體外震波治療對於肌腱內血管之影響及其機轉探討

震波已用於治療骨骼肌肉疾病，但是對於其機制尚無法確定。目前有多篇論文指出其主要治癒機制與該區域的血液供給有關。本研究主要之目的在探討，肌腱炎模型(tendinopathy model)經過震波治療後，肌腱內之血管情形有何改變。實驗分別針對兩種不同型的肌腱炎做探討：慢性肌腱炎(tendinosis)、急性肌腱炎(tendonitis)。治療慢性肌腱炎的目標，主要是想要改善肌腱部份缺血、或是血流不足的情形，以正常肌腱作為實驗模型。除了震波治療(0.49mJ/mm2, 4Hz, 1000 impulses)外，亦比較使用超音波顯影劑(0.06毫升, DEFINITY® )加上震波，是否有更強的效果。在震波治療後的第28天，使用RT-PCR來分析血管內皮細胞成長因子(VEGF)有無表現，以及用病理切片的方法來統計血管是否增生。病理切片之結果顯示震波與震波-超音波顯影劑治療後28天，肌腱內血管比未治療來得多，但震波與震波-超音波顯影劑兩者並無差異。而RT-PCR的結果顯示震波治療前後VEGF的表現無變化。急性肌腱炎模型建立是注射膠原分解酶，然後在發炎最嚴重的時期(注射後第三天)做震波治療，用能量都卜勒超音波影像紀錄血管在震波治療後之變化。且用3D影像分析血管之變化情形。實驗結果發現在震波治療後，6個實驗組中有4組，有立即(隔天)血流增加的情形(66%)，其中有2組發炎時間有縮短的情形(33%)。從兩實驗的結果顯示震波對於血流是有影響的，在慢性肌腱炎上是有新生血管的幫助。在急性肌腱炎模型中有立即增加血流，不過在此增加血流是否是有助於治療，還是會讓患者更加疼痛，這部份還有許多議題可討論。

關鍵字

體外震波；血管內皮生長因子；新生血管；膠原分解酶

並列摘要

Shock wave therapy is a new modality and an alternative method for the promotion of bone growth and tendon repair. However, mechanisms by which shock wave therapy promotes tendon repair is not fully understood. There are several research reports indicating that its leading clinical mechanism relates to the blood supply. The purpose of this study was to investigate the effect of vessels varies after the tendon treated by shock wave. The study focuses on two different types of tendinopathy：tendinosis and tendonitis. To impove the blood supply in tendon is the clinical purpose of tendinosis therapy. In addition to shock wave treatment (0.49mJ/mm2, 4Hz, 1000 impulses), we also combined ultrasound contrast agent (0.06ml, DEFINITY® ) to see if neovascularization could be enhanced. On the 28th day after shock wave treatment, RT-PCR method was used to analyze if VEGF expression enhanced and HE & IHC stain to calculate if number of vessels in tendon increased. The result of HE stain demonstrates that after 28 days of the shock wave treatment and shock wave contrast agent combination, the number of vessels increased compared with the untreated group. However no VEGF expression increased was found on change on the 28th day after the shock wave treatment. The model of tendonitis is induced by collagenase injection. Shock wave was given on the 3rd day after the injection and using 2-D and 3-D power Doppler sonography was used to monitor the variation of vessels after the treatment. The results show that after the shock wave treatment, there are 4 among 6 experiment groups (66%) having blood flow increase at the following day. The results also show that shock wave has effect on blood flow, increasing neo-vessels for health tendons. For acute tendonitis, blood flow enhanced. However, it was not been confirmed that whether the rise of blood flow will help the therapy or will make patients more painful.

並列關鍵字

Shock waves ； VEGF ； Neovascularization ； Collagenase

參考文獻

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體外震波治療對於肌腱內血管之影響及其機轉探討

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