不同處理模式對阿基里斯肌腱斷裂後修復的影響

本研究目的旨在探討不同處理模式在不同時間點對阿基里斯肌腱斷裂後復健的影響。將45 隻8 週大之Spraque-Dawley 品系公鼠隨機分成控制組、『運動』組、『固定＋運動』組。『運動』組在傷後第五天開始運動介入。『固定＋運動』組在受傷後立刻進行模具固定，在傷後第4 週將模具拆除並進行運動介入。在第4、12 週進行阿基里斯肌腱功能評估、每組隨機犧牲3 隻大鼠，觀察肌腱外觀與膠原蛋白生長情形。在第12 週各組犧牲9 隻大鼠，測試肌腱直徑、斷裂強度與拉伸應力。結果：傷後第4 週固定組無法測量AFI 值，因此控制組與運動組進行t 考驗分析，結果兩組無顯著差異；在傷後第12 週3 組AFI 值均無顯著差異。膠原蛋白生長情形在傷後第4、12 週各組的膠原蛋白逐漸轉換為第一型膠原蛋白，且發現波紋結構，傷後第12 週固定組的組織結構較為紊亂。肌腱直徑在傷後第12 週3 組間的正常肢與受傷肢的肌腱直徑均無顯著差異。斷裂強度在傷後第12 週3 組間的正常肢與受傷肢的斷裂強度均無顯著差異。拉伸應力在傷後第12 週3 組間的正常肢與受傷肢的肌腱拉伸應力均無顯著差異。結論：運動介入能使阿基里斯肌腱功能、組織結構與機械特性比固定組更接近正常；固定4 週對於肌腱的功能負面影響很大，應縮短固定的時間。

關鍵字

步態分析；固定；復健

並列摘要

The aim of this study was to investigate the effect of different treatment model on Achilles tendon rupture recovery on different time in rats. Methods: Forty-five Spraque-Dawley (SD) male rats (eight weeks old) randomly assigned to three groups: control, exercise, immobilization + exercise. Exercise group was exercise intervention at five-day post injury. Immobilization + exercise group was immediately immobilization used cast after injury, and dismantle cast at the same time exercise intervention was began at four-week post injury. The Achilles tendon functional index (AFI) were evaluated at four- and twelve-week post at each groups. Each groups were randomly sacrificed three rats and observation outward appearance of tendon and growth of collagen at four- and twelve-week. Each group were sacrificed nine rats and test for diameter, breaking strength, tensile stress of tendon at twelve-week post injury. Result: AFI values: Immobilization + exercise group was unable to test to AFI at four-week post injury, so test to AFI was only to control group and exercise group at four-week post injury to used t test, and not significantly between the two groups. The AFI were not significantly between the three groups at twelve-week post injury, but the rats was unable walking to normal by foot of injury limb to immobilization + exercise group, so it was necessary further studies can calculate to more proper of AFI for immobilization＋ exercise group at twelve-week post injury. Collagen growth: The type III collagen was began to change become type I collagen in three groups at four- and twelve-week post injury, and all group was form crimp to collagen structure. However, the collagen structure was confusion both control group and immobilization + exercise group at four-week post injury, collagen structure was confusion to immobilization + exercise group at twelve-week post injury. Tendon diameter: Not found significantly to normal limbs and injury limbs to tendon diameter between the three groups, but normal limbs were significantly smaller than injury limb to tendon diameter in each groups. Tendon breaking strength: Not found significantly to normal limbs and injury limbs to tendon breaking strength between the three groups, and normal limbs were significantly smaller than injury limbs to tendon breaking strength of control group at twelve-week post injury, and injury limbs were smaller than normal limbs to tendon breaking strength of immobilization + exercise group at twelve-week post injury. Tendon tensile stress: Not found significantly to normal limbs and injury limbs to tendon tensile stress between the three groups, but injury limbs were significantly smaller than normal limb to tendon tensile stress in each groups. Conclusion: Compared to immobilization, the function of Achilles tendon, tissue structure, and mechanic feature are more normal due to the intervention of exercise. However, no obvious benefit for tendon repair was found. As a result, further adjustment for exercise intensity in the latter period of the rehabilitation may lead to normal in tendon tensile stress of Achilles tendon. The period of fixing injured limbs should be shortened due to the negative results from a period of a 4-week of immobilization in the present study.