密、有组织的结缔组织(48.2%+/-19.1%)和无序、疏松的结缔组织(36.9%+/-15.9%)组成，肌肉(10.4%+/-22.0%)和脂肪(6.5%+/-11.6%)的比例明显较小。只有25.8%的活检池中含有任何肌肉纤维。在活检中观察到炎性细胞计数增加(111.3+/-81.5巨噬细胞/毫米(2))和血管形成增加(66.6+/-38.0血管/毫米(2))。90.0%+/-15.6%的可见肌束有肌纤维变性，其中有核的肌纤维比例病理性升高(11.3%+/-6.3%)。肌束周(60.7%+/-41.4%)和束内(42.2%+/-33.6%)均有脂肪积聚，证明脂肪可以替代收缩成分而不改变肌肉组织。结论：肩袖肌肉的剧烈变性和炎症是最慢性和最严重的肩袖疾病状态的特征，提示肌肉丢失比不严重的简单萎缩更复杂，也不同于较轻的简单萎缩。临床相关性：为了解决退行性肌肉丢失，如果晚期肩袖疾病要恢复肌肉功能，必须考虑针对肌肉再生的替代治疗方法。
Background: Cellular remodeling in rotator cuff muscles following a massive rotator cuff tear is poorly understood. The aim of the current study was to provide histological evidence to elucidate the mode of muscle loss in advanced human rotator cuff disease and to assess tissue-level changes in relation to findings on noninvasive imaging.Methods: Rotator cuff muscle biopsy samples were taken from the scapular fossae from 23 consecutive patients undergoing reverse total shoulder arthroplasty in order to evaluate muscle composition in severe rotator cuff disease. Markers of vascularity; inflammation; fat distribution; and muscle atrophy, degeneration, and regeneration were quantified.Results: The samples primarily consisted of dense, organized connective tissue (48.2% +/- 19.1%) and disorganized, loose connective tissue (36.9% +/- 15.9%), with substantially smaller fractions of muscle (10.4% +/- 22.0%) and fat (6.5% +/- 11.6%). Only 25.8% of the biopsy pool contained any muscle fibers at all. Increased inflammatory cell counts (111.3 +/- 81.5 macrophages/mm(2)) and increased vascularization (66.6 +/- 38.0 vessels/mm(2)) were observed across biopsies. Muscle fiber degeneration was observed in 90.0% +/- 15.6% of observable muscle fascicles, and the percentage of centrally nucleated muscle fibers was pathologically elevated (11.3% +/- 6.3%). Fat accumulation was noted in both perifascicular (60.7% +/- 41.4%) and intrafascicular (42.2% +/- 33.6%) spaces, with evidence that lipid may replace contractile elements without altering muscle organization.Conclusions: Dramatic degeneration and inflammation of the rotator cuff muscles are characteristics of the most chronic and severe rotator cuff disease states, suggesting that muscle loss is more complicated than, and distinct from, the simple atrophy found in less severe cases. Clinical Relevance: In order to address degenerative muscle loss, alternative therapeutic approaches directed at muscle regeneration must be considered if muscle function is to be restored in late-stage rotator cuff disease.