The function of proprioceptors in bone organization: A possible explanation for neurogenic heterotopic ossification in patients with neurological damage
The function of proprioceptors in bone organization: A possible explanation for neurogenic heterotopic ossification in patients with neurological damage
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DOI：
10.1016/j.mehy.2006.06.035
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发表时间：
2007-01-01
影响因子：
4.7
通讯作者：
Kalil, Ricardo K.
中科院分区：
文献类型：
--
作者：
da Paz, Aloysio Campos;Carod Artal, Francisco J.;Kalil, Ricardo K.
神经源性异位骨化的特点是神经系统患者周围关节周围的软组织形成额外的骨。25%的脊髓损伤患者发生这种情况，其中20%的患者病理过程严重到足以导致关节活动受限。自主神经系统损伤引起的血管和代谢变化可能在异位骨化的病因中起作用。在防御机制降低的情况下，为了保持关节的活动范围而进行的重复性有力的被动操作也可能损伤软组织，从而引发病理过程。允许本体感觉的韧带和囊内的神经末梢在触发肌肉收缩的开启和关闭，允许步态中的加速和减速方面起决定性作用。在过去的20年里，萨拉康复医院网络治疗了2万多名脊髓和脑损伤患者。基于对这些患者异位骨化发展及其复发倾向的观察，本文推测在神经通路中断后，(1)本体感觉改变是否可以在组织之间建立不同的关系；(2)可能出现混乱的新骨形成。我们推测中枢神经系统损伤患者的异位骨化可能与本体感觉功能障碍有关。随着肢体神经束的中断，韧带失去对本体感觉功能的控制和协调，开始以独立、孤立和偶然的方式对直接刺激作出反应。在没有中枢神经系统控制的情况下，在这些独立信号的直接刺激下，位于软组织中的间充质骨祖细胞开始组织成熟并分化为骨：异位骨。(c) 2006 Elsevier Ltd.版权所有。
Neurogenic heterotopic ossification is characterized by the formation of extra osseous bone in soft tissue surrounding peripheral joints in neurological patients. It occurs in 25% of spinal cord injury patients, and in 20% of these the pathologic process is severe enough to cause limitations in joint motion. Vascular and metabolic changes resulting from autonomic nervous system impairment may play a role in the etiology of heterotopic ossification. Repetitive vigorous passive manipulation of the joint to preserve range of motion, in the presence of reduced defense mechanisms, may also traumatize soft tissue, thereby initiating the pathological process. Nerve terminals within ligaments and capsules that allow for proprioception have a determinant role in triggering on and off muscle contraction, permitting acceleration and deceleration during gait. The Sarah Network of Rehabilitation Hospitals has treated over 20,000 patients with spinal cord and brain injury in the past 20 years. Based on the observation of heterotopic ossification development in some of these patients, and its tendency to relapse, this present article speculates whether, after an interruption in the neural pathways: (1) altered proprioception can forge a different relationship between tissues; and (2) chaotic new bone formation can occur. We postulate that heterotopic ossification in patients with injury to the central nervous system (CNS) may be related to a dysfunction of proprioception. With interruption of the neural tract of a given limb, ligaments lose control and coordination of their proprioceptive function and begin to react to direct stimulus in an independent, isolated and haphazard way. Free of CNS control and directly stimulated by such independent signals, mesenchymal osteoprogenitor cells located in soft tissues begin to occasion tissue maturation and differentiation into bone: heterotopic bone. (c) 2006 Elsevier Ltd. All rights reserved.