| Objective: To study the feasibility of developing injectable gluteal musclecontracture (GMC) animal model using different methods, and to investigate the role ofb-FGF, MMP1and TIMP1, MMP2and TIMP2in the pathogenesis of injectable GMC. Todevelop the clinical rating scale of GMC and to evaluate it's psychometric propertiesincluding reliability, agreement, validity and responsiveness. Develop a new clinicalclassification of GMC, and to evaluate its reliability. Assess the efficacy of arthroscopicminimally invasive treatment of GMC using the clinical rating scale which developedprevious.Method:1. We used different injectable drugs to develop injectable GMC animalmodel in rabbits, and analyzed the characteristics of different animal models through thepathological change of the gluteal muscle in rabbits after injection. We analyzedthe expression and significance of the b-FGF, MMP1and TIMP1, MMP2andTIMP2in the GMC progression using immunohistochemical method in the most reliableGMC animal model.2. We developed the GMC clinical rating scale relying on the reviewof litetature, the clinical practice and the interview of both the patients and the doctors, andevaluated the internal consistency, validity, interrater and intrarater agreement, andresponsiveness of the rating scale in67patients and two orthopedic physicians.3. Wedeveloped a new clinical classification of GMC through clinical practice and intraoperativefindings, and assessed its consistency using interobserver and intraobserverreliability analysis among91patients by three doctors, and we evaluated the efficacy ofarthroscopic minimally invasive treatment of GMC using the rating scale that developedprevious among the91patients.Results:1. Long-term and frequent injection of penicillin+phemethylol or penicillin+Sterile Water for Iinjection (SWFI) in gluteus muscle of rabbits could both develop GMC animal models successfully, the injeciton of penicillin+phemethylol could lead to more secretion and formation of collagen and other extracellularmatrix than injection of penicillin+SWFI in gluteal muscle of the animal model.Immunohistochemistry showed that the positive expression of b-FGF was found in thedamaged muscle and increased with the GMC progression, the positive expressionof TIMP1, MMP2and TIMP2was also found in the GMC progression, and the ratio ofMMPs/TIMPs had changed with the GMC progression.2. The GMC rating scale wedeveloped was found to have good content validity, high contruct validity (Spearman rankcorrelation coefficient was0.55-0.75among the sub-items, and0.70-0.90between thesub-items and the total project): high internal consistency (Cronbach's α=0.8310-0.9087):excellent interrater reliability (ICC=0.90): intrarater reliability (ICC=0.92) andresponsivenee (ES=3.64, SRM=3.97).3. The agreement of the new clinicalclassification of GMC was good; the Kappa value was0.859to0.975between the doctorsand the standard classification,0.726to0.867between different doctoes and0.749to0.838between different times examined by the same doctor. The GMC rating score of thepatients suffered GMC was55.25preoperatively and93.50postoperatively, all patientswere satisfied with the functional recovery from their disease.Conclusion:1. Injection of penicillin+phemethylol or penicillin+SWFI could bothdevelop GMC animal models successfully; the GMC animal model developed by injectionof penicillin+phemethylol is more fitable for pathogenesis research of GMC. b-FGF,TIMP1and TIMP2might play an important role in the progession of GMC, and it couldprovide some new research directions for the prevention and early treatment of GMC.2.The GMC rating scale has good internal consistency, test-retest reliability, construct andcontent validity, and responsiveness, it is an ideal psychological measurement tools in theassessment of the functional status of GMC patients.3. The new classification of GMCwill be conducive to clinical treatment. Arthroscopic treatment of GMC has advantages ofminimally invasive, safe and quick functional recovery compared with open surgery.
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