Early Joint Use Following Elbow Dislocation Limits Range-of-Motion Loss and Tissue Pathology in Posttraumatic Joint Contracture.
Early Joint Use Following Elbow Dislocation Limits Range-of-Motion Loss and Tissue Pathology in Posttraumatic Joint Contracture.
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DOI：
10.2106/jbjs.22.00064
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发表时间：
2023-02-01
期刊：
影响因子：
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单纯肘关节脱位的发生率为2.9 - 5.21/100，000人-年，其中多达62%的患者经历长期肘关节挛缩、僵硬和/或疼痛。不良结局和二次手术干预的需要通常可以通过早期或立即的积极活动和物理治疗来预防。然而，制动或有限的活动可能是必要的创伤后，它是未知的不同时期的制动如何影响肘关节组织的病理变化，以及这些变化如何与活动范围（ROM）。本研究的目的是探讨肘关节创伤后关节挛缩的动物模型中，不同的自由活动开始对肘关节ROM和组织学特征的影响。创伤性肘关节脱位手术诱导单侧大鼠。受伤的前肢被固定在绷带3，7，14，或21天，然后允许自由活动，直到受伤后42天。进行死后关节ROM测试和组织学分析。单因素方差分析用于比较对照组和损伤组之间的ROM数据，并在ROM参数和组织学结果之间进行Pearson相关性分析。制动时间越长，活动范围减少越多。前囊和后囊显示细胞结构、成纤维细胞、粘连、纤维化和厚度增加，而软骨的测量结果大多未受影响。所有测得的关节囊的组织学特征与ROM呈负相关，表明较高程度的病理学与较低的ROM相对应。较长的制动时间导致更大的ROM减少，这与创伤后肘关节挛缩动物模型中关节囊的组织学结局较差相关。本研究揭示的ROM和关节囊组织变化时间的细微差异为生物力学变化以及区域组织病理学的不同时间线提供了新的见解。这项研究表明，受伤后3天开始主动活动可以最大限度地减少创伤后关节挛缩，从而支持立即活动的临床治疗策略（如果可能的话）。此外，未受伤，但病理改变的关节周围组织附近的损伤位置可能会导致更严重的挛缩，在较长的制动期间，随着疾病状态的进展。
Simple elbow dislocation occurs at an incidence of 2.9 to 5.21 dislocations per 100,000 person-years, with as many as 62% of these patients experiencing long-term elbow joint contracture, stiffness, and/or pain. Poor outcomes and the need for secondary surgical intervention can often be prevented nonoperatively with early or immediate active mobilization and physical therapy. However, immobilization or limited mobilization may be necessary following trauma, and it is unknown how different periods of immobilization affect pathological changes in elbow joint tissue and how these changes relate to range of motion (ROM). The purpose of this study was to investigate the effects of varying the initiation of free mobilization on elbow ROM and histological features in an animal model of elbow posttraumatic joint contracture. Traumatic elbow dislocation was surgically induced unilaterally in rats. Injured forelimbs were immobilized in bandages for 3, 7, 14, or 21 days; free mobilization was then allowed until 42 days after injury. Post-mortem joint ROM testing and histological analysis were performed. One-way analysis of variance was used to compare ROM data between control and injured groups, and Pearson correlations were performed between ROM parameters and histological outcomes. Longer immobilization periods resulted in greater ROM reductions. The anterior and posterior capsule showed increases in cellularity, fibroblasts, adhesions, fibrosis, and thickness, whereas the measured outcomes in cartilage were mostly unaffected. All measured histological characteristics of the capsule were negatively correlated with ROM, indicating that higher degrees of pathology corresponded with less ROM. Longer immobilization periods resulted in greater ROM reductions, which correlated with worse histological outcomes in the capsule in an animal model of posttraumatic elbow contracture. The subtle differences in the timing of ROM and capsule tissue changes revealed in the present study provide new insight into the distinct timelines of biomechanical changes as well as regional tissue pathology. This study showed that beginning active mobilization 3 days after injury minimized posttraumatic joint contracture, thereby supporting an immediate-motion clinical treatment strategy (when possible). Furthermore, uninjured but pathologically altered periarticular tissues near the injury location may contribute to more severe contracture during longer immobilization periods as the disease state progresses.
DOI：
10.32098/mltj.03.2021.20
发表时间：
2021-07
期刊：
Muscles, ligaments and tendons journal
影响因子：
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作者：
Reiter AJ;Castile RM;Schott HR;Kivitz GJ;Chamberlain AM;Lake SP
通讯作者：
Lake SP