The effect of myofibroblasts and corticosteroid injections in adhesive capsulitis
The effect of myofibroblasts and corticosteroid injections in adhesive capsulitis
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DOI：
10.1016/j.jse.2016.01.012
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发表时间：
2016-08-01
影响因子：
3
通讯作者：
Hannafin, Jo A.
中科院分区：
文献类型：
--
作者：
Hettrich, Carolyn M.;DiCarlo, Edward F.;Hannafin, Jo A.
假设：粘连性囊炎是一种导致肩关节运动受限的疾病。成纤维细胞与疾病过程有关；然而，它们在纤维化和包膜挛缩的发展中作为收缩因素的作用尚不清楚。我们假设(1)与对照组相比，黏附性囊炎患者的囊活检标本中肌成纤维细胞的患病率会增加；(2)接受关节内注射皮质类固醇治疗的患者肌成纤维细胞会减少。方法：该研究前瞻性地招募了20例计划进行胶囊释放的粘连性囊炎患者和匹配的对照组。从后囊和前囊采集组织标本进行组织形态学和免疫组织学分析。对另外14例未接受皮质类固醇注射的粘连性囊炎标本进行相同的切片和制备。结果：术前未接受皮质类固醇治疗的粘连性囊炎患者比接受关节内类固醇注射的患者表现出更多的纤维瘤病、滑膜增生和a-平滑肌肌动蛋白阳性染色增加的组织学证据。从对照患者中获得的标本均未显示a-平滑肌肌动蛋白阳性染色。讨论：粘连性囊炎患者中肌成纤维细胞染色的发生率较高，暗示肌成纤维细胞的激活与囊挛缩的病理生理有关。关节内类固醇注射减少纤维瘤病、血管增生、纤维化的存在和数量，以及a-平滑肌肌动蛋白染色的成纤维细胞的存在。这支持使用类固醇注射通过减少在囊组织中发现的病理变化来改变疾病过程。(C) 2016年《肩关节外科杂志》董事会。版权所有。
Hypothesis: Adhesive capsulitis is a condition that results in restricted glenohumeral motion. Fibroblasts have been implicated in the disease process; however, their role as a contractile element in the development of fibrosis and capsular contracture is not well understood. We hypothesized (1) that myofibroblast prevalence in capsular biopsy specimens from patients with adhesive capsulitis would be increased compared with controls and (2) that patients treated with an intra-articular injection of corticosteroid would have fewer myofibroblasts.Methods: The study prospectively enrolled 20 consecutive patients with adhesive capsulitis scheduled for capsular release and matched controls. Tissue samples were collected from the posterior and anterior capsule for histomorphologic and immunohistologic analyses. Identical sectioning and preparation was performed in 14 additional adhesive capsulitis specimens from patients who had not received corticosteroid injections.Results: Patients with adhesive capsulitis not treated with preoperative corticosteroid demonstrated more histologic evidence of fibromatosis, synovial hyperplasia, and an increase in positive staining for a-smooth muscle actin than patients who had received intra-articular injections of steroid. No specimens obtained from control patients demonstrated positive staining for a-smooth muscle actin.Discussion: There was a higher prevalence of myofibroblast staining in patients with adhesive capsulitis, implicating activation of the myofibroblast in the pathophysiology of capsular contracture. Intra-articular steroid injection decreases the presence and amount of fibromatosis, vascular hyperplasia, fibrosis, and the presence of fibroblasts staining for a-smooth muscle actin. This supports the use of steroid injections to alter the disease process by decreasing the pathologic changes found in the capsular tissue. (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.