全膝关节置换术前后股四头肌的免疫组化分析。

Ednei Haruo Kawatake, Alberto de Castro Pochini, M. Cohen, Marcus Vinicius Malheiros Luzo, Carlos Augusto Real Martinez, José Aires Pereira
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引用次数: 1

摘要

背景:随着人口的老龄化,全膝关节置换术(TKA)的数量稳步增加。这种手术在缓解疼痛和恢复膝关节功能方面的成功是公认的。然而,TKA后经常观察到股四头肌(QF)肌力下降,但病因不明。有证据表明,手术切口的位置(即手术通路)可以影响QF肌肉的结构和功能。本研究旨在评估全髋关节置换术前后QF股内侧肌(VM)和股外侧肌(VL)的纤维类型组成、结构和组合。方法收集经髌旁内侧途径行TKA并行TKA翻修术的患者(主组,n = 9)和拟行TKA的骨关节病(OA)患者(对照组,n = 18)的肌肉活检(VM和VL肌)。将活检后的肌肉组织制备、保存,然后在-25°C低温恒温器中切片。采用常规病理解剖和组织化学染色技术对组织切片进行评价。结果实验组和对照组膝关节内侧、外侧肌肉嵌合模式正常,未见周围神经损伤。值得注意的是,88.9%的患者表现出轻度至重度VL萎缩,而对照组中只有11.1%的患者表现出这一特征(P < 0.001)。结论经TKA手术通路的髌旁内侧切口对VM和VL肌纤维没有明确的形态学改变,但可能导致VL萎缩。
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Immunohistochemical analysis of the quadriceps femoris muscle before and after total knee arthroplasty.
BACKGROUND The number of total knee arthroplasties (TKA) has increased steadily with the aging of the population. This surgical procedure is recognized for its success in pain relief and restoration of knee function. However, decreased quadriceps femoris (QF) muscle strength after TKA is frequently observed but with unknown etiology. Evidence suggests that the location of the operative incision (i.e., surgical access) can influence QF muscle structure and function. The present study aimed to assess the fiber type composition, structure and assembly of the QF's vastus medialis (VM) and vastus lateralis (VL) muscles before and after TKA. METHODS Muscle biopsies (VM and VL muscles) were collected from patients previously submitted to TKA via the medial parapatellar route and undergoing TKA revision (main group, n = 9) and patients with osteoarthrosis (OA) who were due to undergo TKA (control group: n = 18). The biopsied muscle tissue was prepared, stored, and then sectioned in a cryostat at -25 °C. The tissue sections were evaluated using routine staining techniques in pathological anatomy and histochemistry. RESULTS The normal mosaic pattern of the medial and lateral knee muscles was observed in the main and control groups, with no evidence of peripheral nerve damage. Notably, 88.9 % of the patients exhibited mild to severe VL atrophy, while only 11.1 % of patients in the control group presented this feature (P < 0.001). CONCLUSIONS The medial parapatellar incision for TKA surgical access does not generate definitive morphological changes in the VM and VL muscle fibers but may contribute to VL atrophy.
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